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Sacchini V, Costa A, Bonanni B, Luini A, Rotmensz N, Farante G, D’Aiuto G, Boyle P, Maisonneuve P, Veronesi U. 120 P - Chemoprevention of breast cancer: update of the Italian trial in hysterectomised women. Eur J Cancer 1996. [DOI: 10.1016/0959-8049(96)84874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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152
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Veronesi U. Prevention of breast cancer with tamoxifen: the Italian study in hysterectomized women. Breast 1995. [DOI: 10.1016/s0960-9776(95)80002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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153
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Agresti R, Greco M, Raselli R, Veronesi U. 1024 Axillary surgery can be avoided in selected breast cancer patients: Analysis of 401 patients. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96272-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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154
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Veronesi U, Bonadonna G, Zurrida S, Galimberti V, Greco M, Brambilla C, Luini A, Andreola S, Rilke F, Raselli R. Conservation surgery after primary chemotherapy in large carcinomas of the breast. Ann Surg 1995; 222:612-8. [PMID: 7487207 PMCID: PMC1234987 DOI: 10.1097/00000658-199511000-00002] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The authors evaluated the utility of preoperative chemotherapy in patients with large size breast carcinoma, with a view to rendering a conservative surgical approach possible or easier. SUMMARY BACKGROUND DATA Two hundred twenty-six of 227 patients with breast cancer involving a tumor larger than 3 cm at greatest dimension were candidates for mastectomy. They were treated with various primary preoperative chemotherapies and evaluated for surgery. METHODS After administering various chemotherapeutic regimens, the authors reevaluated the patients' conditions clinically and radiologically to plan definitive surgical treatment. If the tumor diameter was sufficiently reduced, quadrantectomy was planned; otherwise, mastectomy was performed. Complete axillary lymph node dissection was done in all cases. RESULTS In 90% of the cases, the size reduction was sufficient to justify breast conservation; in 10%, tumor size did not decrease enough or increased, thus mastectomy was performed. In 11.8% of the cases, the tumor was no longer identifiable at surgical inspection, and in 3.5% no tumor was found on microscopic examination. Axillary lymph nodes were free of metastases in 39% of cases. Twelve local recurrences occurred among the 203 patients treated with breast conservation (5.9%) and five among the 23 patients treated with mastectomy (21.7%). CONCLUSIONS Primary chemotherapy can expand the indication for breast conservation to large tumors; careful attention, however, must be paid to surgical technique. The position of the tumor should be marked with tattoo points on the skin before chemotherapy. The macroscopic extent of the tumor regression must be evaluated carefully, and multiple frozen section biopsies may be needed. The margins of the resected breast should be evaluated microscopically. All microcalcifications present before treatment must be resected. The skin incision and mammary resection must fulfill criteria of radicality as well as good cosmetic outcome.
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155
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Costa A, De Palo G, Decensi A, Formelli F, Chiesa F, Nava M, Camerini T, Marubini E, Veronesi U. Retinoids in cancer chemoprevention. Clinical trials with the synthetic analogue fenretinide. Ann N Y Acad Sci 1995; 768:148-62. [PMID: 8526344 DOI: 10.1111/j.1749-6632.1995.tb12118.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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156
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Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M, Mariani L, Zurrida S, Rilke F. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients. Eur J Cancer 1995; 31A:1574-9. [PMID: 7488404 DOI: 10.1016/0959-8049(95)00271-j] [Citation(s) in RCA: 343] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Breast conservation has become well-established in the treatment of early mammary carcinoma. However, a standardised treatment modality has not emerged. We have analysed the data from 1,973 patients treated in three consecutive randomised trials by four different radiosurgical procedures: Halsted mastectomy, quadrantectomy plus radiotherapy, lumpectomy plus radiotherapy, and quadrantectomy without radiotherapy, to compare the outcomes of these procedures in terms of local recurrence rate and overall survival. Eligibility criteria were similar in the three trials, and comparability between the four subgroups was excellent. Median follow-up for all patients was 82 months. The annual rates of local recurrence varied markedly according to the treatment. Patients treated with Halsted mastectomy and quadrantectomy plus radiotherapy had low annual rates of local recurrence (0.20 and 0.46, respectively) while both lumpectomy plus radiotherapy and quadrantectomy without radiotherapy had significantly higher rates (2.45 and 3.28, respectively). Patients under 45 years of age had a much higher incidence of local recurrences, while in women over 55 years local recurrences were much less frequent. Overall survival curves were identical in the four groups of patients, so that the three breast conserving radiosurgical procedures had the same survival rates as Halsted mastectomy. However, local recurrence rates were markedly influenced by the treatment method, patient age and specific histological features.
