Adjuvant treatment of high-risk stage II breast cancer with doxorubicin followed by high-dose chemotherapy and autologous stem-cell transplantation: a single-institution experience with 132 consecutive patients.

Several studies have shown conflicting results with the use of intensive consolidation chemotherapy for breast cancer. The aim of the present study was to investigate the efficacy, feasibility and toxicity of high-dose chemotherapy with stem cell support in patients with high-risk stage II breast cancer. From February 1994 to November 1998, 132 consecutive patients with multinode positive breast cancer were entered to the study. In total, 86 patients had >or=10 positive axillary lymph nodes, and 46 had 4-9 positive axillary lymph nodes with at least two additional predetermined risk factors at diagnosis. All patients were offered adjuvant chemotherapy (doxorubicin, 75 mg/m(2) x 4) followed by high-dose chemotherapy (cyclophosphamide 6000 mg/m(2), carboplatin 800 mg/m(2) and thio-tepa 500 mg/m(2)) and autologous stem cell support with growth factor. In all, 131 patients also received local radiation therapy and tamoxifen based on receptor status. After a median follow-up of 51 months (range 27-87), the disease-free and overall survival rates were 72 and 81%, respectively. There was no difference in the outcome for high-risk patients with > or < than 10 positive axillary lymph nodes. On Cox regression analysis only progesterone receptor status was predictive of disease-free, but not overall survival. There were no treatment-related deaths; grades III-IV toxicity was relatively low. This combined approach of doxorubicin followed by high-dose chemotherapy and stem-cell support, followed by locoregional radiotherapy, was safe and seems to be effective in patients with multinode positive stage II breast cancer. In previous trials of adjuvant high-dose therapy in this patient population, treatment-related morbidity and mortality markedly influenced the outcome. For this high-risk patient population, further testing of intensive chemotherapy regimens with a lower toxicity profile is warranted.

Thyroid cancer in children and adolescents in Denmark.

From 1960 to 1985, 20 patients (12 females and eight males) with thyroid cancer, developed before the age of 20, have been registered and observed at the Radium Center, The Finsen Institute. Papillary adenocarcinoma was diagnosed in 11 cases, and mixed papillary/follicular adenocarcinoma in six cases. Three patients had medullary carcinoma. No patients had previously received cervical irradiation. On admission, lung metastases were evident in two cases. All patients underwent surgical treatment, which in 15 cases consisted of total thyroidectomy, and in nine also lymph node dissection. External irradiation was given to 10 patients, and radioiodine treatment was performed in five patients. Local and/or distant relapse of the thyroid carcinoma occurred in five cases: three were patients with medullary carcinoma, and two had papillary and mixed adenocarcinoma. The three patients with medullary carcinoma died of their disease, but the other two with recurrence recovered after surgery, external irradiation and/or radioiodine treatment. Currently, 16 patients are alive without evidence of disease. The period of follow-up ranged from 2 to 23 years.

Hypereosinophilia in a patient with acute lymphoblastic leukemia.

A case of a coincident acute lymphoblastic leukemia and marked eosinophilia is presented. The clinical and pathological features of this case are discussed with special emphasis on the hypereosinophilic syndrome versus secondary hypereosinophilia that can be found to accompany ALL. Special immunological studies may be helpful in the diagnostic procedures.

Familial clustering of salivary gland carcinoma in Greenland.

Salivary gland carcinoma (SGC) occurs at an increased frequency in the Eskimo population. In Greenland the incidence of SGC is 4.5-fold higher for men and 9-fold higher for women as compared with European incidence. The increased incidence is caused by low-differentiated carcinoma. Unusual familial clustering of SGC is reported among two families (five siblings). Peculiar aspects of racial and geographical distribution and possible role of genetic and environmental factors in the etiology of this relatively uncommon tumor are briefly discussed with special emphasis on the recently detected association between the Eskimos' SGC and the Epstein-Barr virus.

School health screening of a birth cohort: a prospective longitudinal study.

School age illnesses, coded according to the International Classification of Diseases (ICD) from information in 4 327 school health records, are reported for a perinatal cohort (The Copenhagen Perinatal Cohort 1959-61) comprising 9 125 successive live births. Although characteristic somatic disorders continue to arise, the medical picture is dominated by problems of a psycho-social nature. This finding suggests that the school health service should be adapted towards this changing pattern of child health.

Metastatic colon adenocarcinoma of the middle ear.

Malignant tumors of the middle ear and metastases to this region are rare. A case report of metastasis of a colon adenocarcinoma to the middle ear is described. The different routes by which tumor cells reach the middle ear are mentioned and the cases reported in the literature are reviewed.