Multidisciplinary management of hepatocellular carcinoma.

BACKGROUND/AIMS: The continuing poor prognosis for patients with hepatocellular carcinoma drives a search for new adjuvant therapies. Targeted locoregional immuno-chemotherapy is one of the most promising. MATERIALS AND METHODS: From 1990 to 1996, 193 patients who were not eligible for liver resection were treated in a prospective randomized study. Ninety-one patients received locoregional targeted chemotherapy only via an arterial catheter (Group A), and 102 received combined locoregional immuno-chemotherapy via two arterial catheters (Group B). RESULTS: Overall survival was significantly different (10.2 months vs 22.3 months), favoring Group B. Complications and side effects of treatment were minimal in Group B and easily handled. Even in Group A, side effects were less severe than effects normally associated with systemic chemotherapy. CONCLUSIONS: Even though the current prognosis for patients with Hepatocellular Carcinoma remains poor, targeted locoregional immuno-chemotherapy has proven to be of benefit in terms of quality of life and survival.

Multidisciplinary management of hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) remains a disease with a poor prognosis. Several different therapies have been recommended for use as adjuvant treatment for this disease. One of the most promising therapies is targeted locoregional immuno-chemotherapy. MATERIALS AND METHODS: From 1990 to 1996, 91 patients who were eligible for liver resection were treated in a prospective randomized study. Forty-two patients received resection alone (Group A) and 49 received resection plus chemoembolization and targeted locoregional immuno-chemotherapy (Group B). RESULTS: The mortality rate for these two groups was significantly different (13% vs 4%) favoring Group B. Overall survival was also significantly different (18 months vs 36.3 months) again favoring Group B. CONCLUSIONS: Although prognosis is still miserable for HCC, the approach of targeted locoregional immuno-chemotherapy can offer new hope of improved resectability and survival.

Cyclophosphamide, mitoxantrone, fluorouracil versus conventional CMF as adjuvant treatment in node-positive breast cancer patients. A Hellenic Cooperative Oncology Group Study.

362 evaluable node-positive patients with stage II breast cancer were randomized, receiving either 6 cycles of conventional CMF or 6 cycles of the combination of cyclophosphamide (500 mg/m2), mitoxantrone (Novantrone 10 mg/m2), and fluorouracil (500 mg/m2; CNF). After a median follow-up of 51 months, 64 (36%) patients relapsed in the CMF group and 60 (33%) in the CNF group (p=0.8276). By Cox multivariate analysis, tumor size, menopausal status and number of involved nodes were retained as independently significant variables. Toxicities were remarkably similar in both groups. It appears that after a median follow-up of 51 months there is no significant difference in relapse-free survival between node-positive patients with breast cancer who received either 6 cycles of the conventional CMF or the CNF combination as adjuvant treatment.

[Is prolonged psychological stress an etiological factor in breast cancer?]. / Le surmenage psychique prolongé est-il un facteur étiologique du cancer mammaire?

1,088 women with cancer were seen in a period of 4 1/2 years at the Cancer Centre of the Greek Social Security Department in Athens. The authors present their results as far as psychological stress influences the development of cancer of the breast in 813 patients (Group A) and in 685 women who did not have cancer of the breast (Group B). They were able to show that Group A had a positive correlation which was statistically very significant (p less than 0.001) with the following parameters: the death of a much-loved person; the negative behaviour of the husband; an unexpected change in life style; continual conflicts in the family; financial problems; unsatisfactory sex life; consultations with a psychiatrist and allergy. There was a positive correlation which was statistically significant (p less than 0.01) with the parameters: disappointment in sentiment; a lowering in life style; a family history of cancer of the breast; hypertension; late start in the menarche and the onset of the menopause. The authors conclude that they believe that it is useful to look at all the factors that are known as risks for cancer of the breast, including the influence of psycho-traumatic factors.

Seasonal variations in the frequency distribution of breast cancer in Greek women according to the month of their birth.

The frequency distribution of patients with breast cancer according to the month of their birth was examined in 1,165 women comprising the total number of patients recorded in our cancer registry from 1975 until the end of 1982. Statistical evaluation of this material using an exact chi 2 for simple null hypothesis demonstrated the existence of two high frequency peaks corresponding to March and April in the spring and September in the autumn. These frequencies were significantly higher (P less than 0.001) than those of the remaining months. Confirmation of this finding would imply the introduction of a new variant in breast cancer epidemiology.

Pre- and postoperative chemoendocrine treatment with or without postoperative radiotherapy for locally advanced breast cancer.

From July, 1978 to September, 1981, 184 patients with localy advanced breast cancer (T3; T4a-b; any N; M0) regardless of their hormonal receptor status, entered a trial to evaluate the contribution of radiotherapy when added to an intensive preoperative chemoendocrine regimen. Seventy-eight patients were ultimately disqualified. All patients underwent sequentially: (1) two cycles of chemotherapy: Day 1--Oncovin 1.4 mg/m2, cyclophosphamide 350 mg/m2, Adriamycin 30 mg/m2; Day 2--methotrexate 20 mg/m2, 5-fluorouracil 350 mg/m2 (in addition, antiestrogens were given to postmenopausal patients); (2) mastectomy with complete axillary dissection combined with oophorectomy in patients before and one year after menopause; (3) radiotherapy randomly to one-half of the patients; and (4) ten additional chemotherapy cycles as above, with antiestrogens to all patients. No serious local sequellae were encountered from mastectomy or radiotherapy, but complications of chemotherapy were numerous, particularly in irradiated patients. One death due to toxicity occurred after preoperative chemotherapy. The results to date suggest that in irradiated patients metastases may become enhanced and that their local disease is not more effectively controlled than in patients not having radiotherapy. Two factors may have been largely responsible for the differences observed between the two groups: the delay of chemotherapy in irradiated patients and the sustained immunosuppression known to occur after mediastinal radiotherapy.