Supraclavicular recurrence after early breast cancer: a curable condition?

The prognosis of ipsilateral supraclavicular lymph node recurrence after early breast cancer appears to be worse than for other loco-regional recurrences, but better than for distant metastases. The purpose of the present study was to investigate the relationship between different types of salvage treatment and primary patient characteristics, treatment response, and survival after supraclavicular recurrence (SR) in a large patient population. From the Danish Breast Cancer Cooperative Group treatment database 1977-2003, 305 patients were identified with SR without distant disease as site of first recurrence. Salvage treatment types as well as other factors were related to response and survival. The median follow-up time for progression after SR was 25 months. Complete remission was 76% among patients receiving excision surgery, 67% with combined loco-regional and systemic therapy, and 48% with systemic therapy alone. Median progression-free survival (PFS) and overall survival was 18 and 29 months, respectively. The 5-year PFS probability was 15%. In univariate analysis, combination salvage therapy, negative nodal status and low malignancy grade were related to longer PFS. In multivariate analysis, salvage therapy and malignancy grade remained independent factors for survival. In conclusion, the prognosis of SR is generally poor. However, it appears to be a curable condition. An independent marker of improved outcome is local and systemic combination salvage treatment, which can be considered.

Eight cases of lower respiratory tract infection caused by Stomatococcus mucilaginosus.

Stomatococcus mucilaginosus was isolated from 8 patients suffering from lower respiratory tract infections over a 4-y period (1999-2003). The infections ranged from mild cases of pneumonia to a life-threatening case of recurrent lung abscesses in a neutropenic patient. The various strains were cultured from specimens obtained by bronchoscopy, blood, and sputum specimens. All strains were fully susceptible to rifampicin, vancomycin and gentamicin. They showed variable susceptibility to penicillin and ciprofloxacin. S. mucilaginosus is likely to be under-reported as a pathogen due to difficulties in obtaining samples for culture as well as misidentification due to its biochemical characteristics.

Nail changes due to docetaxel--a neglected side effect and nuisance for the patient.

GOALS OF WORK: The objective of this study is to estimate the frequency and severity of nail changes due to treatment with the cytotoxic drug docetaxel and, secondly, to estimate how the nail changes effects the patients cosmetically and functionally in their daily activities. Finally, we want to clarify whether fungal infection could contribute in causing the nail changes. MATERIALS AND METHODS: Fifty-five patients with metastatic breast cancer in treatment with the cytotoxic drug docetaxel participated in the study. They filled out two questionnaires about their experience with possible nail changes. The frequency of fungal infection was examined. At each of the two visits, information about the number of treatment cycles, dose of docetaxel the patient received, frequency of lymph oedema, previous treatment with chemotherapy and the reason of discontinuance of treatment, if relevant, were registered. Finally, photos were taken to document the nail changes in hands and feet. MAIN RESULTS: Fifty-eight percent had some degree of nail changes and an increase to 88.5% was seen after three additional cycles. A large proportion of the patients experienced the nail changes as a cosmetic nuisance, and more than 32% had functional problems. CONCLUSION: Nail changes occur more frequently than previous studies have shown. Furthermore, our study indicates that the nail changes are affecting a large proportion of the patients, both cosmetically and functionally, which may lead to a decrease in their quality of life. No significant association was found according to the possible relation between nail changes and fungal infection.