CCL4-induced liver cirrhosis and hepatocellular carcinoma in rats: relationship to plasma zinc, copper and estradiol levels.

A number of biochemical events accompany the development of chronic liver disease and its evolution into hepatic cancer. Low plasma zinc and high plasma copper levels have been observed in individuals with advanced hepatocellular liver disease. Moreover, many investigators have demonstrated an increase in serum estradiol levels in individuals with chronic liver disease and hepatocellular carcinoma (HCC). In the present study, the relationship between these biochemical events and HCC was investigated in an animal model. Specifically, carbon tetrachloride (CCL4) was administered intragastrically to 20 female Sprague Dawley rats for 30 weeks. All 20 animals developed cirrhosis. Six (30%) developed HCC. Significantly higher serum estradiol, zinc and copper levels were observed in the rats developing HCC as compared with those with cirrhosis alone (P < or = 0.05, 0.01 and 0.001, respectively). A trend toward increased serum levels of progesterone, ALT and total bilirubin (0.1 > or = P < or = 0.05) was found in the animals developing HCC. No differences in serum testosterone and alkaline phosphatase levels were noted between animals with and without HCC. These studies demonstrate that in animals with experimental CCL4-induced cirrhosis and HCC serum levels of estradiol, zinc and copper are increased, as is the case in man.

Primary radiotherapy versus surgery and radiotherapy in the management of postmenopausal locally advanced breast cancer.

From 1978 through 1984, 103 postmenopausal patients with locally advanced breast cancer (T4 N1-2-3 MO) were treated by definitive radiotherapy (XRT, 35 patients) or mastectomy and postoperative radiotherapy (RM + XRT, 68 patients). A control group of 35 of the 68 RM + XRT patients was selected by matching several prognostic variables with the XRT group. Patients were followed for 4 to 10 years. At 5 years the probabilities of overall survival and relapse-free survival were 49.9% and 33.2% for XRT patients and 49.2% and 42.8% for RM + XRT patients, respectively (with no significant difference). The probability to remain free of local-regional progression at 5 years, with censoring of deaths, was 71.9% in the XRT group and 79.8% in the RM + XRT group. Of the patients treated with definitive radiotherapy, those who received 60 Gy or more to the primary tumor had a significantly better 5-year rate of local control: 88.0% vs. 68.0%, p less than 0.05. Our results suggest that adequate doses of radiotherapy can provide long-term local-regional control in a large proportion of survivors and can spare mastectomy in most patients, without however achieving substantial improvements in the poor survival results.

Analysis of prognostic factors in patients with isolated chest wall recurrence of breast cancer.

A retrospective analysis of a series of 162 patients treated for isolated chest wall recurrence of breast cancer after mastectomy was undertaken. Cumulative survival, distant relapse-free survival, and freedom from local progression after 5 years from the diagnosis of recurrence were 34%, 28%, and 45% respectively. Five prognostic factors influenced survival: axillary node status, primary T stage, length of disease-free interval, and number and size of recurrences. Four prognostic factors influenced the local control: axillary node status, primary T stage, disease-free interval, and number of recurrences. Patients with three or more, out of five, favorable prognostic factors fared much better than those with two or less: 75% versus 15% survival at 5 years. Our findings suggest that it is possible to identify a group of patients with a distinctly good medium-term survival and local control of disease.

[Clinical results of a radiotherapy-surgery program analyzed in relation to risk factors in cancer of the breast]. / Risultati clinici di un programma radio-chirurgico analizzati in funzione di fattori di rischio per il cancro della mammella.

In the Radio Institute "O. Alberti" of Brescia from 1.1.73 to 31.12.79, 976 patients were treated with postoperative radiotherapy after radical mastectomy. The impact of therapy has been observed on the NED survival and evaluated for prognostic factors. The involvement of axillary lymph nodes appears to be the most relevant prognostic factor; the hormonal perimenopausal status was associated with a poorer prognosis both regarding the high frequency of axillary metastatic nodes and because in N+ 1-3 cases the probability of relapse is different and higher in comparison to post and premenopausal status. The site of origin of the primary tumor does not appear to be a significant prognostic factor related to the same number of nodes involved. Direct correspondence exists between diameter of the primary tumor and metastatic regional nodes. In N- patients the evaluated prognostic factors are not significant; in N+ patients the cases with a significantly different risk of relapse were identified for N+ 1-3 by the perimenopausal status and for N+ greater than or equal to 4 by the diameter of tumor. Postoperative radiotherapy alone seems to be able to modify the prognosis of operable breast cancer. The combination of local radiotherapy and adjuvant medical therapy could be a logical approach not only in order to improve the local control but also to prevent metastases.