Showing papers in "Ejso in 1998"

Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the west Netherlands

Abstract: Aims. We carried out a population-based study of local recurrence rates in curatively resected patients with rectal cancer, diagnosed between 1988 and 1992. The first objective was to make an inventory of the overall local recurrence rate after non-standardized conventional surgery, inter-institutional recurrence rate variability, and correlations between patient- and tumour-related factors and recurrence rate. A second objective was to investigate the compliance to guidelines for post-operative radiotherapy. Methods. Data were obtained from the Comprehensive Cancer Centre West. The study comprised 1105 patients from 12 hospitals. Of these patients, 437 were ineligible because of missing medical records, no carcinoma, incorrect registration, no laparotomy, non-curative resection, or loss to follow-up. Results. The overall local recurrence rate was 22.5% with a range of 9–36% between the hospitals. These differences were not significant. Dukes' Astler-Coller stage, tumour location, and residual tumour were significant independent prognostic factors for the risk of local recurrence. Indications for post-operative radiotherapy were Dukes' Astler-Coller B2 and C tumours, positive surgical margins, and tumour spill. Compliance to the guidelines for radiotherapy was only 50%. However, no significant difference in recurrence rate was found between patients treated according to the guidelines and those not treated according to the guidelines. Conclusion. This study shows a large variability in local recurrence rate between the participating hospitals and confirms that the risk of recurrence in primary rectal cancer is dependent on Dukes' Astler-Coller stage, tumour location and residual tumour. Furthermore, this study contributes to the discussion about the feasibility of guidelines for post-operative radiotherapy.

Resection of liver metastases from colorectal cancer: the real impact of the surgical margin.

Abstract: Aims. The benefit of liver resection for metastatic colorectal cancer is now established. Nevertheless if the surgical margin on pre-operative imaging is considered to be less than 10 mm, this is considered an absolute contraindication to surgery by some, and a relative contraindication by others, so its real impact on prognosis is not clear. Methods. From 1984 to 1996, 269 patients underwent hepatectomy for liver metastases and were prospectively studied. The only two objectives of this surgery were to be curative (or achieve complete R0 resection), and to avoid mortality. Of the 269, 187 patients had surgical margins inferior to 10 mm. Sixty per cent had multiple liver metastases, and 37% had extrahepatic metastatic sites. Their clinical and pathological factors were specifically studied. Results. The crude 5-year survival of these 187 patients (including the 2% post-operative mortality) was 24.7%, and the disease-free survival was 18.8%. The surgical margin was 0 mm in 60 cases and was histologically invaded in 20 cases. The most important prognostic factor was whether the resection was considered palliative (R1-R2 resection according to UICC criteria) (P<0.0001). When the cases with invaded margins were excluded, there was no prognostic difference between the 107 patients with a margin of 0-4mm and the 143 patients with a margin greater than 4mm. However, a surgical margin greater than 9 mm appears to be a second prognostic factor (P=0.001), when these 187 patients are compared to others. The reasons behind this are that there is a close relationship between narrow margins and extensive disease (high number of metastases, bilateral localization and extended hepatectomy), and also an increased possibility of microscopic satellite lesions within 10 mm around the metastases. Conclusions. The real prognostic impact of the surgical margin must not be overestimated. Hepatectomy for metastases can provide long-term survival in patients with supposed poor prognostic factors. Resection is justified so long as it is complete and with minimal risk. An experienced, specialized centre can be a prognostic determinant.

Male breast cancer: a 22-year experience.

