Adjuvant chemotherapy is increasingly being given to patients with early breast cancer. Long-term follow-up studies suggest a higher frequency of secondary tumours, especially leukaemias, among women receiving such cytotoxic drugs. We studied the frequency of new primary malignancies in 1113 patients with early breast cancer who had been included in a randomised trial to compare chemotherapy as an adjunct to primary surgery with adjuvant locoregional radiotherapy. The estimated rate of new primary malignancies at ten years was significantly lower (p less than 0.0003) in the chemotherapy group (1%) than in the radiotherapy group (6%). The corresponding rate among 1986 patients treated with surgery alone was 5%. Our findings suggest that adjuvant chemotherapy in early breast cancer may protect against the development of new primary tumours in the first ten years of follow-up.
Notes
Comment In: Lancet. 1991 Oct 5;338(8771):885-61681236
To evaluate treatment outcome in a large population-based cohort of patients with anal cancer treated according to Nordic guidelines.
Clinical data were collected on 1266 patients with anal squamous cell carcinoma diagnosed from 2000 to 2007 in Sweden, Norway and Denmark. 886 of the patients received radiotherapy 54-64Gy with or without chemotherapy (5-fluorouracil plus cisplatin or mitomycin) according to different protocols, stratified by tumor stage.
High age, male gender, large primary tumor, lymph node metastases, distant metastases, poor performance status, and non-inclusion into a protocol were all independent factors associated with worse outcome. Among patients treated according to any of the protocols, the 3-year recurrence-free survival ranged from 63% to 76%, with locoregional recurrences in 17% and distant metastases in 11% of patients. The highest rate of inguinal recurrence (11%) was seen in patients with small primary tumors, treated without inguinal irradiation.
Good treatment efficacy was obtained with Nordic, widely implemented, guidelines for treatment of anal cancer. Inguinal prophylactic irradiation should be recommended also for small primary tumors.
Chemoradiotherapy of anal cancer is feasible in elderly patients: treatment results of mitomycin-5-FU combined with radiotherapy at Helsinki University Central Hospital 1992-2003.
The number of elderly patients with cancer is steadily increasing in developed countries and their treatment is a growing challenge for oncological departments. Anal cancer is the first tumour in which chemoradiotherapy with the intent of organ preservation has largely replaced surgery and is an interesting model of modern multimodal oncological treatment. At the Department of Oncology of the Helsinki University Central Hospital we have treated all patients irrespective of age following the same guidelines if there have been no specific contraindications on the basis of intercurrent diseases. The results suggest that the chemoradiotherapy protocol used in the treatment of anal cancer is reasonably well tolerated in elderly patients and the tumour control is comparable to those achieved in younger patients. After successful cancer therapy the life expectancy in these patients can be very long.
A total of 48 patients suffering from rectum cancer were included in this randomized study conducted at the Proctology Department of the Donetsk Regional Anti-Cancer Center. Patients in group I (24 patients) received an intensive course of high fractional X-ray therapy (cumulative dose up to 25 Gy) with direct protracted endolymphatic chemotherapy with 5-fluorouracil (5-FU) instilled in 600 mg/m2 each day before operation, up to a cumulative dose of 5 g. The 24 patients in group II were treated with Ukrain as monotherapy, 10 mg each second day before operation (up to a cumulative dose of 60 mg) and a total of 40 mg after surgical intervention. Repeated Ukrain courses (100 mg/per course) were also given 6 months after surgical operation. In each ease preoperative treatment was followed by routine surgical operation. Prolongation morbi were found to have developed 14 months later in six patients in group I (25.0%), whereas in group II they were found only in two cases (8.3%). Comparative investigation of objective and subjective signs, analysis of results of instrument and X-ray data, as well as dynamic study of the histological structure of rectal tumors, indicate that Ukrain exerts a more potent malignotoxic and immunomodulating action than other types of anticancer treatment.
Ninety six colorectal carcinoma patients were included in a randomised study, 48 were treated with Ukrain monotherapy (15 with metastatic and 33 with nonmetastatic colorectal carcinoma) and 48 with 5-fluorouracil (5-FU) and X-ray therapy (the same randomised groups). The results of therapy including clinical, haematological, immunological and biochemical parameters show that Ukrain has favourable properties in the treatment of colon and rectal cancer as a monotherapy because of its malignotoxic and immunomodulating action. Objective response rate in the group of metastatic colorectal cancer treated by Ukrain was 40%. There was no registered tumour regression in the group treated by 5-FU. Operability is strongly facilitated by pretreatment with Ukrain. The survival rate (up to 21 months) in the Ukrain-treated patients with nonmetastatic colorectal cancer was 78.6% and 33.3% in a corresponding control group. Ukrain is a new effective drug in the therapy of colorectal cancer. It can be useful both for the therapy of metastatic colorectal cancer and for neoadjuvant therapy of nonmetastatic colorectal cancer.
