Interstitial brachytherapy for recurrent breast cancer using a high dose rate Ir-192 remote afterloading system: a report of two cases.

We employed interstitial brachytherapy using a high dose rate Ir-192 remote afterloading unit in two breast cancer patients with locoregional recurrence. In the first case, skin metastasis was treated, with favorable control of the infield tumor but subsequent persistent sequelae and multiple outfield metastases. This experience caused us to be cautious when choosing brachytherapy for the second case, in whom a solitary metastasis to an axillary lymph node was successfully treated. Although this method is still investigational, it may play a critical role in the treatment of locoregional recurrence resistant to other treatment modalities.

Pleurocutaneous fistula as a complication of radiation treatment in locally advanced breast cancer.

We report the first case of a pleurocutaneous fistula as a consequence of megavoltage radiation therapy for a recurrent locally advanced breast cancer. Several factors, such as previous surgery, blood supply, fraction size, and perhaps increased radiosensitivity, which influence the tolerance of the late reacting normal tissues to radiotherapy, may have predisposed our patient to this rare complication.

[Humeral head necrosis following irradiation of breast carcinoma. A case report]. / Humeruskopfnekrose beim nachbestrahlten Mammakarzinom. Ein Fallbericht.

Radiation-induced osteoradionecrosis of the ribs and brachial plexus lesions following irradiation of breast cancer patients are well known phenomena and have been reported several times in the literature. Damage to the shoulder joint after irradiation is uncommon. The case of a 75-year-old woman with breast cancer is described; she first developed a brachial plexopathy and then necrosis of the head of humerus after therapy with combined ortho-voltage and high-voltage radiation. The differential diagnosis and possible pathogenetic mechanisms are discussed.

[Breast carcinoma in men: radiotherapy and treatment results]. / Das Mammakarzinom des Mannes: Radiotherapie und Behandlungsergebnisse.

The treatment of 34 men with stage T1 N0 M0 to T3/4 N1 M0 mammary carcinomas was followed by a five-year survival rate of 70%. Three patients suffering from initial remote metastases died after 2 to 3.5 years. The probability of a five-year survival decreases with increasing tumor growth and axillary involvement. The prognostic effect of receptor state and grading could not be investigated in our patients. Our own data as well as recent data from literature suggest that, with respect to TNM stages in mammary carcinoma, there is no prognostic difference between men and women. It is not very clear at present if postoperative irradiation exerts a favorable influence on the survival rate. However, it reduces the local recurrence risk for men and women. 45 Gy in five weeks should be considered as a minimum dose. The indications for postoperative irradiation are discussed.

[Brain metastasis from breast cancer].

Thirty-seven patients with breast cancer who developed brain metastasis were analyzed. At the diagnosis of brain metastasis, all patients had widespread metastasis, and 36 patients were receiving chemotherapy. Thirty patients were treated by radiotherapy to the brain at doses of 4,000 rads. There were 6 CRs (20%) and 5 PRs (17%). The median survival time for all patients was 53 months (8-177+) from diagnosis of the primary tumor, 24 months (7-126+) from the first recurrence, and 6 months (1-47+) from diagnosis of brain metastasis. Patients who achieved CR or PR survived longer than non-responders (11+ months vs. 6 months: p less than 0.01). Several backgrounds factors were analyzed, and the results indicated that patients with better performance status survived significantly longer than those with poorer performance status (11 months vs. 4 months: p less than 0.001).

[Lymphoid cells in the venous blood of 100 female patients with breast carcinoma. Follow-up studies]. / Lymphoide Zellen im Venenblut von 100 Patientinnen mit Mammakarzinom. Eine Verlaufsbeobachtung.

The following blood cells were examined in 100 patients with invasive carcinoma of the breast and 100 control patients without malignant disease: leukocytes, lymphocytes, monocytes and different sub-populations of lymphoid cells. Lymphoid cells were characterized by E-, EA- and EAC-rosetting technique, alphanaphtyl acetate esterase activity and by the ability of latex phagocytosis. Both groups showed no significant differences. In 81 patients undergoing postoperative radiation therapy lymphocytes and lymphoid cells were reduced considerably. These changes were still evident after 12 months (6 months after completion of radiotherapy). Mainly the T lymphocytes were effected by this decrease. A negative effect of the radiation induced reduction of immune competent cells must be discussed and examined further by clinical trials.