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157
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Boyle P, Veronesi U, Tubiana M, Alexander FE, da Silva F, Denis LJ, Freire JM, Hakama M, Hirsch A, Kroes R. European School of Oncology Advisory report to the European Commission for the "Europe Against Cancer Programme" European Code Against Cancer. Eur J Cancer 1995; 31A:1395-405. [PMID: 7577062 DOI: 10.1016/0959-8049(95)00334-f] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A European School of Oncology Advisory Group has reviewed the European Code Against Cancer after its initial use over a 6-year period. With minor modifications, the original ten recommendations were found to be adequate, although it was agreed that an Annex was necessary to explain the scientific evidence supporting each point, and is presented herewith. Tobacco smoking clearly remains the most important cause of cancer, and now it can be quantified better than ever before. It is also clear that it is never too late to stop smoking: stopping even in middle age, prior to the onset of serious illness has a beneficial effect on life expectancy. Alcohol drinking is an important cause of cancer, and yet modest consumption levels protect against cardiovascular disease mortality. The optimal strategy seems to be a consumption not exceeding 2-3 drinks per day, although this limit may be lower for women. Increased consumption of fruits and vegetables, reduction in consumption of fatty foods, reduction of obesity and increased physical activity can all be recommended to reduce cancer risk. Exposure to excessive sunlight remains a problem which should be limited. Control of occupational cancer is a three-way partnership: legislation identifies and limits exposure to known carcinogens, employers enact the legislation and workers should respect the measures introduced. There are a number of signs and symptoms which may lead to cancer being diagnosed earlier, and patients with these should be referred to a doctor. For women, participation in organised programmes of cervical cancer and breast cancer (after 50 years of age) should lead to a reduction in mortality from these forms of cancer. The key element is organised programmes, where quality control and quality assurance are in force. These revised recommendations are the result of an agreement following advice, review and dialogue with cancer experts throughout Europe. They were approved by the European Community Cancer Experts at their meeting in Bonn on 28-29 November 1994. Their implementation by the European population should greatly reduce cancer incidence and mortality.
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Crippa F, Agresti R, Bombardieri E, Seregni E, Chiti A, Greco M, Andreola S, Buraggi G, Veronesi U. Preliminary-results of preoperative axillary radioimmunoscintigraphy with in-111 b72.3 in breast-cancer. Int J Oncol 1995; 6:791-5. [PMID: 21556604 DOI: 10.3892/ijo.6.4.791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nineteen patients with clinical and mammographic diagnosis of breast cancer and 1 patient already mastectomized underwent radioimmunoscintigraphy (RIS) in order to evaluate the axillary node status before surgery. After histologic examination, ductal breast carcinomas were found in 17/19 patients and axillary metastases were found in 11 patients. RIS was performed with planar scintigraphies and SPET (Single Photon Emission Tomography) of mammary and axillary regions after intravenous injection of In-111 B72.3. Overall RIS sensitivity for breast tumors was 71% (12/17); according to the tumor site different RIS sensitivity was demonstrated (90% for lesions of external quadrants versus 43% for lesions of internal quadrants). RIS was negative in 2 patients with post-surgery diagnosis of mammary dysplasia. As regards axillary metastasis RIS sensitivity and specificity were 91% (10/11) and 78% (7/9), respectively. Human Anti-Murine Antibody (HAMA) production was shown in 16.7% (2/12) of the patients. The quantitation of In-111 B72.3 uptake (%I.D./g; mean+/-S.D.) was 0.0054+/-0.0021 in breast tumors, 0.0021+/-0.0011 in normal mammary tissue, 0.0053+/-0.0027 in axillary metastasis and 0.0032+/-0.008 in normal axillary nodes. Our data demonstrated that RIS can detect tumor spread to the axilla in patients with breast cancer. Larger pre-operative study is required to evaluate if RIS can alter the management of this disease.
