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Early diagnosis and treatment of breast cancer relapses
258 EARLY DIAGNOSIS RELAPSES.
AND TREATMENT
OF
BREAST
CANCER
INTENSIVE
DIAGNOSTIC
FOLLOW-UP
OF PRIMARY
BREASTCANCER:
A. Nicolini
Marco
Ross&i
Del Turco.
lnslilule 01 2nd Medical Clinic - Oncologlcal consulting room, University 01 Piss. Ilaly.
Cisuo.
Paolo Pacini and Vito Dislante
In our Center lor a lew years the experience gained I” Ihe clinical practice wilh the use 01 lumor markers has allowed lo plan a rallonal poslooeralive lollow-uo ol breasl cancer oalienls. tieveriheless in b;easl cancer lollow-up lumor markers are nol commonly used and so lar no benefit lrom serial conlrols bv instrumentals radiological exams has been reporled. In 335 01 416 breast cancer palienls posl-operatively lollowed-up wilh planned serial controls locused on tumor markers, 5 and 10 years disease-lree survival (DFS) and overall survival (OS) were compared wllh lhose 01 Ihe maln lrlals carried oul in Cenlers where conlrol-vislls were perlormed by Ihe convenlional means. In 169 node negalives. 135 node poslhves. Iwo high risk groups including 49 palienls wilh more than 3 nodes Involved and 34 wilh stage Ill breasl cancer and in most subsets. posilive dillerences of percentages in lavour 01 lhis sludy occurred. Al the beainnina 01 lhe lollow-UD 5 palienls suspecled onlv with lumor markers were ruled oul and in 43’(75%) 01 the 57’relapsed ialienls IumOr marker increase was lhe alarm sign lo advance dlaanosis 01 dislanl melaslases by lhe radiological mea&Besides in melastatii disease lumor markers allowed belter monilormg 01 response and more rapid change 01 Iherapy. Thirieen (23%) were submilled lo saivage lrealmenl when only suspecled wilh lumor markers. In lhese I3 ‘early’ lrealed palienls lhe lead lime alter lumor marker increase lo Ihe clinical and/or radioloaical signs of relapse signrlicanlly prolonged in comparison with 26 not e;irly” lrealed olhers (15 f 6.9 vs 4.2 f 3.3 monlhs (m f sd: p < 0.001 unpaired I lesl)). Also median survival from salvage lrealmenl and from masledomy was longer in Ihe lormer lhan in the laller group (34 and 70 vs 24.5 and 59 monlhs). Moreover when all relapsed palienls evalualed were considered median survival lrom salvage trealmenl and lrom masleclomy was higher or similar lo lhe highesl values reponed I” comparable Irials. Bul in our sludy 9 palienls (20%) are still alrve. In node neaalives. node wsilives and in Ihe Iwo hiah risk orouos Ihe pe&enlage al ev&ls possibly allecled proponbnally reilecied Ihe diilerenl DFS and OS improvement. These dala poinl oul lhal a raliinal posl-operalive lollow-up wilh tumor markers allows belle, delinilion 01 posl-operallve slagmg and more suilable use of the convenlional radiological examinalions. BesIdes they suggest lhat ‘earlier- lrealmenl wilh more sunable momloring 01 response lo therapy prolongs DFS and OS ol relapsed breast cancer patienls.
Domcnico
Ccnrro per lo Studio c la Prcvcnzionc
AFI-ER
TREATMENT
A RANDOMISED
TKIAL
Palli. Angelo Candd~. S~cf:mo
Oncologica
Fircnx
A prospective trial evaluated Ihc impact of adding chcsr X-ray and bone scan (intensive follow-uo) IO ohvsical examinslion and mammography (clinical follow-u[;j in ih; periodic follow-up of I.243 breast cancer patienrs randomised by twelve halian ccnues. The IWO rsndomiscd groups showed no difference as far as ;I& menopausal SIBIUS. hm~our stage and adjuvnm ~reatmcnt wcrc concerned. Diffcrcnccs in relapse-free and overall burvival were cvalu;llcd nfkx a minimum follow-up of f~vc years. Ovcmll 393 rccurrcnccs (lo4 local. 2X9 dialam) wcrc obacrvcd in [he s(udy period Incrca
DETECTION AND PROGNOSIS OF LYMPH NODE AND BONE MARROW BREAST CANCER-DERIVED MICROMETASTASES A Munro
Neville.
