Manifestation Of Metastatic Disease Research Articles

Patterns of breast relapse after local excision ± radiotherapy for early stage breast cancer

One hundred patients with breast recurrence have been identified from patients at the Royal Marsden Hospital, treated by local excision ± radiotherapy for early stage primary invasive breast cancer between 1961 and 1985. The mean follow-up was 58 months (range 1 month–19 years). In 74 100 patients, breast recurrence occurred within the breast parenchyma, was not associated with systemic relapse and carried a relatively good prognosis with a median survival of 77 months from the time of breast relapse. In 67 patients with parenchymal relapse in whom the site of relapse could be reliably compared with that of the original tumour, 60 (90%) patients developed recurrent tumours at or close to the primary site. In 24 100 patients, breast recurrence occurred in the overlying skin and in only two of these patients (2% of total) did recurrence actually occur within the scar tissue. Skin relapse was associated with systemic relapse and carried a relatively poor prognosis with a median survival of 36 months from the time of recurrence. The pattern of breast relapse was similar in irradiated and unirradiated patients. Skin relapse appears to be a manifestation of metastatic disease while parenchymal relapse may represent regrowth of primary tumour. This pattern of breast relapse questions the requirement for radiotherapy to the whole breast after local excision for early stage breast cancer.

Influence of misonidazole, SR-2508, RSU-1069 and WR-2721 on spontaneous metastases in C57BL mice

The effect of treatments with the hypoxic cell radiosensitizers misonidazole (MISO), SR-2508, RSU-1069, and with the radioprotector WR-2721 on spontaneously disseminated Lewis lung carcinoma (LLC) and B16 melanoma (B16M) was investigated. Tumors were implanted into the tails of C57BL mice and were surgically removed after reaching volumes of approximately 40 mm 3. This technique results in the induction of metastatic disease in lungs and at other anatomical sites and allows the independent treatment of disseminated tumor cells. The radiosensitizers and the radioprotector were administered 24 hr after surgery and animals were killed 14 and 30 days after removal of LLC and B16M, respectively. The time to death from spontaneous metastases was also measured. Both single treatments with large doses of MISO (1.0 g/kg) and fractionated therapy with smaller doses (0.5 g/kg on 5 consecutive days) promoted the formation of metastases to the lungs, lymph nodes and other organs. The survival times of MISO treated animals did not differ from control animals but manifestation of metastatic disease in the lungs and other organs occurred at earlier times. Administration of equitoxic doses of SR-2508 (3.0 g/kg) and RSU-1069 (0.1 g/kg) also promoted metastases formation. Mice treated with these radiosensitizers developed more metastases in the lungs and at other sites. Treatment with a single dose of WR-2721 (0.4 g/kg) promoted lung metastases but exerted a suppressive effect on lymph node tumors. When the radioprotector was given in fractionated schedules in three different doses (0.05 g/kg, 0.1 g/kg and 0.2 g/kg for 10 consecutive days) a slight enhancement of lung metastases and suppression of extrapulmonary metastases was observed.

The role of skeletal scintigraphy in detection of metastatic breast cancer.

AbstractThe most common site of metastases from breast cancer is the skeleton. Conventional methods of detecting skeletal metastases are not very sensitive. Substantial evidence indicates that skeletal scintigraphy is the most accurate method of demonstrating metastases to bone, particularly in patients with “early” breast cancer who have no manifestations of metastatic disease. In a study of 50 patients with advanced mammary carcinoma, skeletal metastases were demonstrated by scintigram (and later confirmed) in 84%, but by conventional x‐rays in only 50%. More important, in 50 patients with “early” breast cancer who had negative skeletal x‐rays, lesions were found by scintigraphy in 24%. All of these patients developed disseminated carcinoma and 83% of them died within 5 years. In contrast, only 34% of patients with a negative scintigram developed disseminated carcinoma within 5 years.

Expectoration of Bronchogenic Tumor Tissue

BRONCHOGENIC carcinoma can present itself in a variety of ways. Some patients with this disease may have an abnormal chest roentgenogram but no symptoms. Others may have manifestations of metastatic disease. Although cough and hemoptysis are common, expectoration of tumor tissue as a part of the presenting complaint is extremely rare. Report of a Case A 78-year-old man came to the emergency room complaining of hemoptysis for the past 12 hours. Bleeding was initially brisk but had steadily decreased in amount. He had noted an irritative cough for about three months that did not respond to antibiotics, expectorants, or bronchodilators. The patient denied any acute dyspnea, sputum production, orthopnea, paroxysmal nocturnal dyspnea, angina, ankle edema, pleuritic pain, bone pain, or weight loss. He had a myocardial infarction at 51 years of age. He was being treated for chronic atrial fibrillation, with digoxin, 0.25 mg daily. He worked 42 years in