Chemotherapy for breast cancer (Review).

The use of cytotoxic chemotherapy in both advanced and early stage breast cancer has made significant progress in the last 10 years with several landmark studies identifying clear survival benefits for newer therapies. In spite of these developments the optimal approach for any specific patient can not be determined from a literature review or decision-making algorithm alone. Treatment choices are predominantly based on practice determined by individual or collective experience and the historical development of treatment within a locality. The improvement in the understanding of the molecular biological basis of breast cancer provides possible targets for novel therapies. Personalised therapies for breast cancer based on the molecular characteristics of the tumour could improve the risk: benefit ratio of current therapies. Increased improvements in the use of a panel of biomarkers will thus not only move us towards tailored therapies but will also spare a group of patients that do not benefit from adjuvant chemotherapy. At the same time a better understanding of tumour biology will also streamline the development of new regimens for those who are unlikely to benefit from existing drugs. This review will focus on the evidence for the use of chemotherapy and highlight advances in chemotherapy treatments with the addition of new and novel drugs marching into our clinics as standard treatments based on evidence from clinical trials and from a better understanding of tumour biology that has transformed the outlook in breast cancer in both the adjuvant and metastatic setting.

Temporary ectopic implantation of digits prior to reconstruction of a hand without metacarpals.

Temporary ectopic implantation has been described for a variety of injuries, with several different implantation sites used. Although varied results have been achieved, many feel this technique has a role to play under special circumstances. We describe the ectopic implantation of digits to the contralateral forearm, with subsequent reconstruction of the injured hand when combined with microvascular toe transfer. The outcome was a functionally useful hand which could be incorporated into daily life, and a cosmetic appearance preferable to that of amputation. We feel ectopic implantation still has a valuable role to play in carefully selected cases.