Ludwig Institute for Cancer Research. 153-155 Regent St. London WI.
5lh Floor, Hedges
House,
During lhe pas1 decade inleresl has developed in methods IO delecl micromelaslases in various organs and lo assess lheir prognoslic importance. While many cancer syslems have been examined, mosl research has been concenlraled on breast cancer patients wilh respecl lo bone marrow and and/or axillary lymph node micrometaslases. Using immunohislochemical approaches, approximately 25% of breast cancer subiecls. wilh no evidence of melaslases al lhe time of primary treatment. will be found lo have bone marrow micrometaslases. The incidence is higher in lhose with node involvement, larger lesions and perilumoral vascular invasion. Prolonged lollow-up shows that such micromelaslases forecast early relapse and decreased survival. Axillary node micromelaslases have been sludied by several groups, bul ils prognostic signilicance is no yel resolved. In the large Ludwig (Inlernalional) Breast Cancer Trial(V) of over 1.000 palienls. 9% of subjects with presumed node negalive disease, as determined al the initial hislopalhological assessment were found, alter serial seclioning of lhese nodes, lo have micromelaslalic involvement which carried a poor prognoslic outcome. Using an immunohislochemical probe for cylokeralins and examining only I section 01 the nodes, 24% of so-called node negative palienls had evidence of micromelaslases. The pathological and clinical ramilicalions ol these results and whether both nodes and marrow need lo be examined will be discussed together with lhe interesting biological issue lhal not all subjecls with micromelastases proceed lo develop overi d&ant diiease.
12.6)
2
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ITS ringlc nwhiplc
nodvlf nalulcr
dirrvre “ululerilynq,h. Suprdavisular ndcr Mammary chr,n n,&x
Axilluy Ilm.
nalcr
11”
5 YRS 56.3
IO YHS
f
5.4 6.0
67.0
*
5.6
75.3
1
6.0
69
75.3
+
23
71.5
+ 14.3
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93
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4.0
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+
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23
74.6
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9.2
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t
8.U
52 48 398
72.3 15.3 74.1
2 + +
9.3 63 2.5
72.3 85.3 79.4
jm Y.3 + b., + 2.5
AND TREATMENT
OF
BREAST
CANCER
INTENSIVE
DIAGNOSTIC
FOLLOW-UP
OF PRIMARY
BREASTCANCER:
A. Nicolini
Marco
Ross&i
Del Turco.
lnslilule 01 2nd Medical Clinic - Oncologlcal consulting room, University 01 Piss. Ilaly.
Cisuo.
Paolo Pacini and Vito Dislante
In our Center lor a lew years the experience gained I” Ihe clinical practice wilh the use 01 lumor markers has allowed lo plan a rallonal poslooeralive lollow-uo ol breasl cancer oalienls. tieveriheless in b;easl cancer lollow-up lumor markers are nol commonly used and so lar no benefit lrom serial conlrols bv instrumentals radiological exams has been reporled. In 335 01 416 breast cancer palienls posl-operatively lollowed-up wilh planned serial controls locused on tumor markers, 5 and 10 years disease-lree survival (DFS) and overall survival (OS) were compared wllh lhose 01 Ihe maln lrlals carried oul in Cenlers where conlrol-vislls were perlormed by Ihe convenlional means. In 169 node negalives. 135 node poslhves. Iwo high risk groups including 49 palienls wilh more than 3 nodes Involved and 34 wilh stage Ill breasl cancer and in most subsets. posilive dillerences of percentages in lavour 01 lhis sludy occurred. Al the beainnina 01 lhe lollow-UD 5 palienls suspecled onlv with lumor markers were ruled oul and in 43’(75%) 01 the 57’relapsed ialienls IumOr marker increase was lhe alarm sign lo advance dlaanosis 01 dislanl melaslases by lhe radiological mea&Besides in melastatii disease lumor markers allowed belter monilormg 01 response and more rapid change 01 Iherapy. Thirieen (23%) were submilled lo saivage lrealmenl when only suspecled wilh lumor markers. In lhese I3 ‘early’ lrealed palienls lhe lead lime alter lumor marker increase lo Ihe clinical and/or radioloaical signs of relapse signrlicanlly prolonged in comparison with 26 not e;irly” lrealed olhers (15 f 6.9 vs 4.2 f 3.3 monlhs (m f sd: p < 0.001 unpaired I lesl)). Also median survival from salvage lrealmenl and from masledomy was longer in Ihe lormer lhan in the laller group (34 and 70 vs 24.5 and 59 monlhs). Moreover when all relapsed palienls evalualed were considered median survival lrom salvage trealmenl and lrom masleclomy was higher or similar lo lhe highesl values reponed I” comparable Irials. Bul in our sludy 9 palienls (20%) are still alrve. In node neaalives. node wsilives and in Ihe Iwo hiah risk orouos Ihe pe&enlage al ev&ls possibly allecled proponbnally reilecied Ihe diilerenl DFS and OS improvement. These dala poinl oul lhal a raliinal posl-operalive lollow-up wilh tumor markers allows belle, delinilion 01 posl-operallve slagmg and more suilable use of the convenlional radiological examinalions. BesIdes they suggest lhat ‘earlier- lrealmenl wilh more sunable momloring 01 response lo therapy prolongs DFS and OS ol relapsed breast cancer patienls.
