[Significant extension of survival by complete resection of isolated lung metastases after breast carcinoma]. / Signifikante Verlängerung des Uberlebens durch komplette Resektion isolierter Lungenmetastasen nach Mammacarcinom.

At least 25% of breast cancer patients develop distant metastases. In spite of increasingly sophisticated palliative therapies, the survival time of patients with metastasis did not appear to be significantly prolonged during the last 25 years (19-32 months following diagnosis) and 95% of them die from metastatic disease. Therefore, it seems appropriate that the therapeutic risk/benefit ratio and impact on quality of life should be reassessed when asymptomatic patients are treated. Surgical treatment and pulmonary resection for metastatic disease has been proven a valuable therapeutic concept for a variety of malignancies. Three epidemiologically comparable collectives out of a total of 125 patients from our clinic were treated for isolated pulmonary metastasis following breast cancer (observation period: 1977-1997). Complete data sets could be established for 96 patients and were retrospectively analyzed following stratification into three groups according to their surgical therapy. Twenty-eight patients underwent complete resection (K), 34 had incomplete resections (I) and 34 had no surgical intervention for lung metastases (N). Comparison of the three therapy arms concerning stage, histology and receptor levels of the primary tumor, number of metastases, and the disease-free interval yielded no significant differences between groups K, I and N. Patients after complete resection of isolated lung metastases (group K) had a mean survival of 79 months (5-year survival 80%, 10-year survival 60%). This was significantly better than groups I and N (P < 0.00002). The mean survival of groups I and N was not significantly different (15.5 and 9 months respectively). The disease-free interval after operation of the primary tumor had no impact on the survival of group K, but showed a high correlation with the survival of group N (R2 = 0.81). Complete resection of isolated pulmonary metastases from carcinoma of the breast results in marked prolongation of survival with a low morbidity rate. Hence, routine chest X-ray should be considered an indispensable part of the oncological aftercare in breast cancer patients.

Lytic effector cell activity and major depressive disorder in patients with breast cancer: a prospective study.

The study examined lymphokine-activated killer cell (LAK) and natural killer (NK) cell activity in breast cancer patients prior to surgery as compared to effector cell lysis in patients with non-malignant breast tumors, further in connection with lifetime diagnosis of major depression, severity of current depression, anxiety and coping styles. Follow up studies covered a period of 6 and 12 months. Prior to surgery, life time diagnosis of major depressive disorder, trait anxiety and coping styles did not discriminate patients as far as effector cell lysis is concerned. LAK activity but not NK activity was reduced in patients with actual depressive symptoms (P < 0.01) and high state anxiety (P < 0.05). These findings support the hypothesis that LAK activity is a state marker of actually existing depression and anxiety prior to surgery. Affective rather than coping measures showed significant differences in LAK activity. For LAK activity, 1 year after surgery the only predicting factors were Tamoxifen therapy and chemotherapy.

Prognostic factors for local recurrence in patients with limited surgery and irradiation of breast cancer.

Between January 1975 and December 1984, 239 patients after breast conserving surgery were referred to the University Clinic for Radiotherapy and Radiobiology of Vienna. Of these patients 214 were available for analysis with regard to loco-regional control and cosmetic outcome. The breast received supervoltage irradiation from two tangential fields, in 82% with a tumor dose of 50 Gy and in 15% 50 to 60 Gy. In addition 70% of the patients received a boost dose with 7.5 to 15 MeV electrons to the tumor bed and the scar. The overall local failure rate was 10.2%. For patients with T1,2 and negative axillary nodes or less than four positive lymph nodes (N = 160) a recurrence rate of 7.1% was observed. Factors correlated to a higher local recurrence rate were in this retrospective study axillary status (greater than 3 positive lymph nodes), histopathologic grade (G III), absence of clear margin after surgery and absence of additional electron boost.

Effects of adjuvant chemotherapy on specific and non-specific immune mechanisms.

Adjuvant chemotherapy is a well accepted concept in the treatment of breast cancer and has resulted in most clinical studies in a significant prolongation of the disease-free interval in certain subgroups of patients. However, very little is known about the late effects of adjuvant chemotherapy and its influence upon the function of a series of physiologic mechanisms. In the present paper, a review of our studies on the influence of adjuvant chemotherapy consisting of cyclophosphamide, methotrexate and fluoruracil (CMF) upon the function of B, T and natural killer (NK) cells is given. It is shown that CMF adversely influenced primary antibody production following vaccination for a prolonged period of time after the termination of CMF treatment. In investigating T cell function, it was found that the administration of CMF led also to a similarly prolonged impairment of phytohemagglutinin (PHA-)stimulated soluble interleukin 2 receptor (sIL-2R) production and to a decrease in the proliferation of peripheral blood mononuclear cells following mitogenic stimulation with PHA. Finally, NK cell activity was found to be decreased for such a prolonged period of time after the termination of CMF treatment, too. We thus conclude that the administration of CMF in the adjuvant setting leads to a pronounced and prolonged impairment of certain immune mechanisms.

