Long-term relapses of breast cancer: a working hypothesis.

The study of long-term relapses that present 8 years or more after mastectomy in breast cancer patients indicates these cases are strictly related to the presence of hormone receptors and particularly to estrogen receptors. It is possible to infer that the presence of estrogen receptors indirectly conditions the formation of antimitotic factors more effective than those used for therapy, to the point of determining in some cases the phenomenon of long-term relapses.

Long-term relapses of breast cancer: questions, interpretations and hypotheses.

The author has demonstrated in previous publications that the consistent characteristic of long-term relapses of carcinoma after more than 8 years from surgery is hormone dependence, since long-term relapses occur almost exclusively in hormone-dependent tumors such as carcinoma of the breast, prostate, endometrium and thyroid. Such publications presented a series of 237 long term relapses of breast cancer that occurred at no less than 8 years from the mastectomy, which proved that all the patients were estrogen-receptor positive. Estrogen-negative cases who did not relapse after 8 years from surgery should be considered cured, as is found for cases of non-hormone-dependent tumors.

Estrogen-receptor status of patients who underwent mastectomy for breast cancer with a disease-free interval of not less than 8 years.

The authors present a series of 1,226 patients who underwent total or partial mastectomy for breast cancer, who for a period of no less than 8 years from surgery did not have a relapse or relapsed only after 8 years. The patients were evaluated for estrogen-receptor (ER) content of the primary tumor. In the group of 237 patients who relapsed, only 8.

Breast cancer patients: long-term relapses.

The authors evaluated 200 cases of long-term relapses in patients subjected to mastectomy at least 8 years before and not given any hormonal or other therapy that would have significantly affected the course of the disease. A group of 200 mastectomy patients with early relapses (within 3 years) was used as a control. The following parameters were compared: histologic type, singularity or multiplicity of the relapses at the time of the diagnosis, the patient's age at the time of the mastectomy, the presence of metastatic lymphnodes at the axilla, the clinical course of the disease after the diagnosis of relapse, and the presence of estrogen receptors in the primary tumor.

[Therapeutic management of recurrent uterine cervix carcinoma following surgery alone or surgery with complementary endocavitary curietherapy].

Sixty-eight cases of recurrence of cancer of the uterine neck, among which 8 after conization and 60 after Wertheim's enlarged hysterectomy, in a group of 472 patients are examined. No one of these 472 patients was subjected to external radiotherapy, because metastatic lymph nodes were not found at the time of the surgery of the primary tumor. The aim of the work was to examine the possibilities of identifying a subgroup of patients, among those without metastatic lymph nodes, for whom external radiotherapy, besides brachytherapy, could be considered useful on the basis of the extent of the primary tumor and of the histological type.

Long-term relapses in breast cancer patients (estrogen receptor status).

To investigate the relation between estrogen receptor (ER) status and timing of relapse, we retrospectively studied two groups of patients (200 cases in each group) who underwent radical mastectomy and developed an early relapse (within 3 years of the surgery) or a long-term relapse (more than 8 years after surgery). One-hundred and eighty-two (91%) patients who developed a long-term relapse were ER-positive (ER+), whereas only 64% of patients who developed an early relapse were ER+ (P < 0.001), supporting the hypothesis that a long-term relapse is more frequently associated with an ER+ tumor.

On extravisceral soft tissue sarcomas. Effectiveness of radiation treatment and problems of radiotherapy and radiosurgical treatment.

A series of 355 extravisceral soft tissue sarcomas is presented with reference to the effectiveness of radiation treatment for each histological type and the problems of radiotherapy and surgical treatment. Liposarcoma was the most radiosensitive soft tissue sarcoma. By utilizing all types of treatment and especially radiosurgery with postoperative radiotherapy, the percentage of disease-free patients after a minimum of 3 years from treatment varied from 27% to 52.

Bronchial carcinoid tumors: radiologic observations in 49 cases.

A retrospective evaluation was performed of radiographs obtained in 49 cases of bronchial carcinoid at presentation and during a follow-up period of 12 years. Histologic diagnosis from the surgical specimen was available in all cases. Carcinoids appeared most frequently (77%) as round or oval opacities with sharp and often notched margins.

