Alternative therapy for elderly patients with breast cancer.

Breast cancer treatment has undergone significant changes in concept, concurrent with alterations in our understanding of cancer biology and natural history. Within the last 10 years, oncologists have brought into question the traditional Halstedian concepts of the natural history of breast cancer and its appropriate management. The goal of treatment, once a primary cancer is detected in the breast, is to prevent metastasis and subsequent death of the patient. One hundred forty-two female patients over the age of 65 with histologically confirmed breast cancer were treated at Lankenau Hospital from 1982 to 1990. We treated 32 women over the age of 65 with quadrantectomy and tamoxifen as the sole form of therapy. No radiation, standard chemotherapy, nor axillary dissection was utilized. A cohort of 110 women of similar age, treated for breast cancer with "standard therapy" (total mastectomy or "segmental resection" and radiation with axillary nodal dissection) during the same time period, were also analyzed retrospectively. All segmental resections were followed by standard radiation doses to the ipsilateral breast and draining nodal basins with a local boost. Twenty-nine of 32 patients in the quad + tam group were available for follow-up 1 to 8 years following treatment (mean 52 months). The cumulative overall survival was 67 per cent and disease-free survival 92 per cent. No patient developed local recurrence. Follow-up analysis of the 110 women treated in "standard fashion" was complete in 88 patients 1 to 8 years post-treatment (mean 56 months). Cumulative overall survival was 82 per cent and disease-free survival 83 per cent. Local recurrence was noted in five per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Photo detection of carcinoma of the colon in a rat model: a pilot study.

Photodynamic sensitizers are light-absorbing chemicals that cause photoreactions in biologic systems when exposed to light of the proper wave-length. Dihematoporphyrin ethers (DHE) are the active porphyrin derivatives most commonly used as a photosensitizer (Photofrin, QLT). DHE accumulates in tumor tissue and also fluoresces when light activated. A more reliable and less costly screening method for early detection and treatment of colon cancer is needed. The present study was designed to induce adenocarcinoma of the colon in rats with 1,2 dimethylhydrazine (DMH) and attempt to identify tumors early in their evolution by DHE fluorescence. Forty rats were injected with 20 mg/kg of DMH at weekly intervals until sacrifice. Photofrin (3 mg/kg) was injected through the tail vein in each prior to sacrifice. Eight colonic specimens contained invasive adenocarcinoma, seven of which fluoresced when exposed to a Woods lamp. Carcinoma in situ was identified in two specimens by fluorescence, and one fluorescent specimen contained dysplasia.

Intraductal carcinoma of the breast.

The management of intraductal carcinoma of the breast at the present time is necessarily diverse because there is difficulty in detecting it, as well as understanding its basic biology and natural history. Therapy has ranged from excisional biopsy with or without radiation to radical and extended radical mastectomy. The effects of radiation therapy upon these well-differentiated in situ lesions is undefined. The popularity of total mastectomy stems from a concern for the fate of breast tissue left in situ after removal of the focus of preinvasive carcinoma. Intraductal carcinoma of the breast has been shown to be a multicentric disease process in a large percentage of patients. Indeed, all breast tissue in these patients appears to be at risk for the eventual development of preinvasive and invasive carcinoma. However, the clinical significance of such residual foci of in situ carcinoma or ductal hyperplasia and dysplasia following resection of the breast, as in papillary carcinoma of the thyroid, is still open to question. Similar concern exists for a significant "sampling error" involved in biopsies of lesions of the breast: there were six instances of this in the present series (11 per cent). A "sampling error" of 6 per cent was found in a similar study of a group of patients with intraductal carcinoma. An error rate of 18 per cent was reported in another study. Again, the clinical significance of this "sampling error" remains open to question. The difficulty encountered in evaluating remaining breast tissue after a partial mastectomy has also been reason to consider total mastectomy in these patients. Residual or recurrent carcinoma in such altered breast tissue is difficult to diagnose at an early stage, either by physical examination or by the results of mammography. None of the patients in the present series had axillary nodal metastases and, theoretically, intraductal carcinoma should not be associated with axillary nodal metastasis. The small percentage of patients found to have invasive carcinoma following mastectomy for in situ carcinoma are likely to have minimally invasive lesions with, at most, a 23 per cent incidence of positive axillary nodes. The advantage gained by performing full axillary dissection or extensive nodal sampling in 60 per cent of the patients in this series, as well as in patients in other series, is difficult to ascertain without further study. The most logical choice of therapy would appear to be total mastectomy with limited axillary node sampling.(ABSTRACT TRUNCATED AT 400 WORDS)