Diagnostic value of mucin-like carcinoma-associated antigen (MCA) in breast cancer.

The diagnostic value of mucin-like carcinoma-associated antigen (MCA) was compared to that of carcinoembryonic antigen (CEA) and/or CA 15.3 in patients with breast cancer. A total of 368 patients with breast cancer were studied, of whom 253 were free of metastases, whereas 94 had either skeletal or visceral metastases or diffuse metastatic disease. The diagnostic sensitivity of MCA proved to be comparable to that of CA 15.3 and superior to that of CEA in patients with metastatic breast cancer. In contrast, the specificity of MCA was superior to that of CA 15.3. Finally, the diagnostic sensitivity of each of the tested tumour markers, i.e. MCA, CEA and CA 15.3, could be improved by their combined use. We conclude that MCA, either alone or in combination with CA 15.3 and CEA, can improve the monitoring of disease progression in patients with metastatic breast cancer.

[Breast-preserving treatment of breast carcinoma]. / Die brusterhaltende Behandlung des Mammakarzinoms.

Based on our 14-year experience with breast-preserving treatment of breast cancer, we recommend limited surgical intervention for the removal of a small mammary carcinoma under the proviso that adequate radiotherapy is available and that the patient can be thoroughly followed up. We are convinced that the good cosmetic result and especially the excellent psychological reaction are particularly important in order that women lose their fear of an ablative operation. Only then, by performing an operation which is not excessive at the earliest possible time can the prognosis of this type of carcinoma, which is increasing be improved.

[10 years' experience with the concept of breast-saving therapy in the treatment of breast cancer]. / 10-Jahres-Erfahrung mit einem brusterhaltenden Therapiekonzept in der Behandlung des Mammacarcinoms.

A therapeutic concept dependent on staging of breast carcinoma is presented. In 1974 we started at the 2. Surgical University Clinic Vienna to use the non ablative treatment in patients with breast cancer smaller than 2 cm. Up to 1984 102 patients underwent quadrantectomy axillary dissection, and radiotherapy. With equal therapeutic results the smaller and cosmetically preferable surgical intervention is recommended.

[Significance of hormone receptors of breast cancer cells for the duration of a disease-free interval]. / Die Bedeutung der Hormonrezeptoren von Mammakarzinomzellen für die Dauer des erkrankungsfreien Intervalls.

The importance of the presence of hormone receptors of cells derived from breast cancer tissue for the duration of the relapse-free interval was evaluated in 41 patients with stage II breast cancer. After modified radical mastectomy with axillary lymphadenectomy the patients received radiotherapy and adjuvant polychemotherapy and/or hormone therapy. There was no indication of metastases in any patient at the time of operation. There was a significant correlation of the relapse-free interval to tumor size (p less than 0.05), to the number of involved lymph nodes (p less than 0.0005), and also to the presence of the progesterone receptor (PgR), which seemed to play a more important role in this context than the oestrogen receptor (ER) (p less than 0.001). We conclude from this study that the evaluation of the PgR in breast cancer cells is important for the prognosis of the duration of the relapse-free interval.

Angiographic demonstration of phlebectasia in a case of Turner's syndrome.

A case of congenital vascular bowel lesions in Turner's syndrome resulting in severe gastrointestinal bleeding is presented. The vascular malformations were verified by angiography. Pathogenesis, diagnosis, and treatment are discussed.

[Problems of a stage-based therapeutic approach to surgery in breast carcinoma (author's transl)]. / Zur Problematik der stadiengerechten Chirurgie des Mammakarzinoms.

A therapeutic concept dependent on staging of breast carcinoma is presented: 1. Stage T0-T1 N0 M0: wide local excision or quadrant resection with axillary lymph-node excision. 2. Stage T2 and T3 N0-N1: simple mastectomy (Patey). 3. Stage T4 or N2: radical mastectomy (Rotter). 4. Stage N3 or M1: tumour excision according to the T-stage, lymph-node excision, local excision of affected distant lymph nodes. With equal therapeutic results the smaller and cosmetically-preferable surgical procedure is to be recommended.

[Clinical aspects, radiology and therapy of angiosarcoma of the breast gland]. / Klinik, Radiologie und Therapie des Angiosarkoms der Brustdrüse.

A case of angiosarcoma of the breast is described. The problems of clinical appearance, roentgenology and therapy are discussed. The case described is similar to those seen in the literature, of which 44 cases are known in the literature. Problems of diagnosis even during surgery are evident.

[The roentgen morphology of isolated tumourous pulmonary amyloidosis (author's transl)]. / Zur Röntgenmorphologie der isolierten, tumorförmigen Lungenamyloidose

A patient with isolated tumourous pulmonary amyloidosis was seen and surgically treated in our clinic. The roentgen morphology of this extremely rare condition is described and the cases published in the literature are reviewed. Knowledge of this disease makes the radiological diagnosis easier and is of importance to the surgeon in planning treatment.