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160
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Veronesi U, Costa A, Sacchini V, Luini A, Bonanni B, Veronesi P, Rotmensz N, Boyle P. [Italian study on the chemoprevention of breast cancer with tamoxifen]. CONTRACEPTION, FERTILITE, SEXUALITE (1992) 1995; 23:258-60. [PMID: 7757133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
There is currently a large breast cancer chemoprevention trial in Italy. The trial is based on the use of the antioestrogen tamoxifen, which is one of the most successful and most studied anticancer drugs. There is a strong evidence that this drug can prevent the growing of controlateral cancer in women previously operated for breast cancer. The chemoprevention trial using tamoxifen includes healthy women, aged 35 to 70 and hysterectomised. The participants are taking either 20 mg/day of tamoxifen or placebo for 5 years, in double blind; then they are followed-up clinically and instrumentally every 6 months for the further 5 years. The main end-point of the study is to verify the reduction of incidence and mortality from breast cancer. It was decided to recruit only hysterectomised women on the consideration that, according to some studies, tamoxifen could give an additional risk of endometrial cancer: the Italian study was especially designed with the intention of avoiding this unjustified risk.
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161
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Silvestrini R, Daidone MG, Luisi A, Boracchi P, Mezzetti M, Di Fronzo G, Andreola S, Salvadori B, Veronesi U. Biologic and clinicopathologic factors as indicators of specific relapse types in node-negative breast cancer. J Clin Oncol 1995; 13:697-704. [PMID: 7884430 DOI: 10.1200/jco.1995.13.3.697] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE AND METHODS We evaluated, in 1,800 patients with node-negative tumors treated with locoregional therapy until relapse, the competitive risks for different types of metastasis by cell proliferation (3H-thymidine labeling index [3H-dT LI]), estrogen receptors (ERs), and progesterone receptors (PgRs), and by the integration of biologic and clinicopathologic information. RESULTS Hormone receptor status and proliferative activity of the primary tumor were not indicative of contralateral failures. Hormone receptors failed to predict the 8-year incidence of locoregional recurrence, but they were significant indicators of distant metastasis and overall survival. The latter finding was confirmed even in multivariate analysis. Conversely, cell proliferation predicted both locoregional and distant metastases and survival, regardless of patient age, tumor size, and ER and PgR status. Recursive partitioning and amalgamation analysis ascribed to cell proliferation an important prognostic role for locoregional recurrence together with patient age and tumor size. CONCLUSION Biologic markers, in particular cell proliferation, provide information for the different types of relapse and could complement the predictive role of pathologic staging.