Abstract: Aims. To carry out a retrospective study of male breast cancer over a 22-year experience. Methods. Data from 121 male patients with breast cancer treated between the years 1972 and 1994 at the Surgical Clinic of Ankara Oncology Hospital were reviewed. Distribution of cases according to stage was: 2.5% stage I, 28.9% stage II, 55.4% stage III and 13.2% stage IV (AJCC staging method). The surgical treatment for 23 of the patients (19%) was Halsted's radical mastectomy or modified radical mastectomy. Seventy-three cases (60.3%) had total mastectomy without axillary node dissection and 25 (20.7%) had local tumour excision only. Seventy-two of 121 patients had adjuvant treatment. Results. In general the prognosis of men with breast cancer was worse than for women. In the analysis of patients in stages I, II and III-A (operable disease group), the 5-year survival rates were 73% in axillary node-negative patients and 77% in those with tumours sized under 5 cm (P<0.001). In these patients, univariate analysis demonstrated that axillary status (relative risk of death in positive status vs. negative=3.6), tumour size (relative risk in T 3 vs. T 1+2 = 2), surgical treatment type (relative risk in simple mastectomy vs. radical mastectomy = 1.9) and adjuvant chemotherapy (relative risk if no chemotherapy 1.4) were statistically significant factors associated with survival. Conclusions. Cox's regression model revealed that axillary status, tumour size and type of surgical treatment were the most important independent prognostic factors (P<0.001).

Prediction of nipple and areola involvement in breast cancer

Abstract: Aims. To find a pre-operative test for nipple and areola involvement in breast cancer.Methods. Areola-tumour distance was measured in 140 consecutive patients (median age 45, range: 23-83) undergoing a mastectomy. We analysed whether nipple and areola correlated with areola-tumour distance, tumour size, nodal status, perinodal involvement and lymphatic embolization.Results. The nipple was involved in 22 (16%) cases and this correlated with tumour size, number of lymph nodes, perinodal extension and presence of lymphatic emboli. In all these 22 cases, the tumour was within 2.5 cm of the areola. Tumour size, however, could not predict nipple involvement in tumours within 2.5 cm of the areolar edge.Conclusions. In the one-fifth of cases where the tumour is over 2.5 cm from the areola, preserving the nipple and areola for reconstruction may be worthwhile. In remaining cases, some other predictive test for nipple involvement would be necessary.

Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery

Abstract: Aims To shed light on the controversy surrounding the methods of evaluating, staging and final treatment of intramedullary chondroid lesions. Controversy particularly exists for enchondroma and low-grade chondrosarcoma located in the extremities, because their accurate distinction is hampered by their radiographical and histological similarity. Methods Since 1991 we have treated 22 patients (mean age: 39.6 years) with 26 lesions (three chondroblastomas, 14 enchondromas and nine grade 1 chondrosarcomas) with curettage, cryosurgery and bone grafting. Results After a mean follow-up of 26 months no recurrences were observed. Complications consisted of two postoperative fractures, one wound infection and one intraoperative venous gas embolism. All bone grafts incorporated, resulting in full weight-bearing capacity and excellent functional results. Conclusion The usefulness of a combination of curettage and cryosurgery as adjuvant therapy is considered to be equal to marginal resection according to orthopaedic oncological principles. The pre-operative assessment of these lesions and cryosurgical technique is described in detail.

Conservative treatment of lower pole breast cancers by bilateral mammoplasty and radiotherapy

Abstract: Aims. This series analyses the results of conservative surgery for large lower pole breast cancers by lumpectomy associated with a bilateral remodelling mammoplasty, in order to avoid residual deformities. Methods. This retrospective study concerns 50 patients with a lower pole breast cancer treated between 1986 and 1996 by lumpectomy, mammoplasty and irradiation. The contralateral breast was immediately made symmetrical in all cases. The mean tumour size was 32.5 mm. Results. The mean weight of the lumpectomy specimen was 270g. Resection margins were tumour-free in 90% of cases. The main complication observed was delayed healing, thus postponing post-operative treatment in 6.5% of cases. The median follow-up was 48 months. The 5-year actuarial ipsilateral local recurrence rate was 7% and 5-year actuarial metastasis-free and overall survival rates were 81 and 97%, respectively. Cosmesis was satisfactory in 85% of patients. We observed better results when radiotherapy was performed after rather than prior to surgery (92 vs. 67%: NS). Conclusions. Performing a bilateral mammoplasty at the time of initial surgery for large breast cancers situated in the lower quadrants of the breast facilitates larger lumpectomies with good cosmetic results.

Sentinel lymph node involvement—a predictor for axillary node status with breast cancer—Has the time come?

