European Journal of Cancer and Clinical Oncology最新文献

Using an antiserum to epithelial membrane antigen we have screened multiple bone marrow aspirates from 350 patients with primary breast cancer taken at the time of initial surgery. 89 (25%) patients were found to have micrometastases and their presence was related to pathological size (P < 0.01), the presence of peritumoral vascular invasion (P < 0.001), and positive lymph nodes (P < 0.005) but not menopausal status. At a median follow-up of 76 months (range 34–108) 107 patients had relapsed with distant metastases. 48% (43 of 89) of these patients had micrometastases initially compared with 25% (64 of 261) who did not (P < 0.005). The test predicts for relapse in bone (P < 0.01) and other distant sites excluding bone (P < 0.001) and is associated with a shorter overall survival (P < 0.005). We conclude that the detection of micrometastases signals a high likelihood of early relapse and decreased survival in breast cancer.

Left handedness was found to be significantly less common among patients with breast cancer in southern Sweden (1.5%) than among a female referent population (5%) (P<0.0025). The findings lend support to theories suggesting that hormonal factors in early life are of importance both for handedness and for the risk of breast cancer.

From 1963 to 1988, 281 patients with newly diagnosed follicular lymphomas were treated and followed at the Foundation Bergonié. Distribution of stages was: 72 I, 61 II, 83 III and 65 IV. Within stage III, two subgroups were retrospectively defined: stages III₁ (32 cases) included patients with less than 8 involved sites, only 1 or 2 above diaphragm, and no spleen or mediastinal enlargement. Stage III₂ (51 cases) included the remaining stage III cases. Median follow-up was 9 years. Complete remission (CR) rate was 82%. 10-year overall survival (OS) and time to treatment failure (TTF) rates were, respectively 38% and 29.5%. 10-year time to relapse (TTR) rate was 36%. Statistical analyses showed concordant results with two main prognostic factors: age ($\text{<60}\text{>60}$) and stage (I to III₁/III₂ and IV). Age was the most important factor for OS analysis and stage for CR and TTR analysis. This leads to only three prognostic groups with different outcome. The first includes younger patients (<60 years) with limited stages (≤III₁); the second, patients either older than 60 or with advanced stages; the last, elderly patients with advanced stages. CR rates of these three groups were, respectively 97%, 75% and 57%. 10-year OS were, respectively 73.5%, 27% and 0%; 10-year TTR were 54%, 22% and 0%. These results have lead to data which are easy to handle and which can help to establish a rationale for further prospective trials.

46 patients with malignant pleural mesothelioma were entered in a phase II study of mitoxantrone 14 mg/m² every 3 weeks. Histology was confirmed by a pathology panel. None of the patients had received previous chemotherapy. Toxicity was mainly mild gastrointestinal and haematological side-effects. Out of 34 patients evaluated for response, only 1 partial response was recorded. Mitoxantrone at this dose and schedule has marginal activity in malignant mesothelioma.

Metastatic renal cell carcinoma remains an incurable disease and current modalities can only offer major palliation to a small percentage of patients. Since treatment is palliative, choice and type of therapy must be carefully considered and reconciled with patient desires. When possible, patients should be offered participation in a clinical trial. For patients choosing progestin therapy, treatment with interferon (IFN) or other biological response modifiers can be instituted at the time of progestin failure. Those patients who have slow tumour progression and maintain a high quality of life can be observed without continued progestin therapy. Although pretreatment characteristics predict response to biologicals, no pretreatment characteristic should preclude an individual patient from a trial of IFN therapy. Whether high-dose interleukin-2 (IL-2), IL-2/lymphocyte-activated killer cells, or IL-2/IFN are superior to IFN alone is uncertain, but clinical trials currently underway should help resolve these issues.

A novel non-immunosuppressive cyclosporin A, PSC-833, has been tested for its ability to circumvent resistance to doxorubicin, vincristine and colchicine in human and murine multidrug resistantant (MDR) cell lines. This compound is shown to be a highly potent resistance modifier, being 7–10-fold more potent than the parent compound, cyclosporin A, whilst approximately equal to cyclosporin A in the growth inhibitory effects of compound alone. Reversal of the P-glycoprotein-associated MDR drug accumulation defect is a major component of resistance reversal for PSC-833, as it is for cyclosporin A.