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162
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De Palo G, Veronesi U, Camerini T, Formelli F, Mascotti G, Boni C, Fosser V, Del Vecchio M, Campa T, Costa A. Can fenretinide protect women against ovarian cancer? J Natl Cancer Inst 1995; 87:146-7. [PMID: 7707390 DOI: 10.1093/jnci/87.2.146] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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163
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Veronesi U, Marubini E, Del Vecchio M, Manzari A, Andreola S, Greco M, Luini A, Merson M, Saccozzi R, Rilke F. Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst 1995; 87:19-27. [PMID: 7666458 DOI: 10.1093/jnci/87.1.19] [Citation(s) in RCA: 408] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Local disease recurrences are a concern in conservative breast cancer surgery, and many studies have attempted to identify risk factors for these events. It is important to distinguish local recurrences linked to increased risk of distant spread from those due to inadequate local treatment. PURPOSE We evaluated the incidence of local and distant recurrences according to demographic, biological, and pathologic variables in a large series of women who were conservatively and uniformly treated for breast cancer, with the aim of identifying women in whom local failure is predictive for distant metastases and who are therefore candidates for aggressive systemic treatment. METHODS Medical records of 2233 women who had been hospitalized at the Milan Cancer Institute from 1970 to 1987 were analyzed. All women received quadrantectomy and axillary lymph node dissection followed by radiotherapy for the breast. Quadrantectomy is breast-conserving removal of most of the affected quadrant by a radial incision that includes part of the skin. The end points considered were local failures (including local recurrences and new ipsilateral carcinomas) and distant metastases. Statistical analysis employed the competing risks and multiple failures approaches. RESULTS There were 119 local recurrences, 32 new ipsilateral carcinomas, and 414 distant metastases as first events. The timing of local failures and distant metastases differed: The yearly probability for local failures was approximately 1% up to the 10th year and for distant metastases was 5% in the 2nd year and decreased progressively until the 8th year. Young age was an important risk factor, with peritumoral lymphatic invasion also predictive for local and distant recurrences. Tumor size and axillary lymph node involvement were not related to local recurrence but were important predictors of distant metastases. Extensive intraductal component was only a risk factor for local recurrence. Early (< 2 years) local failure predicted for distant metastases compared with later failure. In local failure patients, the 5-year survival rate was 69% from failure. CONCLUSIONS Local recurrences and distant metastases are partially independent events that occur at different times; several predicting factors also differ. However, women with local recurrences have increased risk of distant metastases. In particular, women 35 years old or younger at first diagnosis who had initial peritumoral lymphatic invasion and local recurrence within 2 years are at high risk for distant spread. For recurrence in cases with an extensive intraductal component or where initial local surgery was possibly inadequate, women are at lower risk.
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164
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De Palo G, Veronesi U, Marubini E, Camerini T, Chiesa F, Nava M, Formelli F, Del Vecchio M, Costa A, Boracchi P. Controlled clinical trials with fenretinide in breast cancer, basal cell carcinoma and oral leukoplakia. JOURNAL OF CELLULAR BIOCHEMISTRY. SUPPLEMENT 1995; 22:11-7. [PMID: 8538187 DOI: 10.1002/jcb.240590803] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We are conducting three randomized studies (breast cancer, basal cell carcinoma, oral leukoplakia) and report our methodological approach and accrual here. The aim of the breast cancer study is prevention of a contralateral primary lesion in women already treated for breast cancer; the aim of the basal cell carcinoma study is prevention of recurrences or new occurrence after surgical resection; and the aim of the oral leukoplakia study is prevention of recurrences and new occurrence after CO2 laser resection. The studies were planned according to a randomized design with an intervention arm vs a no-treatment arm. Patients in the intervention group receive 4-HPR at a dose of 200 mg po. The duration of treatment is five years in the breast cancer study, and one year in the basal cell carcinoma and oral leukoplakia studies. The breast cancer study started in March 1987, closing accrual on July 31, 1993. A total of 2,972 patients entered the study; 2,849 were evaluable (1,422 in the 4-HPR group and 1,427 in the control group). Of 2,849 evaluable patients, 867 completed the first five years, 1,142 are still ongoing, and 840 patients have interrupted the study for various reasons. Follow-up is ongoing. The basal cell carcinoma study started in January 1990. As of January 1994, a total of 786 patients had entered the study; 760 were evaluable (363 in the 4-HPR group and 367 in the control group). Of 760 patients in the study, 568 completed the first year, 62 are ongoing and 130 discontinued for various reasons. The study is ongoing.(ABSTRACT TRUNCATED AT 250 WORDS)
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165
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Zurrida S, Greco M, Veronesi U. Surgical pitfalls after preoperative chemotherapy in large size breast cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1994; 20:641-3. [PMID: 7995414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Preoperative chemotherapy in 226 women with large breast cancers reduced tumour size sufficiently for breast conservation surgery, according to our criteria, in 203 patients (90%). After 50 months' mean follow-up there were 13/203 local relapses (5.3%). This approach is therefore effective but only if the breast can be conserved with good aesthetic result, otherwise mastectomy plus reconstruction is preferable. The type of surgery must be decided during operation after careful assessment of tumour regression, resection margins, tumour size in relation to breast size and extent of microcalcifications.