Abstract: Aims Axillary node dissection for breast cancer is important for staging and its prognostic value. Sentinel nodes are defined as the first nodes into which the primary cancer drains. This study investigates whether identification, removal and pathological examination of these nodes indicates whether the completion of axillary lymphadenectomy is required. Methods Using a vital dye injected at the primary tumour site, we were able to identify sentinel nodes in 96 out of 98 women examined. Results An average number of 2.7±1.2 nodes per patient were identified as sentinel nodes. In 83% of cases there was a correlation between the involvement of the sentinel nodes and the rest of the axillary nodes. In 14% of patients the sentinel nodes were the only nodes involved with tumour. In three cases the sentinel nodes were negative, but other axillary nodes were tumour-positive. Conclusion The major problem in routine application of this method to the decision to perform axillary lymph node dissection (ALND) is the time needed for pathological identification of lymph node involvement by tumour.

Identification and biopsy of the sentinel lymph node in breast cancer

Abstract: Aims: To examine the hypothesis that lymphatic dissemination in breast cancer occurs sequentially. Methods: Thirty patients with clinically localized adenocarcinoma were studied. Patent blue dye was administered into the tumour at the beginning of a modified radical mastectomy or segmental mastectomy with en bloc axillary lymph-node dissection (ALND). In the removed specimen, blue-stained lymphatic channels were dissected from the primary tumour to the first draining lymph node(s) (sentinel node(s)). Results: Identification of a sentinel node (SN) was successful in 26 patients (87%). In 10 patients the SN was tumour-positive. In six of these patients, the SN was the only tumour-positive node. There was no incidence of ‘skip' metastasis. Conclusions: This study confirms the sequential nature of lymphatic dissemination. When confirmed in vivo , these data may lead to a substantial reduction of the need for ALND without compromising survival and regional control and without loss of prognostic and staging information.

Treatment of liver metastases from uveal melanoma by combined surgery-chemotherapy.

Abstract: Aims To investigate sporadic results demonstrating prolonged survival after surgical resection and/or intraarterial chemotherapy (IACH) for liver metastases from uveal melanoma. Methods From December 1992 to March 1997 every patient with liver metastases from uveal melanoma was enrolled in a prospective study including: (1) aggressive surgical approach removing as much liver disease as possible; (2) implantation of an intraarterial catheter; (3) intraarterial chemotherapy for 6 months. 75 patients were enrolled: 38 men, 37 women, mean age 51 years (range: 18–72), mean time from initial diagnosis of uveal melanoma to liver metastases 37 months (ranged: 1–168). Results Disseminated disease in both lobes was present in all but one patient. Macroscopically curative surgery was possible in 27.5%. Significant tumour reduction was performed in 49.3% and a simple biopsy was possible in 23.2%. Eight patients did not receive chemotherapy and died soon after. IACH included Fotemustine and/or DTIC-Platinum for 4–9 cycles. Overall median survival was 9 months; very similar to non-operated historical controls. In the 61 patients receiving complete treatment surgery plus chemotherapy, median survival improved to 10 months. When curative resection was possible, survival increased to 22 months ( P Conclusions Aggressive surgical resection, when possible, appears to be the best method of improving survival of liver metastases from uveal melanoma. New drug combinations are also required to improve survival.

Breaking bad news

Abstract: The way in which news about a cancer diagnosis or recurrence is broken can have a profound effect on the patient's psychological wellbeing. When the information given is perceived by the patient as too much or too little and resultant concerns remain undisclosed and unresolved there is a high risk that the patient will develop clinical anxiety and/or depression. Guidelines are provided, therefore, to help them appropriately. Strategies are also suggested which will allow the patient's concerns to be elicited in an efficient but caring manner.

