Conservative treatment of early-stage breast cancer. The Emory experience

Between January 1983 and December 1991, 80 women with AJCC clinical stage I or II breast cancer were treated with conservative surgery and radiation therapy. Reexcision of the primary was performed in 40 breasts, and residual tumor was identified in 40% of these. Margins of resection were assessed in 80% and, of these, 46 patients had final margins of resection that were negative, 86% had axillary node dissection, 45 patients had histologically negative axillary nodes, and 24 had histologically positive axillary nodes. Of patients with histologically positive lymph nodes, 92% received systemic adjuvant treatment consisting of chemotherapy in 19/24 and tamoxifen in 14/24. Median follow-up was 34 months (range: 6-90 months). The adjusted 5-year actuarial Overall Survival for the group was 92%, and Disease-Free Survival was 80%. The 5-year Local Recurrence-Free Survival was 96%. The present study confirms the excellent results that can be obtained with conservative surgery plus radiation therapy.

Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women's Intervention Nutrition Study

PURPOSE

To evaluate the feasibility of integrating a program based on dietary fat intake reduction into adjuvant treatment strategies for postmenopausal women receiving therapy for early breast cancer.

PATIENTS AND METHODS

Two hundred ninety postmenopausal women with localized (stage I to IIIa) breast cancer receiving conventional systemic therapy provided informed consent and were randomized in a multicenter trial to either a dietary intervention group receiving a program of individualized instruction for reducing total fat intake or a dietary control group with minimal dietary counseling.

RESULTS

Significantly reduced (P < .001) fat intake (in terms of percent calories derived from fat) was observed in the intervention group versus the control group at 3 months (20.3% +/- 2.4% v 31.5% +/- 2.6%, mean +/- SD, respectively) and maintained throughout 24 months of observation. The 50% reduction in daily fat-gram intake (from 66 +/- 23 to 33 +/- 14 g, P < .001) seen at 6 months was associated with reduced saturated fat, monounsaturated fat, polyunsaturated fat, and linoleic acid (P < .001). Significantly lower body weight was also seen in intervention compared with control patients at all observation periods, resulting in a 3.3-kg weight difference 18 months after randomization (P < .001).

CONCLUSION

Substantial and sustained dietary fat reduction with associated weight change can be achieved at relatively low cost within the context of conventional multimodality clinical management of postmenopausal women with localized breast cancer. This result supports the feasibility of conducting a full-scale evaluation of the influence of dietary fat intake reduction on the clinical outcome of breast cancer patients.

Randomized study of interleukin 2 (IL-2) alone vs IL-2 plus lymphokine-activated killer cells for treatment of melanoma and renal cell cancer

The purpose of this study was to evaluate the efficacy and safety of a continuous-infusion interleukin 2 (IL-2) regimen for patients with metastatic melanoma and renal cell cancer. To investigate the contribution of adoptively transferred lymphokine-activated killer cells, patients were randomized to receive either IL-2 alone or IL-2 plus lymphokine-activated killer cells. Twenty-three patients with renal cell carcinoma and 20 with melanoma were entered into the protocol. There were no objective responses noted in the 38 assessable patients (20 with renal cell carcinoma, 18 with melanoma). Most patients demonstrated progressive disease following one 31-day cycle of weekly continuous-infusion IL-2. Grade I and II toxic reactions, including fever, rash, anorexia, and weight gain, were common and treated symptomatically. Significant in vivo stimulation of lymphokine-activated killer and natural killer cell activity was noted in most patients. This continuous-infusion IL-2 regimen with or without lymphokine-activated killer cells was ineffective in the treatment of melanoma and renal cell carcinoma.

Bleomycin, vincristine, lomustine, and DTIC chemotherapy for metastatic melanoma

Forty-six consecutive, evaluable patients with a diagnosis of metastatic melanoma without prior chemotherapy were treated with bleomycin, vincristine, lomustine, and DTIC (BOLD). Treatment was repeated every 28 days for two cycles. Complete restaging then was performed, and response to treatment was determined. Of the 46 patients, five (11%) achieved a complete response, five (11%) achieved a partial response, nine (19%) obtained disease stabilization, and 27 (59%) had progressive disease. If four patients who died of rapidly progressive disease are included, the response rate drops to 20%. Overall median survival was 6 months. These results are inferior to the 40% and 46% response rates reported by other investigators. The modest response rate toxicity and expense of the regimen do not support its use in metastatic melanoma except, perhaps, in selected patients with soft tissue and/or lung metastasis.

Treatment of metastatic malignant melanoma with vinblastine, bleomycin by infusion and cisplatin

Twenty-five patients with metastatic melanoma were treated with Velban, bleomycin by infusion, and cisplatin. Of 20 evaluable patients, there were no objective responses. Side effects and toxicity were severe.

Immunologic abnormalities in two patients with pulmonary hyalinizing granuloma

Pulmonary hyalinizing granuloma (PHG) is a disease of slowly enlarging pulmonary nodules made up of dense bundles of collagen accompanied by an infiltrate of chronic inflammatory cells. The etiology is unknown. Although it has been suggested that the lesions represent an exaggerated immune response to unidentified agents, results of a detailed immunologic work-up of these patients have not been published. This report presents the laboratory findings of two patients with biopsy-proven PHG who have been followed four and eighteen years. Autoantibodies were detected (antinuclear antibody, rheumatoid factor, and positive antiglobulin tests), although clinically there was no evidence of a specific collagen-vascular disorder. Both patients had elevated levels of circulating immune complexes. These data suggest that immune complex mechanisms may be important in the pathogenesis of PHG.

Treatment of small cell lung cancer

The prognosis for patients with small cell lung cancer has improved over the past ten years from a median survival of 2.5 months to 8 to 10 months for patients with extensive metastatic disease and 12 to 16 months for patients with limited disease. This progress has been primarily through advances in chemotherapy. A small percentage of patients are having prolonged disease-free survival. Methods of staging are reviewed. The best current chemotherapeutic programs are discussed, as well as the present role of radiation therapy in the management of small cell lung cancer.

Dermatologic changes after systemic cancer therapy

Dermatologic changes associated with systemic cancer therapy are common. These changes can be conveniently grouped into three clinical categories: 1) cytotoxic effects; 2) pigment alterations; and 3) rashes and eruptions. The clinician should be alert to these manifestations so that needless work-up is avoided..

Cystine requirement of continuous human lymphoid cell lines of normal and leukemic origin

A number of continuous, human lymphoid cell lines from healthy and leukemic donors have been studied. Those from healthy individuals were found to be cystine prototrophs (cys+), while those from leukemic donors were observed to be cystine auxotrophs (cys-). The former can grow in either cystine or cystathionine-containing media. The latter grow only in cystine-containing medium. The former contain readily measurable levels of cystathionase, the last enzyme in the mammalian cysteine biosynthetic pathway, while the latter contain much less of this activity. The apparent molecular weight, overall charge, pH versus activity, Km, and [pyridoxal phosphate] versus activity properties of the enzyme from both cell types were indistinguishable. No soluble cystathionase inhibitor could be detected in cys- cell lines. Thus, it is reasonable to hypothesize that those leukemic cell lines studied synthesize less active cystathionase protein than their cys+ counterparts and that this difference in enzyme production underlies the differential growth properties in cystathionine-containing medium.