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P957. Radiotherapy and concomitant chemo or hormonotherapy in early stage breast cancer: acute and late local toxicity
344
The Breast
will be the basis of 2 large international multicentric randomized trials comparing TAC to FAC in both the metastatic and adjuvant setting.
P954. Toremifene, tamoxifen and the dynamics of blood hormones in breast cancer patients’ treatment V Tarutinov, I Kasjanenko, I Dosenko, A Lisitza Instate of Oncology Radiology, Ministry of Health; Institute Experiment Pathological Oncology, Acadamy of Science, Kyiv, Ukraine This a comparative evaluation of the influence of tamoxifen and toremifene on hormonal level in breast cancer patients after radical operation. 23 patients received tamoxifen, 12-toremifene. Tamoxifenum was prescribed in a dose of 10 mg daily, and toremifene given in a dose of 15 or 30 mg, toremifene-1.5 or 30 twice a day. Hormonal investigations were conducted using a radioimmunologic kit before and 3-6 months after the beginning of hormonal treatment. 3 months after the beginning of tamoxifen treatment the estrogen level, especially oestradiol, in 70% of patients increased 334 times, in half of patients testosterone, progesterone, prolactin and cortisone was reduced. At 6 months the oestradiol level appeared to be augmented 4-5 times. During toremifene treatment the increase of estrogen in blood was absent or increased in 15-2 times less than after tamoxifen treatment. Progesterone level was increased and prolactin was reduced. The dynamics of blood hormonal levels after tamoxifenum treatment shows its oncogenic danger. Toremifen in such case compares favourably with tamoxifen.
P955. Diagnosis and treatment of nipple discharge - a restrospective study WR Gioffr2, A Ditto, A Tripodi, F Franchi C.I.R.A.S., Clinica Ost. e Ginec., Univ. di Siena, Italy Aim: to review the clinical feature of the consecutive series of cases of nipple discharges in our centre 1986-‘96. Methods: nipple discharge features were recorded (colour, spontaneous/provoked, unilbilateral, single/multiple duct, presence of palpable mass) as well as results of examinations (palpation and cytology followed by other test if necessary). Results: 1200 cases were observed among a total of 19 690 patients (6.1%). Discharge was spontaneous in 669 and provoked in 53 1 cases. Discharges associated with cancer or papillomas were serous, bloody or watery. Of the 669 patients with spontaneous discharge 459 had relevant lesions worthy of assessment, 330 attended for further evaluation which demonstrated either a single intraductal papilloma, carcinoma, fibrocystic disease, duct ectasia, papillomatosis, fibroadenoma or other benign lesions. In 39 cancer cases there was a palpable mass. The 531 cases with provoked discharge had no relevant lesions. Overall 32.8% of patients with spontaneous discharge and 4.7% of those with provoked discharge had surgical biopsy. Conclusions: in our series spontaneous, serous or bloody discharge are more likely to be associated with benign or malignant lesions, whereas other discharge type, with the execption of watery discharge, are not. We recommend circumscribed digital pressure and cytologic examination in the presence of provoked discharge, as several single papillomas were identified and localized only in this way.
P957. Radiotherapy and concomitant chemo or hormonotherapy in early stage breast cancer: acute and late local toxicity MC Valli, LF Cazzaniga, A Bossi, D Cosentino, L Scandolaro
Dept. of Radiotherapy, Azienda Ospedaliera S Anna Como, Italy From 1 August 1990 to 31 December 1993 we treated 276 consecutive women with adjuvant radiotherapy f hormono or chemotherapy following quadrantectomy plus axillary dissection for stage I or II breast cancer. The mean age of the patients was 54 f 10 years (28-78). The whole breast was irradiated with 2 tangential fields of 60 Cobalt or 6 Mv X rays and the booster dose was given with Roentgentherapy or direct field of electrons. The mean dose to the breast was 50.6 * 2.7 Gy. Supraclavicular and internal mammary nodes, when treated, received respectively 45.6 f 2 Gy and 46.2 f 3.4 Gy. The mean booster dose was 9.8 f 1 Gy. The mean dimensions of the breast fields were 9.2 f 2.2 cm x and 15.8 f 2.1 cm (y); the ones of the boost were 8.2 f 1.9 cm 8 x and 9.5 f 2.9 cm (y). 173 patients did not recieve adjuvant medical therapy and 54 patients were treated with concomitant adjuvant Tamoxifen 20 mg/d (Group A = 227 patients). 49 patients (Group B) were treated with concomitant chemotherapy: 41 women with 6 cycles of CMF and 8 women with 4 cycles of EPI-ADM followed by 6 CMF, dependently on the axillary lymph nodes status. The mean follow-up was 1120 * 408.4 days. The mean overall radiotherapy treatment time was 43.9 + 4.7 days; it was 44 * 4.4 days in Group A and 45.6 f 6 days in Group B. We evaluated the acute toxicity (EORTCRTOG Scale) according to the treatment: a significant enhancement in grade 2 and 3 cutaneous and mucosal toxicity was obseved in Group B (p < 0.005) and 0.05 respectively), while no significant difference was observed in the incidence of grade 1 toxicity. The late local toxicity was reported in our charts using the EORTCRTOG scale and we did not register any significant difference between the two group. We translated the objective and subjective late toxicity parameters in the new SOMA-LENT toxicity scale (in validation) and also with this method there were no differences between the two groups. Concomitant adjuvant radiotherapy and chemotherapy is well tolerated. Radiotherapy and chemotherapy can be delivered without delay and the cosmetic results do not seem worse than those obtained with the two treatments administerd sequentially.