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166
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Ménard S, Bufalino R, Rilke F, Cascinelli N, Veronesi U, Colnaghi MI. Prognosis based on primary breast carcinoma instead of pathological nodal status. Br J Cancer 1994; 70:709-12. [PMID: 7917924 PMCID: PMC2033423 DOI: 10.1038/bjc.1994.379] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In breast cancer patients, prognostic information required to plan post-surgical therapy is obtained mainly through axillary dissection. This study was designed to establish a new prognostic score based solely on parameters of the primary tumour as an alternative to axillary surgery in assessing prognosis. Eight different prognostic factors, including menopausal status, tumour size, grading, lymphatic invasion, desmoplasia, necrosis, c-erbB-2 and laminin receptor expression, were evaluated retrospectively on a large series of primary breast carcinoma patients. From multivariate analysis, four independent parameters were selected and examined, alone and in combination, for their prognostic potential. These parameters were used to generate a prognostic score that was analysed retrospectively in 467 N0-N1a patients to determine its predictive value for survival. The score, which includes variables such as tumour size, grading, laminin receptor and c-erbB-2 overexpression, was established based on the number of negative prognostic factors: score 1 refers to cases in which all four parameters reflect a good prognosis, scores 2 and 3 refer to tumours in which, respectively, one or two of the four parameters reflect a poor prognosis, whereas score 4 refers to tumours with three or four poor prognosis factors. Analysis of the overall survival of the four score groups shows that patients with score 1 tumours (22% of the total) had the best prognosis with a 15 year survival of 82%, patients with score 2 and 3 had an intermediate prognosis, whereas score 4 patients had the poorest prognosis with a 15 year survival of only 38%. Moreover, survival in the N+ score 1 cases was found to be longer than that in the total N- patients. Our data suggest that the primary tumour score provides more reliable prognostic information than pathological nodal status, and that axillary dissection can be avoided in a large number of patients.
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168
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Mariotti A, Marcora E, Bunone G, Costa A, Veronesi U, Pierotti MA, Della Valle G. N-(4-hydroxyphenyl)retinamide: a potent inducer of apoptosis in human neuroblastoma cells. J Natl Cancer Inst 1994; 86:1245-7. [PMID: 8040893 DOI: 10.1093/jnci/86.16.1245] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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169
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Veronesi U, Luini A, Mariani L, Del Vecchio M, Alvez D, Andreoli C, Giacobone A, Merson M, Pacetti G, Raselli R. Effect of menstrual phase on surgical treatment of breast cancer. Lancet 1994; 343:1545-7. [PMID: 7911875 DOI: 10.1016/s0140-6736(94)92942-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
1175 premenopausal women whose date of last menstrual period was known were followed up for up to 20 years (average 8 years) after surgery for breast cancer. 525 patients were in the follicular phase and 650 in the luteal phase. We observed 192 unfavourable events among patients operated on during the follicular phase (36.6%) and 192 among patients operated on during the luteal phase (29.6%). The effect of phase was restricted to patients with positive axillary nodes. The 5-year relapse-free survival was 75.5% in 246 node-positive patients operated on during the luteal phase and 63.3% in 190 node-positive patients who had surgery during the follicular phase. The hazard ratio at Cox multivariate analysis was 1.329 for all patients (p = 0.006) and 1.431 for node-positive patients (p = 0.03). In our study, premenopausal patients with breast cancer and positive axillary nodes operated on during the luteal phase had a significantly better prognosis than patients operated on during the follicular phase. It may be that the processes of cell metastases, such as loss of adhesiveness, may be enhanced by high concentrations of unopposed oestrogens or by reduced activity of natural killer cells during the first half of the menstrual cycle.
