Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy

Article Abstract:

Stomach cancer is the eighth most common cause of cancer death in the US and was responsible for 13,700 deaths last year. The primary treatment is surgery, but the outlook is poor, and fewer than 20 percent of patients are likely to survive more than five years. Since many patients with stomach cancer relapse after apparently complete surgical removal of the cancer, a study was undertaken to evaluate the use of a regimen of chemotherapeutic treatment along with surgery. A total of 25 patients with previously untreated stomach cancer were given chemotherapeutic courses of etoposide, 5-fluorouracil, and cisplatin both before and after the surgical removal of their cancer. Six of the 25 patients had major responses to the preoperative chemotherapy, and 20 of 25 had subjective improvements including better appetite. At surgery, it was found that none of the 25 patients had a complete response to the chemotherapeutic treatment. In three cases, however, the only residual cancer was microscopic deposits. In seven patients, cancer spread was found at the time of surgery and so the surgery was potentially curative in only 18 cases. All seven patients with cancer spread were dead within 15 months. Of the remaining 18 patients, seven have died within an average follow-up period of just over two years. The side effects of the chemotherapy were only moderate, and there were no deaths attributed to this treatment, although one patient died of postoperative respiratory complications. This study indicates the feasibility of combining chemotherapy with surgical treatment for stomach cancer. Before a study is conducted to compare surgery with chemotherapy with surgery alone, it would seem appropriate to develop a chemotherapeutic regimen with a better response rate for this cancer. Based on comparisons with other forms of cancer, a suitable goal would be the development of an adjuvant chemotherapeutic protocol with a complete response rate of between 5 and 10 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, Chemotherapy, Stomach cancer, Fluorouracil, Cisplatin, Adjuvant chemotherapy, Etoposide

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Predicting the rate and extent of locoregional failure after breast conservation therapy for early breast cancer

Article Abstract:

There are two surgical approaches in the treatment of breast cancers. One is mastectomy or removal of the entire breast. The other is a more conservative approach which removes only the primary tumor with a small amount of localized tissue, followed by radiation treatment. This approach is preferred by patients because of its cosmetic and psychological advantages. Recurrences of cancer cells after mastectomy are usually associated with the spread of cancer to other areas of the body and they develop within five years of treatment. Recurrences after conservative breast surgery are found primarily at the site of the original tumor. The outcome of the conservative approach to breast cancer surgery was reviewed in 536 patients with early breast cancer. Localized recurrences in the area of surgical excision occurred in 55 patients after an average of 40 months. The rate of recurrence was nine percent after five years, and 19 percent after 10 years. The recurrences occurred more often in younger patients. However, the survival rates were the same. A poor prognosis was associated with tumors involved with the skin or fixed to the chest wall, tumors greater than five centimeters (two inches) and lymph nodes that were not resected. An initial cancer with a more advanced staging was also associated with disease recurrence. The five-year survival rate after treatment of the localized recurrence was 63 percent. If the recurrence was advanced, the survival rate decreased to 37 months. Patients deciding on surgical approaches should be aware of the contraindications and limitations of conservative surgery. The risk of breast tumor recurrence continues indefinitely. Women with larger tumors can consider breast removal followed by breast reconstruction as an alternative to the conservative surgical approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Breast cancer, Mastectomy, Breast, Breast surgery

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The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival

Article Abstract:

Soft tissue cancer of the arms or legs often poses a dilemma for the surgeon and patient. While no one prefers amputation, conservative surgery may increase the risk of a local recurrence. Since some authorities have suggested that local recurrence carries with it an increased risk of metastatic spread and death, it becomes important to know if conservative surgery, with its concomitant increased risk of local recurrence, might be unjustified. In a review of 175 cases of soft tissue cancer of the limbs or limb girdle, the chance of local recurrence was confirmed to be related to the initial treatment, with the best control achieved with wide margins or radical surgery, and radical radiotherapy. As might be expected, large tumors and high-grade tumors had a poorer prognosis. It is difficult to determine if local recurrence actually has an influence on survival. While in this study, the patients with local recurrence fared worse, this may be because local recurrence is more likely among patients who already had imperceptible metastatic disease at the time of surgery. It is not at all certain that more radical surgery, which might eliminate local recurrence, would actually have any influence on the survival of such patients. Unfortunately, the limited data in this study do not permit deciding on this question. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sarcoma, Amputation

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