A STUDY was undertaken in which eight patients aged 22 to 80 years with Ph¹-positive chronic myelogenous leukaemia (CML) were treated with interferon alfa-2b at an initial dose of 4 million units (MU)/m² per day.

One patient in accelerated phase was pretreated with vindesine and prednisone, and showed an increase in white blood cell count during interferon treatment. In addition, one of the seven patients in chronic phase, who was previously untreated, dropped out because of skin eruption. According to the response criteria of Alimena et al. [1], three of the other six patients in chronic phase achieved haematological response (two complete, one partial) and two had cytogenetic improvements (one complete, one minor).

Adverse effects included fever (six patients), malaise (two), anorexia (one), delirium (one), liver disorder (two) and skin eruption (one).

We present here the pre-treatment features and clinical course of a patient who achieved complete cytogenetic response (CCR). A 32-year-old female patient, admitted to hospital because of marked hepatosplenomegaly (spleen 11 cm under the navel) and anaemia, was diagnosed as having Ph¹-positive CML and treated with interferon alfa-2b 6 MU/body daily for 4 months and twice weekly thereafter. Her pretreatment blood cell counts were as follows: red blood cells 2.17 × 10⁶/μL; haemoglobin 6.6 g/dL; white blood cells (WBC) 206,700/μL; and platelets 610 × 10³/μL.

The patient achieved complete haematological response [1] at the 32nd week of interferon administration, together with resolution of hepatosplenomegaly.

Cytogenetic and molecular biological analyses revealed partial suppression of the Ph¹ chromosome at the 38th week (75% Ph¹-positive) and complete cytogenetic response (CCR, 0% Ph¹-positive) at the 140th week of interferon treatment.

In conclusion, long-term administration of interferon alfa-2b alone induced complete suppression of the Ph¹ chromosome in one patient with Ph¹-positive CML, and the duration of this CCR is more than 4 months. The combination of alpha interferon with other treatments in order to enhance cytogenetic improvement should be investigated.

Laserthermia by a novel interstitial probe adapted to low power Nd-YAG laser machine was used to treat small hepatocellular carcinoma (HCC). The set condition was 43–45°C in thermocouple with power of 2–3 W and the duration 20–30 min. In the 5 cases studied, 1 had a good result with total necrosis of the tumour without recurrence in 16 months. 1 died of liver failure 2.5 months later although death was not related to the procedure. 1 patient died of progressive disease 18 months later. The remaining 2 had recurrent tumours 5 and 12 months later, although the treated small tumours showed good response. Histological examination showed cell degeneration and necrosis. It is concluded that laserthermia is potentially useful in the treatment of the patients with small HCC.

A statistical overview of published results on correlations between various prognostic factors in breast cancer was undertaken. A distinction was made between clinical (or anatomical) prognostic factors—namely, axillary lymph node status and tumour size—and eight different biological prognostic factors. The latter included: tumour grade, oestrogen and progesterone receptor status, thymidine labelling index, DNA ploidy, S-phase fraction, epidermal growth factor receptor expression and c-erbB-2 gene amplification (or overexpression). 139 articles were eligible for review which reported a total of 432 individual correlations. A simple form of meta-analysis was employed: the counting method, in which the number of studies achieving a statistically significant correlation or not were counted. For each possible correlation examined, the proportion of studies showing a statistically significant correlation was calculated and an exact binomial 99% confidence interval determined for that proportion. If the 99% confidence interval included 5% (the proportion of correlations that would be expected to be statistically significant if the null hypothesis was true), it was taken as failing to exclude the null hypothesis of a zero correlation, while if it excluded 5% it was taken as rejecting the null hypothesis of a zero correlation. A broad agreement was found among published reports on the existence of a statistically significant correlation between the various biological prognostic factors in breast cancer. Of the 20 correlation examined, 18 had a 99% confidence interval excluding 5%, thus rejecting the null hypothesis of a zero correlation. On the other hand, a completely different result was obtained when reports on possible correlations between lymph node status and tumour size on the one hand and the eight biological prognostic factors on the other were analysed. Of the 16 correlations examined, 13 had a 99% confidence interval including 5%, failing to reject the null hypothesis of a zero correlation. These observations suggest the hypothesis that the prognostic influence of node status and tumour size cannot be explained by an analysis of the biology of breast cancer; and is compatible with the contention that axillary node status is merely a reflection of the relative chronological age of breast cancer.