Domcnico
Ccnrro per lo Studio c la Prcvcnzionc
AFI-ER
TREATMENT
A RANDOMISED
TKIAL
Palli. Angelo Candd~. S~cf:mo
Oncologica
Fircnx
A prospective trial evaluated Ihc impact of adding chcsr X-ray and bone scan (intensive follow-uo) IO ohvsical examinslion and mammography (clinical follow-u[;j in ih; periodic follow-up of I.243 breast cancer patienrs randomised by twelve halian ccnues. The IWO rsndomiscd groups showed no difference as far as ;I& menopausal SIBIUS. hm~our stage and adjuvnm ~reatmcnt wcrc concerned. Diffcrcnccs in relapse-free and overall burvival were cvalu;llcd nfkx a minimum follow-up of f~vc years. Ovcmll 393 rccurrcnccs (lo4 local. 2X9 dialam) wcrc obacrvcd in [he s(udy period Incrca
DETECTION AND PROGNOSIS OF LYMPH NODE AND BONE MARROW BREAST CANCER-DERIVED MICROMETASTASES A Munro
Neville.
Ludwig Institute for Cancer Research. 153-155 Regent St. London WI.
5lh Floor, Hedges
House,
During lhe pas1 decade inleresl has developed in methods IO delecl micromelaslases in various organs and lo assess lheir prognoslic importance. While many cancer syslems have been examined, mosl research has been concenlraled on breast cancer patients wilh respecl lo bone marrow and and/or axillary lymph node micrometaslases. Using immunohislochemical approaches, approximately 25% of breast cancer subiecls. wilh no evidence of melaslases al lhe time of primary treatment. will be found lo have bone marrow micrometaslases. The incidence is higher in lhose with node involvement, larger lesions and perilumoral vascular invasion. Prolonged lollow-up shows that such micromelaslases forecast early relapse and decreased survival. Axillary node micromelaslases have been sludied by several groups, bul ils prognostic signilicance is no yel resolved. In the large Ludwig (Inlernalional) Breast Cancer Trial(V) of over 1.000 palienls. 9% of subjects with presumed node negalive disease, as determined al the initial hislopalhological assessment were found, alter serial seclioning of lhese nodes, lo have micromelaslalic involvement which carried a poor prognoslic outcome. Using an immunohislochemical probe for cylokeralins and examining only I section 01 the nodes, 24% of so-called node negative palienls had evidence of micromelaslases. The pathological and clinical ramilicalions ol these results and whether both nodes and marrow need lo be examined will be discussed together with lhe interesting biological issue lhal not all subjecls with micromelastases proceed lo develop overi d&ant diiease.
12.6)
2
T&A? Clmt-wall. Chul.wall. Chcrt-wall.
ITS ringlc nwhiplc
nodvlf nalulcr
dirrvre “ululerilynq,h. Suprdavisular ndcr Mammary chr,n n,&x
Axilluy Ilm.
nalcr
11”
5 YRS 56.3
IO YHS
f
5.4 6.0
67.0
*
5.6
75.3
1
6.0
69
75.3
+
23
71.5
+ 14.3
“b.P 2 I,.U
93
X6.2
f
4.0
95.4
+
4.”
23
74.6
t
9.2
81.0
t
8.U
52 48 398
72.3 15.3 74.1
2 + +
9.3 63 2.5
72.3 85.3 79.4
jm Y.3 + b., + 2.5