Simultaneous bilateral breast carcinomas: a retrospective review of 149 cases.

PURPOSE: To evaluate clinical and biological characteristics as well as treatment outcome in simultaneous bilateral breast carcinomas. METHODS AND MATERIALS: Between 1981 and 1990, 149 patients were diagnosed to have simultaneous bilateral breast carcinoma, defined as tumor arising in both breasts within a maximum of a 6-month interval, in the absence of distant metastases. The median age was 58. Out of a total of 298 tumors, the clinical tumor size was T0-T1 in 40%, T2 in 45%, and T3-T4 in 15% of tumors. The majority of patients (83%) were clinically node negative. Seventy-eight percent of all tumors were classified ductal invasive; 6% were invasive lobular carcinomas; in situ tumors were present in 9%. More than two-thirds of all tumors were well or moderately well differentiated. Tumors were estrogen positive in 86% and progesterone positive in 69% of 62% of patients for whom this information was available in both tumors. Treatment had been by bilateral mastectomy in 43%, by exclusive irradiation in 16%, and by combined surgery and radiation in 41%. RESULTS: Median follow-up was 68 months (11-141). A number of positive correlations existed between the tumors in both breasts more often than by chance alone: These were the presence of lobular carcinomas in both breasts (p = 0.06), the same histological grade (p = 0.002), similar ER (p = 0.03) and PR (p = 0.01) status. Five-year rates for survival and disease-free interval were 86% (80-92) and 70% (62-78), respectively. For each patient the stage of the largest tumor at diagnosis was defined as maximum stage. When survival figures were compared between each maximum stage and matched stages of a group of unilateral breast cancer patients treated during the same time interval in our institute, bilateral breast cancer fared not worse than unilateral breast tumors. Treatment related complications occurred in eight patients (5%). CONCLUSION: Simultaneous bilateral breast carcinomas have similar biological, but not clinical, features more frequently than would be predicted by chance alone. So far, the number of patients is too small, and the follow-up is too short to determine whether or not the prognosis is equivalent to that of unilateral breast cancer patients of equal stage. Bilateral conservative treatment is feasible with acceptable cosmetic results and toxicity by using carefully designed radiotherapy techniques.

Salvage split course brachytherapy for tonsil and soft palate carcinoma: treatment techniques and results.

From December 1981 to October 1990, 28 patients with prior irradiation of the oropharynx underwent salvage brachytherapy for a squamous cell carcinoma of the tonsil and/or the soft palate. The patients were free of cervical nodes and without metastatic disease. There were 4 immediate failures of radiotherapy, 14 local recurrences, and 10 new malignancies. The mean size of the lesion was 2.7 +/- 1.7 cm (range, 0.5 to 7 cm). The initial irradiation had delivered 40 to 80 Gy (mean, 69 Gy) to the oropharynx with a mean interval between external therapy and salvage treatment of 22 +/- 28 months. Salvage brachytherapy consisted of two split course implants done 1 month apart, delivering 35 and 30 Gy, respectively. Fifteen patients (46.5%) were clinically disease-free before the second implant and 23 (82%) were clinically disease-free at the end of treatment. Five local failures have been observed without any influence of the tumor size, the topographic site of the tumor, or the histological differentiation. Of the 4 patients who previously had failed with external beam therapy, 3 were disease-free after salvage brachytherapy. Among the 23 patients in complete remission, 4 (17%) presented a local recurrence within a mean time of 5 months. The overall local control rate was 68% with a mean follow-up of 41 +/- 29 months. The overall actuarial survival was 25% and 19% at 2 and 5 years, respectively; it was 30% at 5 years for the patients presenting with lesions less than or equal to 3 cm. Tolerance was acceptable. Among the 23 patients who achieved complete remission, subsequent soft-tissue necrosis was observed in 4 cases. For these 4 patients, the interval between previous radiation therapy and salvage treatment was short (mean, 7 months). Interstitial split course brachytherapy offers an effective and reasonable option for salvage therapy in patients with recurrent and second cancers occurring in the tonsillar region and in the soft palate, even when the tumor arises in a zone that has previously received high-dose irradiation.

Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma.