[Use of fast electrons in oncologic therapy. More than a decade's experience].

Criteria of choice in the utilization of fast electrons in radiotherapy on the basis of 2400 cases and 13 years of experience in the radiotherapy department of Cancer Institute in Milan are discussed. In the opinion of the authors fast electrons represent the most rational treatment to homogenize or differentiate the dose distribution according to space as a complementary technique after first time treatments by different ionizing radiation. Authors demonstrate also that fast electron treatment is the most rational technique for metastases in the retina and for recurrence of rhinopharynx cancer.

Long-term relapses in breast cancer patients.

The authors examined 100 cases of long-term relapses of breast cancer arising more than 5 years after radical mastectomy and 100 cases of early relapses (within 3 years). Precautional radiotherapy or chemotherapy had not been performed during these intervals. Histologic type did not appear important.

[Somatic sequelae of radiotherapy: the possibility of surgery].

The possibilities of surgical treatment for sequelae from radiotherapy in different organs and apparatuses are examined. Clinical severity of such sequelae is correlated to the causal factors: dose and its distribution with time, physiological status and volume of the irradiated tissues, association of the radiotherapy with chemotherapy and/or surgical treatments. For sequelae in the soft tissue the main question is to find trophic tissues for surgical wounds; plastic surgery is very often unavoidable.

Therapy of malignant schwannomas: usefulness of an integrated radiologic. Surgical therapy.

A series of 30 patients with malignant schwannomas, who underwent diagnostic and therapeutic treatment at the Istituto Nazionale Tumori of Milan, is presented. Twenty-five of the patients have been followed for at least 3 years. Paravertebral regions were the most frequent sites of primary localizations of the malignant schwannomas.

[Sequelae of radiosurgical treatment in patients having undergone Wertheim radical hysterectomy].

The sequelae from therapeutic treatment in a series of 361 patients subjected to Wertheim's hysterectomy, 125 of whom had a lumbo-aortic lymphadenectomy, have been studied. All these patients underwent postoperative external beam irradiation and intracavitary radium or caesium. Twenty-six cases of functional vesical disturbance, 12 of iliac lymphocele, 24 of parametritis, 4 of bladder vaginal fistula, 35 of ureteral fistula, 16 of ureteral fibrosis, 6 of lymphedema of the lower limbs and 1 of rectal ulcer were found.

[The sequelae of radiotherapy: possibilities of medical therapy].

The possibilities of medical treatment for the sequelae of radiotherapy of the various organs and apparatus are examined. Medical therapy may be utilised as a support in cases in which a favourable course is possible spontaneously, as a support in cases with chronic changes not liable to develop favourably, in cases with prospects of radical treatment, with substitutive purposes based therefore on the administration of substances that are missing as a result of the sequelae, as in the case of hormones after irradiation of endocrine organs, and finally for preventive purposes. The variously acting pharmacological substances applied locally or introduced generally which permit biological recovery, albeit partially, are recalled.

[Usefulness of gallium 67 in research into the need for radical cervical lymph node dissection in patients with head and neck carcinomas].

Fifty-nine patients with head and neck carcinoma were examined with 67Ga scintigraphy. All patients had undergone lymph node dissection of the neck. They were followed for a minimum of 2 years after the examination.

[Thyroid cancer induced by radiotherapy. Clinico-anatomopathological comparison with spontaneously occurring cancer].

Thirty-three patients with thyroid cancer following irradiation of head, neck and chest were compared to 389 patients, with the same kind of cancer, who had not undergone irradiation therapy. The two groups showed a different distribution of different isotypes. In group 1 (following irradiation) the papillary isotype was most common in a much greater number of cases than in group 2.

[Somatic sequelae induced by radiotherapy in bone segments in adults].

The authors, on the basis of reports found in literature and of a personal series, discuss the radiological aspects, the differential diagnosis, the main factors that lead to bone sequelae, and the possible contributory causes and complications. The radiological aspects is characterized by the association of sclerotic and atrophic changes, with a prevalence of the latter in the involvement of the mandible and the cranial bones. Among the main factors there are the radiation dose and its chronological distribution.