The use of neoadjuvant CMF to avoid mastectomy.

AIMS: Large operable cancers have traditionally been treated surgically by mastectomy. More recently centres have investigated the use of neoadjuvant chemotherapy to allow breast-conserving surgery. Between 1991 and 1995, a prospective study into the response of large operable breast cancers to CMF neoadjuvant chemotherapy was performed. METHODS: Patients with cancers requiring mastectomy, and with or without clinically involved non-fixed lymph nodes, were offered neoadjuvant CMF chemotherapy. Patients declining neoadjuvant treatment underwent mastectomy and appropriate axillary surgery. Clinical response was assessed after two cycles in the neoadjuvant group. Subsequent surgical or non-surgical management was planned after this. RESULTS: Thirty-eight patients were suitable for neoadjuvant treatment. Twenty-two underwent two cycles of CMF and were then reassessed. Seventy-three per cent achieved a response [three (14%) complete remission, 13 (60%) partial remission]. Fifteen (68%) patients avoided mastectomy, with six (27%) requiring no surgery at all with no clinically detectable residual disease. Sixteen (42%) declined neoadjuvant chemotherapy and opted for immediate mastectomy, seven of whom accepted chemotherapy post-operatively. After 3 years' follow-up there is no statistical difference in local recurrence, distant recurrence or overall survival. CONCLUSION: Approximately 40% of patients offered neoadjuvant chemotherapy will demand prompt surgical treatment but will consider the use of adjuvant chemotherapy post-operatively. Sixty-eight per cent of patients receiving neoadjuvant CMF will successfully avoid mastectomy.

Acidic and basic fibroblast growth factors in human breast tissue.

Previously we have reported changes in fibroblast growth factors (FGF) in conditioned medium (CM) derived from rat mammary tumours undergoing remission. We have used a similar approach to assay for the presence of FGFs in human breast tissue and cell lines. The majority of cancer tissues (35/50), benign tissues (8/9) and all cancer adjacent normal tissues (20/20) released heat labile, NR6 transforming activity which coeluted from heparin with acidic FGF (aFGF) at 0.9-1.1 M NaCl and was neutralised by antibodies to aFGF. The conclusion that the majority of breast cancers contain active aFGF was supported by immunoblotting. The CM of a minority (15/50) of cancers and one benign tissue had highly transforming activity for NR6 cells, and was mitogenic for a breast cancer cell line, was heat labile, and strongly heparin binding, eluting at 1.5-2.0 M salt. It was not immunoreactive with antibodies to aFGF, basic FGF (bFGF) or Kaposi's FGF (kFGF) and its activity was reduced by the presence of aFGF, suggesting competition for the same receptor. Very little aFGF was observed in the CM of these tumours, and neither aFGF nor other FGF activity was detected in CM of breast cell lines.

Bilateral carcinoma of the breast.

In a retrospective review of 2820 patients with breast carcinoma seen at the Combined Breast Clinic of St George's Hospital over a 23-year period 101 cases were bilateral of which 52 (1.8%) presented synchronously and 49 (1.7%) metachronously. Twenty deaths occurred in the synchronous group after a mean follow-up of 56.2 months and 15 deaths in the metachronous group after a mean follow-up of 48.5 months following diagnosis of the second tumour. If timed from initial presentation patients with metachronous tumours fared better than those with unilateral disease (P < 0.01). There was no significant difference in survival between patients with metachronous (if timed from the second tumour), synchronous or unilateral breast carcinoma.

Infective endocarditis in a heart transplant recipient.

A 38-year-old man underwent orthotopic heart transplantation because of heart failure caused by ischemic heart disease. Three months after the operation cholestatic jaundice related to azathioprine hepatotoxicity developed, necessitating supplementation of cyclosporine immunosuppression with prednisolone. Seven months after heart transplantation he had a septic right femoral embolus and, by transesophageal echocardiography, was found to have a vegetation on the anterior leaflet of the mitral valve. Treatment with appropriate antibiotics resulted in complete resolution of symptoms and healing of the vegetation. Six months after the episode he remains free of symptoms and has normal heart function.

Diagnosing breast carcinoma in young women.

OBJECTIVE: To assess the individual and combined diagnostic accuracy of clinical examination, mammography, and fine needle aspiration biopsy in young women with breast cancer. DESIGN: Analysis based on case notes of patients presenting with breast cancer during 1971-89. SETTING: A combined breast clinic. PATIENTS: Consecutive series of 81 women aged less than 36 with histologically proved breast cancer presenting with a discrete mass over 19 years. MAIN OUTCOME MEASURES: Results of clinical examination, xeromammography or conventional mammography, fine needle aspiration biopsy, and examination of tissue removed by surgery. RESULTS: The clinical diagnosis was correct in 47 women and radiography in 35. Fine needle aspiration biopsy was correct in 47 of the 63 women in whom it was successfully performed. Fine needle aspiration was significantly more accurate than mammography (78% v 45%, p less than 0.01). Ten (16%) patients had negative results on clinical examination, mammography, and fine needle aspiration. CONCLUSION: Mammography alone seems inadequately sensitive to detect breast cancer in young patients. When all investigations give negative results excision biopsy is the only way of obtaining a definitive diagnosis.