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170
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Ménard S, Squicciarini P, Luini A, Sacchini V, Rovini D, Tagliabue E, Veronesi P, Salvadori B, Veronesi U, Colnaghi MI. Immunodetection of bone marrow micrometastases in breast carcinoma patients and its correlation with primary tumour prognostic features. Br J Cancer 1994; 69:1126-9. [PMID: 7911032 PMCID: PMC1969436 DOI: 10.1038/bjc.1994.221] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Methods such as immunohistochemistry that have enhanced the detection of carcinoma cells in bone marrow aspirates appear to be useful in identifying patients with aggressive tumours. To detect epithelial cells in bone marrow aspirates from breast carcinoma patients, we used a pool of five different monoclonal antibodies (MAbs), which recognise 100% of breast carcinomas, together with the alkaline phosphatase method on cytospun cells obtained from sternum and iliac crest. Primary tumours were also analysed for the expression of the c-erbB-1 and c-erbB-2 oncogene products, and of two differentiation-related markers and laminin receptors. Immunoreactive cells were detected in the bone marrow of 62 of the 197 patients tested (31%) without any correlation with clinical parameters such as tumour size or lymph node metastasis, whereas a significant (P < 0.01) correlation was found with enhanced monomeric laminin receptor expression in the primary tumour. In fact, this receptor was expressed in respectively 63% and 38% of primary tumours from patients with and without immunoreactive cells in the bone marrow aspirates. Thus, the presence of immunoreactive cells in bone marrow correlates with the expression in the primary tumour of a marker of the metastatic potential of the tumour, the 67 kDa laminin receptor.
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Silvestrini R, Veneroni S, Daidone MG, Benini E, Boracchi P, Mezzetti M, Di Fronzo G, Rilke F, Veronesi U. The Bcl-2 protein: a prognostic indicator strongly related to p53 protein in lymph node-negative breast cancer patients. J Natl Cancer Inst 1994; 86:499-504. [PMID: 8133533 DOI: 10.1093/jnci/86.7.499] [Citation(s) in RCA: 319] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The bcl-2 gene (also known as BCL2) encodes for a mitochondrial protein thought to prevent apoptosis of normal cells. The protein has been detected by immunohistochemical procedures in hormonally regulated epithelia. PURPOSE We analyzed the predictive relevance of Bcl-2 expression on 6-year relapse-free and overall survival in lymph node-negative breast cancers in relation to pathologic (tumor size) and biologic ([3H]thymidine-labeling index, p53 protein expression, and estrogen receptor [ER] status) features. METHODS The expression of Bcl-2 and p53 was detected by immunohistochemistry on paraffin-embedded sections from 283 node-negative resectable breast cancers treated with local-regional therapy alone until relapse. The [3H]thymidine-labeling index was evaluated on histologic sections after incubation of fresh tumor tissue with [3H]thymidine, and ER content was determined by the dextran-coated charcoal absorption technique. RESULTS A significantly higher fraction of Bcl-2-positive cells was observed in small, ER-positive, slowly proliferating, and p53-negative tumors than in large, ER-negative, rapidly proliferating, and p53-positive tumors. A stronger association was observed between Bcl-2 and p53 expression than between these variables and [3H]thymidine-labeling index. In univariate analysis, Bcl-2 and p53 expression, [3H]thymidine-labeling index, tumor size, and ER status were indicators for relapse-free and, with the exception of tumor size, overall survival within 6 years of surgery. In multivariate analysis, Bcl-2 failed to maintain its prognostic role for relapse-free and overall survival in the presence of p53 expression, whereas the [3H]thymidine-labeling index was still statistically significant as a predictor for both events. CONCLUSION The predictive role of Bcl-2 expression on 6-year relapse-free and overall survival was mainly dependent on p53 expression.