One hundred thirteen patients with cervical metastases from a squamous cell carcinoma and no evidence of the primary tumor were treated for cure by surgery and routine large-field postoperative irradiation. Patients were staged according to the 1987 American Joint Committee on Cancer (AJCC) classification. There were 24 N1, 54 N2, 29 N3, and 6 Nx lesions. One hundred four patients underwent cervical lymph node dissection and 9 had adenectomy. All patients received postoperative external beam therapy to the entire naso-oro-pharyngo-larynx and all cervical lymphatics. The overall nodal failure rate was 13.7%. Nodal failure was significantly correlated with N staging (P = .01) and with the number of histologically involved nodes (P = .05). NOdal failure was 21% when nodes were initially fixed versus 7.5% when they were not (P = .07) and 18% when there was extracapsular spread versus 4.3% when the capsule was intact (P = .11). Eleven patients (9.7%) developed a subsequent primary lesion. In 3 patients (2.6%), this primary was located in the previously irradiated area and, in 2 cases, under the anterior block of lateral fields. Metastases occurred in 18 patients (16%). The five-year overall survival rate was 38%. Survival was correlated with N staging (P less than .02), nodal fixation (P = .05), extracapsular spread (P = .01) and loosely with the number of histologically involved nodes (P = .08). On the contrary, histological differentiation did not influence the local control rate, nor the development of metastases or subsequent primary lesions. Large-field prophylactic radiation therapy appears to be effective in preventing the emergence of initially occult primary lesions. However, control of disease in the neck and survival remain disappointing in patients with advanced nodal disease, even after combined surgery and radiation therapy.

[Primary cervical lymph nodes of epidermoid type. Results of a series of 123 patients treated by the association surgery-radiotherapy or irradiation alone]. / Adénopathies primitives du cou de type épidermoïde. Résultats d'une série de 123 patients traités par association chirurgie-radiothérapie ou irradiation exclusive.

Between 1972 and 1986, 123 patients were treated with curative intent for a metastatic squamous cell carcinoma in cervical lymph nodes of an unknown primary. The lesions, staged according to the 1987 AJC classification were 24 N1, 59 N2, 34 N3 and 6 Nx. A hundred four patients underwent a cervical lymph node dissection and 9 an adenectomy. All these patients received post-operatively external beam therapy on the Waldeyer ring, the pharyngo-larynx, the cervical nodal areas (45 Gy); a boost (20 Gy) was delivered to nodes presenting with extracapsular spread. The 10 remaining patients were inoperable and were treated by radiation therapy alone to a total tumor dose of 70-75 Gy. In the group treated by surgery-radiation therapy, the 5-year overall nodal failure rate was 13.7% and it was 60% for the patients treated by radiation therapy alone. For the first group, this failure rate was correlated to the AJC stage (p = 0.01) and to the number of histologically involved nodes (p = 0.05). The failure rate was 7.7% if the node was clinically fixed versus 21% if it was not (p = 0.07). It was 18% when there was an extracapsular spread and 4.3% when it was absent (p = 0.11). Thirteen patients developed a subsequent primary lesion, in pre-irradiation volume in 5 cases (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Colloid cancers of the breast. Value of radiotherapy. A series of 138 cases treated at the Curie Institute]. / Cancers colloides du sein. Intérêt de la radiothérapie. Série de 138 cas traités à l'Institut Curie.

A series of 138 mucinous breast carcinomas was treated at the Institut Curie from 1970 to 1980: 107 were diagnosed as "pure" mucinous carcinoma and 31 as "mixed" mucinous carcinomas. Fifty per cent of the cases were stage T2 and 78% N0-N1a. Treatment methods were radical mastectomy in 113 cases (82%) with pre-operative irradiation for 37 patients and post-operative irradiation for 14 patients. A conservative treatment was used for 25 patients, consisting either of lumpectomy followed by radiotherapy (in 15 cases) or radiotherapy alone (in 10 cases). The five-year actuarial survival rate was 81% for the "pure" group and 87% for the "mixed" group; it was 70 and 75%, respectively, at ten years follow-up. In this series, survival was not influenced by the type of treatment. The efficacy of radiotherapy was evaluated from the local recurrence rate: only four local failures among the 25 conservative treatments were noted. Our conclusion is that radiotherapy, with or without lumpectomy, is efficient in mucinous breast carcinoma and could be useful in selected cases.