Results of salvage mastectomy for local recurrence after breast-conserving surgery without radiation therapy.

BACKGROUND: Between 1975 and 1987, 128 patients with infiltrating breast cancer, categorized as clinical Stage I and II disease, were treated by breast conservation surgery without radiation therapy. MATERIALS: After a median disease-free interval of 20 months (range, 8-64 months), 25 of 128 patients had local recurrence, for which salvage mastectomy was performed. The results of modified radial mastectomy as a salvage procedure were analyzed in these 25 patients. RESULTS: After a median disease-free interval of 52 months (range, 8-75 years) after the salvage procedure, 12 patients had chest wall and distant recurrences, whereas 13 patients remained free of disease. The 5-year actuarial disease-free and overall survival rates after the salvage mastectomy were 51% and 65%, respectively. CONCLUSIONS: Univariate analyses of factors affecting disease-free survival and overall survival showed that the size of the local recurrence (< or = 2 cm) (P = 0.009) and the number of pathologically positive axillary nodes at the time of the salvage procedure (fewer than four nodes) (P = 0.002) were associated with a better prognosis.

Altered immunoglobulin A (IgA-1) levels in patients with advanced colorectal adenocarcinoma presenting with normal preoperative levels of carcinoembryonic antigen (CEA).

We investigated the value of serum IgA-1 as a complementary tumour marker to carcinoembryonic antigen (CEA) in the monitoring of the postoperative follow-up of 19 patients with advanced colorectal carcinoma presenting with normal levels of CEA. Mean follow-up period was 14 months (range 2-72 months). Mean number of serum specimens was 5 (range 2-9). IgA-1 assay employed rabbit antihuman IgA for binding IgA-1 from patient's serum and peanut agglutinin to detect the IgA-1 O-glycosidic structure. Ten patients developed distant metastases while nine patients had locoregional recurrence. All 19 patients had generally persistent elevation of serum IgA-1 throughout the follow-up period while serum CEA levels were subsequently elevated in only 10 patients. IgA-1 predicted recurrence with an average lead time of 8 months (range 1-19 months). On the other hand, mean lag time for CEA was 12 months (range 6-50 months). The data indicate the clinical utility of serum IgA-1 as a potential complementary tumour marker to CEA in the monitoring of the postoperative course of this particular subset of colorectal cancer patients.

Prevalence of colorectal polyps in Filipinos. An autopsy study.

From May 1988 to May 1990, a prospective autopsy study was performed in patients who died at the Philippine General Hospital in Manila, Philippines. Patients younger than 10 years of age, patients with a history of large bowel resection, and patients whose deaths were related to trauma were excluded. There were 416 patients; 246 were males, and 170 were females. The mean age was 47 years (range, 11-95 years). Six of the 416 patients (1.4 percent) were found to have polyps. One patient had an inflammatory polyp, one was diagnosed with familial adenomatous polyposis, and one had an associated cecal carcinoma. Five "sporadic" adenomatous polyps were found in the remaining three patients (prevalence rate, 0.7 percent). All of the adenomatous polyps were located distal to the hepatic flexure and exhibited only mild atypia. The mean size was 6.4 mm (range, 2-20 mm). The incidence of colorectal adenomas in Filipinos is low compared with that in age-adjusted Western populations. This finding coincides with a low incidence of colorectal carcinoma. The documentation of a low risk for adenomatous polyps and colorectal cancer indicates that it would be difficult for massive screening programs to demonstrate a significant positive impact on the early detection of colorectal neoplasias in the Filipino general population.