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Costa A, Formelli F, Chiesa F, Decensi A, De Palo G, Veronesi U. Prospects of chemoprevention of human cancers with the synthetic retinoid fenretinide. Cancer Res 1994; 54:2032s-2037s. [PMID: 8137334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fenretinide or N-(4-hydroxyphenyl)retinamide is a vitamin A analogue synthesized in the United States in the late 1960s. This retinoid shows a preferential accumulation in breast instead of liver, is effective in the inhibition of chemically induced mammary carcinoma in rats, and has proved to be less toxic than many other vitamin A analogues. The Milan Cancer Institute has put a particular effort in this molecule in both the experimental and clinical fields. We have demonstrated, in animals and humans, that fenretinide induces a rapid reduction of retinol plasma concentration, that its blood levels remain constant during administration for as long as 5 years, and that the drug is able to accumulate in the human breast. To date, 2969 stage I breast cancer patients have been randomized to evaluate the efficacy of this retinoid to prevent contralateral new primaries, 709 subjects have been accrued in a prevention trial of basal cell carcinoma of the head and neck, and 153 patients entered a study the preliminary results of which already show the capability of fenretinide to prevent recurrences and new localizations of oral leukoplakia. Further studies on fenretinide will be aimed at evaluating its preventive efficacy in superficial bladder and prostate cancers and at exploring possible synergism with tamoxifen and interferons in breast cancer and skin cancer, respectively.
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Zucali R, Merson M, Placucci M, Di Palma S, Veronesi U. Soft tissue sarcoma of the breast after conservative surgery and irradiation for early mammary cancer. Radiother Oncol 1994; 30:271-3. [PMID: 8209012 DOI: 10.1016/0167-8140(94)90469-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
At Istituto Tumori of Milano in a series of 3295 patients treated with conservative surgery and radiotherapy for breast cancer from 1973 to 1989 three cases of soft tissue sarcoma were observed in irradiated breasts. One patient developed a fibrosarcoma of the breast stroma, 16 months after irradiation. A grade II bulky angiosarcoma was diagnosed in the breast of a patient treated 59 months previously. The third was a grade II angiosarcoma detected 41 months after therapy. At present, the risk of a second primary in the irradiated breast seems too low to justify modification of our present policy of conservative therapy of breast cancer, but a careful and longer follow-up is needed.
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MESH Headings
- Aged
- Breast Neoplasms/etiology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Cobalt Radioisotopes/therapeutic use
- Cohort Studies
- Female
- Follow-Up Studies
- Hemangiosarcoma/etiology
- Hemangiosarcoma/pathology
- Humans
- Lymph Node Excision
- Mastectomy, Segmental
- Middle Aged
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Radiation-Induced/pathology
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/pathology
- Osteosarcoma/etiology
- Osteosarcoma/pathology
- Particle Accelerators
- Radiotherapy Dosage
- Radiotherapy, High-Energy/adverse effects
- Randomized Controlled Trials as Topic
- Sarcoma/etiology
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174
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Balsari AL, Morelli D, Ménard S, Veronesi U, Colnaghi MI. Protection against doxorubicin-induced alopecia in rats by liposome-entrapped monoclonal antibodies. FASEB J 1994; 8:226-30. [PMID: 8119493 DOI: 10.1096/fasebj.8.2.8119493] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Alopecia is a common side effect of several anti-cancer drugs, including doxorubicin. Based on our recent observation that a monoclonal antibody (MAD11) directed against this anthracycline inhibits the systemic toxic effect of the drug in mice, we investigated the possibility that MAD11 administered topically might protect against doxorubicin-induced alopecia. In 31 of 45 young rats treated intraperitoneally with doxorubicin, alopecia was completely prevented by topical treatment of the skin with liposome-incorporated anti-doxorubicin monoclonal antibody. This type of treatment might find relevance in preventing anthracycline-induced alopecia in cancer patients. Our findings also provide the first demonstration that liposome-entrapped monoclonal antibodies are capable of penetrating the stratum corneum of the skin without losing their function.
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175
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Zurrida S, Galimberti V, Bartoli C, Raselli R, Veronesi U. Variables in the axilla: New prognostic factors in N+ breast cancer analysis of 1003 cases. Eur J Cancer 1994. [DOI: 10.1016/0959-8049(94)90788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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