Preservation versus section of intercostal-brachial nerve (IBN) in axillary dissection for breast cancer—a prospective randomized trial

Abstract: Aims Preservation of the intercostal-brachial nerve is advocated to reduce side-effects of axillary dissection for breast cancer. We conducted a prospective randomized trial to compare functional results: sensory deficit and/or shoulder pain in preserved (group I) vs sacrificed (group II) intercostal-brachial nerve (IBN). Methods From July 1993 to April 1994, 128 patients presenting with an invasive operable breast cancer were operated on by mastectomy n =28 or lumpectomy n =100 and axillary dissection. The patients were eligible for randomization when the IBN was preserved at the end of the axillary dissection. Group I (nerve preservation) included 66 patients and group II (nerve section) 62 patients. Results The two groups were well balanced for TNM, type of surgery, number of nodes dissected and positive, postoperative adjuvant treatment. Examinations were conducted at 3, 6 and 12 months after surgery. Sensory deficit in the IBN area was reported by one patient in group I and four patients in group II at 3 months ( P =0.36, NS). No patients, apart from one in group 11, reported functional trouble at 18 months. Major shoulder motion, limitation and pain developed in four patients in group I and three in group II (NS). This was attributed to depression and treated adequately. Analysis of sensory deficit was impossible in these patients. Conclusions Conservation of the IBN, while anatomically preferable, is not functionally necessary during axillary dissection for breast cancer.

European guidelines for quality assurance in the surgical management of mammographically detected lesions

Abstract: European guidelines for quality assurance in the surgical management of mammographically detected lesions.

Complications of latissimus dorsi myocutaneous flap breast reconstruction

Abstract: Aims To review the experience of a single unit in post-mastectomy reconstruction using the latissimus dorsi flap. Method A retrospective review of 111 cases treated between 1984 and 1993. The notes were evaluated for type of procedure, associated treatment and complications. Results A significant morbidity of this procedure was demonstrated with 41 (37%) patients requiring a second operation during the period of the study. The majority of these second operations were related to the prosthesis used to achieve symmetry. Second operations were more common in those who had saline-filled prostheses. Other complications seen included wound infection, small areas of flap necrosis, hypertrophic scars and problems with the donor scar. No differences in complication rates were demonstrated for delayed vs immediate procedures or for patients receiving or not receiving radiotherapy. No life-threatening complications were seen during the study. Conclusions The latissimus dorsi reconstruction is reliable but the overall programme is beset with considerable morbidity. This factor needs to be taken into consideration when discussing reconstructive options with the postmastectomy patient.

A histopathological assessment of the response of rectal adenocarcinoma to combination chemo-radiotherapy: relationship to apoptotic activity, p53 and bcl-2 expression

Abstract: Aims To investigate the use of pre-operative chemo-irradiation in downstaging advanced rectal cancer prior to surgical resection. Methods We examined the pathological effects of chemo-irradiation on 24 rectal tumours and correlated the efficacy of treatment with the level of apoptosis, mitosis, p53 and bcl-2 protein expression in pre-treatment biopsies. Results All tumours were resectable following chemo-irradiation. Six cancers showed complete regression with no viable tumour in the resection specimen. A significant correlation was found between spontaneous tumour apoptosis and tumour regression. Conclusions Our results suggest that in rectal cancer the apoptotic rate in untreated tumour tissue may predict sensitivity to radiation and cytotoxic agents. No relationship was found between regression and mitotic rate, p53 or bcl-2 expression.

Appraisal of transplantation for malignant tumours of the liver with special reference to early stage hepatocellular carcinoma.

Abstract: The enthusiasm to treat or even cure patients with unresectable hepatobiliary malignancy by total hepatectomy and liver transplantation has considerably diminished. Nowadays, due to organ-donor shortage, patients have to be selected with predictable likelihood for long-term survival. According to own experience and a review of the literature, liver transplantation may be considered in unresectable early stage hepatocellular and proximal bile duct carcinoma, the uncommon entities fibrolamellar carcinoma, epithelioid haemangioendothelioma and hepatoblastoma as well as in liver metastases from neuroendocrine tumours. At present, advanced stages of hepatocellular and proximal bile duct carcinoma, as well as intrahepatic bile duct carcinoma, haemangiosarcoma and metastases from nonendocrine tumours, should be excluded from transplantation. In order to cure the cancer-bearing disease, liver transplantation might be the ideal treatment for small but still resectable hepatocellular carcinoma with underlying cirrhosis. Our retrospective comparison of survival after resection and transplantation for early stage hepatocellular carcinoma does not reveal a significant difference. Although a tendency has been observed in favour of transplantation, resection of these tumours is still justifiable, not least because of donor organ shortage.

