Radiation therapy after breast-conserving surgery; first results of a randomised clinical trial in patients with low risk of recurrence.

To study the role of radiotherapy and tamoxifen after breast-conserving surgery (BCS) in patients with a favourable prognosis, a clinical trial was initiated by the German Breast Cancer Study Group. Between 1991 and 1998, 361 patients (pT1pN0M0, aged 45-75 years, receptor positive, grade I-II) were randomised to radiotherapy (yes/no) and tamoxifen for 2 years (yes/no) in a 2x2 factorial design; the exclusion of seven centres (14 patients) left 347 patients in the analysis. After a median follow-up of 5.9 years, 77 events concerning event-free survival have been observed. Since a strong interactive effect between radiotherapy and tamoxifen has been established, the results are presented in terms of the treatment effects for all four treatment groups separately. Mainly due to the presence of local recurrences, the event rate was about three times higher in the group with BCS only than in the other three groups. No difference could be established between the four treatment groups for distant disease-free survival rates. It is concluded that even in patients with a favourable prognosis, the avoidance of radiotherapy and tamoxifen after BCS increases the rate of local recurrences substantially.

Of false negative results in the ultrasound of female breast cancer.

The preoperative results of sonography of 108 malignant breast tumors were analysed for reasons of false negative results by correlation of sonographic features with the corresponding clinical, histological and cytological findings. Previously we found no typical sonographic criteria of malignancy. Here we show, that diagnosis was especially difficult in carcinoma of young women, and in estrogen receptor negative, as well in progesterone positive tumors. The accuracy of diagnosis of tubular carcinoma was lower than of solid carcinomas. There was no correlation between false negative ultrasound results an histological or cytological grading, nuclear size, or tumor mitosis rate. We emphasize the importancy of sonography in diagnosis of female breast cancer.

[Prognostic value of sonography in breast cancer]. / Die prognostische Wertigkeit der Sonographie beim Mammakarzinom.

The prognostic value of sonography was tested in 108 cases of breast carcinoma. The criteria of prognosis were the low-risk and high-risk groups of histological and cytological gradings, the positive or negative hormone receptors as well as the nodal positive and nodal negative clinical stages. In the low risk group there were mostly elderly women with smaller carcinoma. Under the sonography these tumors were polycyclic and had a dorsal ultrasonic shadow. In the high risk group were younger women with bigger tumors. When scanned they mostly showed branches, a lateral ultrasonic shadow and sound intensification. In general, the different risk groups couldn't be clearly distinguished by sonography. As high disintegrate scanners have not been used long enough, there are no studies to prove their accuracy. We suppose, however, that the accuracy of prognosis can be improved with the new generation of scanners.

[Correlations between sonographic and clinical findings in breast cancer]. / Korrelationen zwischen sonographischen und klinischen Befunden beim Mammakarzinom.

We recorded the sonographic findings of 108 cases of carcinoma of the breast and compared the different criteria with the respective histological and clinical parameters. When scanned, carcinomas of the breast usually presented as irregular carcinomas with good sound conduction, few internal echoes and rarely with a lateral or dorsal ultrasonic shadow. Sonography showed a smaller diameter of the tumours than measured histologically. Medium-size and solid carcinomas with a smooth surface could be distinguished mos easily. Histological and cytological grading classified these tumours in the high risk group. Tubular and scirrhous tumours were significantly less easy to identify and delineate. This applies also to bigger and smaller tumours. In most cases small carcinomas were smooth, were likely to show sound intensification, and rarely had a dorsal ultrasonic shadow. The bigger they became, the more often we could observe branches; sound intensification decreased, and the dorsal ultrasonic shadow increased. Carcinomas of young women had the same sonographic characteristics as small tumours, whereas carcinomas in elderly women had those of big tumours, although there was no correlation between age and the size of the tumours. We emphasise the importance of sonography in determining tumours dynamics.

[Correlation of estrogen receptors and histologic and cytologic grading of breast cancer]. / Die Beziehungen zwischen den Ostrogenrezeptoren und dem histologischen und zytologischen Grading beim Mammakarzinom.

Correlations between estrogen receptors and other prognostic criteria have been examined. These criteria are clinical extent, status of lymph nodes, histologic differentiation, histologic and cytologic grading. Cancers with a good prognosis are much more receptor positive than those with a bad prognosis. The quantity of receptors does not allow any prognostic statement. Possible reasons for it are discussed.

[Biomechanical investigations on the parry fracture of the ulna (author's transl)]. / Biomechanische Untersuchungen zur Parierfraktur der Elle

108 ulnae from the cadavers of 50 men and 6 women were fractured in four positions with a tension testing machine with electronic measurement of force. Stress-strain-diagrams were registered, and the values of breaking load, breaking energy, breaking stress and ultimate deflection were correlated to the areas of cross sections of compacta and medulla. Breaking load and breaking energy decrease distally: medium breaking load in the upper portion of the ulna about 320 kp, in the lower portion about 100 kp; breaking energy in the upper portion about 65 kpcm, in the lower about 20 kpcm. Breaking stress is greatest in the middle portion of the ulna (19 kp/mm-2 in contrast to 11-14 kp/mm-2 near the joints). With increasing age the cross sections of the medulla increase significantly, but breaking load, breaking energy, breaking stress and area of cross section of the compacta decrease significantly. Ulnae from females are less resistant than those from males. Intact periosteum rises resistance to breaking and ultimate deflection. Experimental data agree with clinical observations.