P958. Analysis of mutations in ~53 gene and detection of increased levels of ~53 protein in women with sporadic or familial breast cancer C Napal, M Garcia-Delgado, CJ GonzBlez-Navarro, C Baldonado, JM Lera, A GulMn, JL Alc&m.r, G Lbpez-Garcia Dept. of Genetics, Faculty of Science, University of Navarra, Pamplona, Spain and Dept. of Ginecology, School of Medicine, University of Navarra, Pamplona, Spain and Dept. of Surgery, Hospital of Navarra, Pamplona, Spain and Primary Health Care Center, Department of Public Health, Government of Navarra, Pamplona, Spain Breast cancer is the most frequent tumour among women in western countries so it is necessary to study of genes involved in development of this kind of tumour as they could be used as prognostic markers. As ~53 is the supressor gene most frequently mutated in several types of cancer we have analysed alterations in this gene and tried to associate them with clinical parameters. The mutations in p53 gene and the accumulation of ~53 protein were analysed in 36 tumour tissue samples taken from women in Navarra (Spain). 22 tumours were classified as sporadic (SBC) and 14 tumours came from 19 families with histories of breast cancer (FBC). The existence
The Breast
will be the basis of 2 large international multicentric randomized trials comparing TAC to FAC in both the metastatic and adjuvant setting.
P954. Toremifene, tamoxifen and the dynamics of blood hormones in breast cancer patients’ treatment V Tarutinov, I Kasjanenko, I Dosenko, A Lisitza Instate of Oncology Radiology, Ministry of Health; Institute Experiment Pathological Oncology, Acadamy of Science, Kyiv, Ukraine This a comparative evaluation of the influence of tamoxifen and toremifene on hormonal level in breast cancer patients after radical operation. 23 patients received tamoxifen, 12-toremifene. Tamoxifenum was prescribed in a dose of 10 mg daily, and toremifene given in a dose of 15 or 30 mg, toremifene-1.5 or 30 twice a day. Hormonal investigations were conducted using a radioimmunologic kit before and 3-6 months after the beginning of hormonal treatment. 3 months after the beginning of tamoxifen treatment the estrogen level, especially oestradiol, in 70% of patients increased 334 times, in half of patients testosterone, progesterone, prolactin and cortisone was reduced. At 6 months the oestradiol level appeared to be augmented 4-5 times. During toremifene treatment the increase of estrogen in blood was absent or increased in 15-2 times less than after tamoxifen treatment. Progesterone level was increased and prolactin was reduced. The dynamics of blood hormonal levels after tamoxifenum treatment shows its oncogenic danger. Toremifen in such case compares favourably with tamoxifen.
