A randomized phase III comparative trial of immediate consolidation with high-dose chemotherapy and autologous peripheral blood progenitor cell support compared to observation with delayed consolidation in women with metastatic breast cancer and only bone metastases following intensive induction chemotherapy

The prognosis for patients with metastatic breast cancer remains poor. Metastatic breast cancer confined to the bones may have a better prognosis, especially hormone receptor-positive disease. We performed a prospective, randomized clinical trial to compare immediate consolidation with high-dose chemotherapy and hematopoietic support versus observation with high-dose consolidation at the time of disease progression in women with metastatic breast cancer and only bone metastases. The patients received chemotherapy with doxorubicin, 5-fluorouracil and methotrexate before randomization. In all, 85 patients were enrolled and 69 were randomized. The median follow-up is 8.1 years from randomization. The median event-free survival (EFS) for the immediate transplant arm is 12 months and for the observation arm is 4.3 months (P<0.0001). The median overall survival for the immediate transplant arm is 2.97 years and for the observation arm 1.81 years, a difference that is not statistically significant. Immediate high-dose chemotherapy and radiation therapy as consolidation offers a clinically and statistically significant improvement in EFS compared with radiation therapy alone following induction chemotherapy for women with metastatic breast cancer confined to the bones.

The last deglaciation of the southeastern sector of the Scandinavian ice sheet

The Scandinavian Ice Sheet (SIS) was an important component of the global ice sheet system during the last glaciation, but the timing of its growth to or retreat from its maximum extent remains poorly known. We used 115 cosmogenic beryllium-10 ages and 70 radiocarbon ages to constrain the timing of three substantial ice-margin fluctuations of the SIS between 25,000 and 12,000 years before the present. The age of initial deglaciation indicates that the SIS may have contributed to an abrupt rise in global sea level. Subsequent ice-margin fluctuations identify opposite mass-balance responses to North Atlantic climate change, indicating differing ice-sheet sensitivities to mean climate state.