Clinical and pathological response to primary chemotherapy in operable breast cancer.

Neoadjuvant chemotherapy is used to improve patients' survival in locally-advanced and inflammatory breast cancer and to increase conservative surgical procedures in bulky tumours. Pathological complete responses are unusual. The aim of this pilot study was to assess the clinical and pathological response rates and to evaluate toxicity with a new protocol of primary chemotherapy in 50 high-risk breast cancer patients. All tumours were > 3 cm and had at least one other adverse prognostic factor: lymph node involvement (32 N1, 6 N2), SBR grade III (20), aneuploidy (29), negative hormonal receptors (19). Patients were treated by 3-week cycles of THP-doxorubicin 20 mg/m2 D1 to 3, vinorelbine 25 mg/m2 D1 and 4, cyclophosphamide 300 mg/m2 and 5-fluorouracil 400 mg/m2 D1 to 4 (TNCF). 38 patients received G-CSF or GM-CSF support. After 4-6 cycles, all underwent surgery (39 conservative, 11 modified radical). Tumour response was assessed clinically, by mammography and echography and on pathological specimens. An objective clinical response was observed for 43 patients: 26 complete (51%) and 18 partial (37%). After pathological review, 11 patients (22%) were devoid of any tumour cells, 4 others (8%) had only in situ carcinoma. From 253 evaluated cycles, grade III-IV toxicity occurred, 81% with neutropenia, 25% with anaemia, and 20% with thrombocytopenia. All patients recovered. This regimen induced a severe but not life-threatening haematological toxicity and resulted in a high pathological response rate (30%).

[First-line chemotherapy in operable breast neoplasms: results of 3 protocols]. / Chimiothérapie première dans les cancers du sein opérables supérieurs à 3 cm: résultats de 3 protocoles.

In order to avoid modified radical mastectomy, a neoadjuvant approach was adopted in our institute for operable bulky breast cancers. From January, 1982, to December, 1995, 288 patients received primary chemotherapy with 3 different regimens (all doses mg/m2): (1) AVCF/AVCFM, 167 patients (adriamycin 30, vincristine 1 d1, cyclophosphamide 300, fluorouracil 400 d2-d5 and methotrexate 20 d2 and d4, every 28 days); (2) NEM, 78 patients (vinorelbine 25, epirubicin 35, methotrexate 20 d1 and d8, every 28 days); and (3) TNCF, 43 patients (THP-adria 20, d1-d3, vinorelbine 25 d1 and d4, cyclophosphamide 300, fluorouracil 400 d1-d4, every 21 days). Evaluation of the response comprised 3 methods: clinical (C), echographic (E), mammographic (M). The overall objective response rate (C: 63/90/93; E: 49/61/85; M: 53/65/83%) is higher with regimens (2) and (3). The complete response rate was increased 2-fold with TNCF but the hematologic toxicity was very superior with this combination. Patients were all operated for (2) and (3), only several for (1), and the breast conservation rate (68/83/79%) was quite similar in the 3 regimens. The pathological complete response rate reached 23% with TNCF. However the impact on patient survival has to be confirmed.

Paracervical block anesthesia in labour.

The efficacy and safety of paracervical block anesthesia were studied in 153 patients in the first stage of labour. Transient decrease in uterine activity was noted in 77 patients. There was no acceleration in cervical dilatation following the block. The duration of action of the block in 80 primiparas was 31 to 120 minutes in 69, and over 120 minutes in five. In the 73 multiparas, 53 of the blocks lasted 31 to 90 minutes, eight from 90 to 120 minutes, and two over 120 minutes. The results were good in 66 primiparas and 54 multiparas. The blocks failed in four primiparas and six multiparas. Twenty-six infants had low Apgar scores, but in none could this be related to the paracervical block. There were no significant fetal or maternal complications.

The use of paracervical block anesthesia for dilatation and curettage.

Paracervical block anesthesia was used for dilatation and curettage in 37 patients in situations where general anesthesia or sophisticated forms of conduction anesthesia were either unavailable or contraindicated. Ten millilitres of either 1% xylocaine or procaine or 5 ml. of 2% xylocaine was placed into each lateral fornix with a standard 6-inch, 20-gauge needle at a depth of six to 12 millimetres. The block's effect was good in 34 cases and fair in three; there were no failures. No significant complications occurred. The necessity of guarding against and/or being prepared to treat local anesthetic sensitivity is recognized. Paracervical block proved to be a convenient, safe, simple and effective anesthetic technique for dilatation and curettage, including when other anesthetic techniques were contraindicated.