Non-metastatic locally advanced cancer of the breast treated with radiation.

One hundred forty-seven female patients with retrospectively classified (AJCCS 1977) Stage III and nonmetastatic noninflammatory Stage IV breast carcinoma from June 1958 to December 1978 were studied to determine the effects of primary radiation on local recurrence and survival. Fifty-one patients recurred in the breast; 24 patients recurred in the local-regional area of breast and draining lymphatics and 15 patients recurred in the axilla only. Distant metastases developed in 97 patients. The 5 year actuarial survival was 24%. Decreased recurrence rates were associated with megavoltage and higher doses of radiation (34% vs. 65%); with smaller tumors (27% vs. 57%); with total extirpation of gross tumor (33% vs. 53%); and with those tumors that were given a "boost dose" (26% vs. 58%). The addition of systemic treatment did not appreciably alter either local-regional recurrence or survival. However, most of the patients received endocrine ablation or single-agent chemotherapy. Polyagent chemotherapy was used late in the series, making its true impact on survival difficult to evaluate.

[Cardiac damage during radiotherapy of the mediastinum]. / Cardiolesività in corso di radioterapia sul mediastino.

Two cases of patients with neoplasias who were given radiotherapy on the mediastinum are reported. Serious and fully documented ECG alterations were observed in these patients, but the cause is not easy to ascertain, since the results were neither identical nor clinically attributable to a common pathogenetic factor.

An analysis of the role of radiotherapy alone and in combination with chemotherapy and surgery in the management of advanced breast carcinoma.

One hundred-eight consecutive patients with Stage III breast carcinoma received radiotherapy as the primary method of treatment. Of these, 53 had prior chemotherapy and 47 had a postirradiation mastectomy as planned adjunct modalities. The overall actuarial survival probability is 40 +/- 6% at five years and 14 +/- 6% at ten years. The corresponding probabilities of freedom from metastases are 27 +/- 5% and 14 +/- 5%, while those of local control are 58 +/- 8% and 52 +/- 8% respectively. The patients receiving chemotherapy show both increased five and ten year probabilities of metastatic control of 38 +/- 7% and 22 +/- 8% and also a five and ten year local control rate of 73 +/- 8%. The patients with additional mastectomy exhibit an improved five year local control rate of 80 +/- 8% but the probability of remaining free from metastatic disease is unaltered being 31 +/- 7% at five and 12 +/- 7% at ten years. The 23 patients receiving chemotherapy prior to radiotherapy, without a subsequent mastectomy have the highest metastatic control of 41 +/- 12% at five years. In this group, eight patients treated with time-dose factors (TDFs) of over 80 have had only one local failure with a preliminary five year local control probability of 80 +/- 18% and metastases-free rate of 58 +/- 19%. Based on these results recommendations are made for minimum tumor doses of 6000 rad and adjuvant chemotherapy. This should be delivered before radiotherapy, since with this sequence of treatment both local control and survival are improved.

[The problem of sequential cancers after antineoplastic chemotherapy or radiotherapy]. / Zum Problem der Zweitmalignome nach antineoplastischer Chemo- und/oder Strahlentherapie.

It is reported on 4 patients who in a period of 2 to 14 years after successful therapy of a malignant tumour using the therapy with cytostatics and (or) radiotherapy fell ill with a genuine secondary neoplasia. A connection of the therapeutic procedures mentioned with the repeated tumour induction is obvious, a genetic disposition (cancer diseases in parents and brothers and sisters) might favourably cooperate in three of the cases mentioned. It is referred to the necessity of strongest indication to the therapy with cytostatics and ionising rays.

Spinal cord compression from metastatic breast carcinoma: treatment by radiation therapy alone.

There are few reports in the medical literature of treatment of compression of the spinal cord by the use of radiation therapy alone. Laminectomy has been the standard procedure to relieve compression of the spinal cord and should be performed within 48 hours of initial symptoms. In this patient, radiation therapy was the only modality used. It was supplemented by diethylstilbestrol in the course of follow-up. The result of radiotherapy so far has been excellent. The authors emphasize that radiotherapy was begun three months after development of paraplegia, which makes this an interesting case for presentation.