P955. Diagnosis and treatment of nipple discharge - a restrospective study WR Gioffr2, A Ditto, A Tripodi, F Franchi C.I.R.A.S., Clinica Ost. e Ginec., Univ. di Siena, Italy Aim: to review the clinical feature of the consecutive series of cases of nipple discharges in our centre 1986-‘96. Methods: nipple discharge features were recorded (colour, spontaneous/provoked, unilbilateral, single/multiple duct, presence of palpable mass) as well as results of examinations (palpation and cytology followed by other test if necessary). Results: 1200 cases were observed among a total of 19 690 patients (6.1%). Discharge was spontaneous in 669 and provoked in 53 1 cases. Discharges associated with cancer or papillomas were serous, bloody or watery. Of the 669 patients with spontaneous discharge 459 had relevant lesions worthy of assessment, 330 attended for further evaluation which demonstrated either a single intraductal papilloma, carcinoma, fibrocystic disease, duct ectasia, papillomatosis, fibroadenoma or other benign lesions. In 39 cancer cases there was a palpable mass. The 531 cases with provoked discharge had no relevant lesions. Overall 32.8% of patients with spontaneous discharge and 4.7% of those with provoked discharge had surgical biopsy. Conclusions: in our series spontaneous, serous or bloody discharge are more likely to be associated with benign or malignant lesions, whereas other discharge type, with the execption of watery discharge, are not. We recommend circumscribed digital pressure and cytologic examination in the presence of provoked discharge, as several single papillomas were identified and localized only in this way.
P957. Radiotherapy and concomitant chemo or hormonotherapy in early stage breast cancer: acute and late local toxicity MC Valli, LF Cazzaniga, A Bossi, D Cosentino, L Scandolaro
Dept. of Radiotherapy, Azienda Ospedaliera S Anna Como, Italy From 1 August 1990 to 31 December 1993 we treated 276 consecutive women with adjuvant radiotherapy f hormono or chemotherapy following quadrantectomy plus axillary dissection for stage I or II breast cancer. The mean age of the patients was 54 f 10 years (28-78). The whole breast was irradiated with 2 tangential fields of 60 Cobalt or 6 Mv X rays and the booster dose was given with Roentgentherapy or direct field of electrons. The mean dose to the breast was 50.6 * 2.7 Gy. Supraclavicular and internal mammary nodes, when treated, received respectively 45.6 f 2 Gy and 46.2 f 3.4 Gy. The mean booster dose was 9.8 f 1 Gy. The mean dimensions of the breast fields were 9.2 f 2.2 cm x and 15.8 f 2.1 cm (y); the ones of the boost were 8.2 f 1.9 cm 8 x and 9.5 f 2.9 cm (y). 173 patients did not recieve adjuvant medical therapy and 54 patients were treated with concomitant adjuvant Tamoxifen 20 mg/d (Group A = 227 patients). 49 patients (Group B) were treated with concomitant chemotherapy: 41 women with 6 cycles of CMF and 8 women with 4 cycles of EPI-ADM followed by 6 CMF, dependently on the axillary lymph nodes status. The mean follow-up was 1120 * 408.4 days. The mean overall radiotherapy treatment time was 43.9 + 4.7 days; it was 44 * 4.4 days in Group A and 45.6 f 6 days in Group B. We evaluated the acute toxicity (EORTCRTOG Scale) according to the treatment: a significant enhancement in grade 2 and 3 cutaneous and mucosal toxicity was obseved in Group B (p < 0.005) and 0.05 respectively), while no significant difference was observed in the incidence of grade 1 toxicity. The late local toxicity was reported in our charts using the EORTCRTOG scale and we did not register any significant difference between the two group. We translated the objective and subjective late toxicity parameters in the new SOMA-LENT toxicity scale (in validation) and also with this method there were no differences between the two groups. Concomitant adjuvant radiotherapy and chemotherapy is well tolerated. Radiotherapy and chemotherapy can be delivered without delay and the cosmetic results do not seem worse than those obtained with the two treatments administerd sequentially.
P958. Analysis of mutations in ~53 gene and detection of increased levels of ~53 protein in women with sporadic or familial breast cancer C Napal, M Garcia-Delgado, CJ GonzBlez-Navarro, C Baldonado, JM Lera, A GulMn, JL Alc&m.r, G Lbpez-Garcia Dept. of Genetics, Faculty of Science, University of Navarra, Pamplona, Spain and Dept. of Ginecology, School of Medicine, University of Navarra, Pamplona, Spain and Dept. of Surgery, Hospital of Navarra, Pamplona, Spain and Primary Health Care Center, Department of Public Health, Government of Navarra, Pamplona, Spain Breast cancer is the most frequent tumour among women in western countries so it is necessary to study of genes involved in development of this kind of tumour as they could be used as prognostic markers. As ~53 is the supressor gene most frequently mutated in several types of cancer we have analysed alterations in this gene and tried to associate them with clinical parameters. The mutations in p53 gene and the accumulation of ~53 protein were analysed in 36 tumour tissue samples taken from women in Navarra (Spain). 22 tumours were classified as sporadic (SBC) and 14 tumours came from 19 families with histories of breast cancer (FBC). The existence