Screening for colorectal cancer reduces emergency admissions

Abstract: Aims Colorectal cancer is common and accounts for over 15,000 deaths annually in England and Wales. Up to 30% of these patients require emergency surgery. Screening for colorectal cancer can reduce the mortality of colorectal cancer. This study addresses the impact of a population-based screening study on emergency admissions with colorectal cancer. Method From 1981 a randomized trial of Faecal Occult Blood (FOB) screening has been undertaken in the Nottingham area, recruiting over 150,000 patients. The present study examined the records of patients enrolled in this study who presented as an emergency with colorectal cancer. Results Colorectal cancer was identified in 1962 cases, of which 468 (23.9%) presented as emergencies. The overall compliance was 60% (proportion of individuals completing at least one test). There were significantly fewer emergencies in the Screen-detected group compared with the Control group (P = Conclusions Screening for colorectal cancer using a faecal occult blood test can significantly reduce the number of emergency presentations with colorectal cancer. It is likely that the introduction of a national programme of screening for colorectal cancer would lead to increased compliance and that this would lead to a significant reduction in the emergency workload on the National Health Service from colorectal cancer.

Long-term results of surgery for adenoid cystic carcinoma of the trachea and bronchi

Abstract: Aims: Over a period of 26 years, 16 patients (9 women, 7 men) underwent surgery for primary adenoid cystic carcinoma (ACC) of the trachea and bronchi. The median age at diagnosis was 41.4 years (range 25–67). Nine tumours were located in the bifurcational area, five in the trachea, one in the middle-lobe bronchus and one in the parenchyma of the left lower lobe. Methods: Surgical procedures were as follows: three tracheal transversal resections; five resections of the distal trachea including the bifurcational region, followed by bifurcational reconstruction; two right-sleeve pneumonectomies; three left-sleeve pneumonectomies; two lobectomies; and one explorative sternotomy. Results: Eleven patients were available for follow-up at least 5 years after surgery. Three of these patients (27%) had local recurrence 155 ± 30 (range 120–175) months after surgery. Distant metastases occurred in six patients (55%) after a median time interval of 96 ± 68 (range 24–180) months after surgery. Conclusions: Five-year and 10-year survivals were excellent, 79 and 57% respectively, but the long-term outcome was poor due to late local recurrences and late metastatic spread. It is not yet certain whether a cure can really be achieved in ACC.

Gamma probe-guided sentinel node biopsy--optimal timing for injection

Abstract: Aims. We initiated a Phase I feasibility study using a gamma-detecting probe (GDP) and radiolabelled colloid to localize the sentinel lymph node (SLN) in breast cancer. The aim of the study was to establish the ideal timing for injection and examine any possible exclusion criteria for this method. Methods. Thirty breast cancer patients diagnosed by fine needle aspiration (FNA) were included in this study. All were injected with 60 M Bq rhenium colloid labelled with 99m Tc (Tck-17). Scintigraphy was done 20 min, 2, 6 and 25 hours post-injection. Patients were then taken to surgery where they were injected with patent blue dye. During surgery, the SLN was located with a GDP (Neoprobe ® Model 1000). In 28 patients, the SLN was identified by scintigraphy 2 hours after injection, identical to the images seen after 24 hours. Results. In all 28 patients, the SLN was found by the GDP during surgery. In 26 patients the SLN was dyed blue. The two patients with no SLN localization had received prior radiation. Pathology disclosed SLNs with metastases in seven patients. Two patients had a negative SLN but had an axillary lymph node replaced by tumour. Conclusions. Two to 24 hours prior to surgery is suitable timing for injection. Previous radiotherapy predicts failure for this procedure. Further studies are needed to find the exact false-negative rate of this method for breast cancer.

Technique of lymphatic mapping and sentinel node biopsy for melanoma

Abstract: Aims. An increasing number of surgeons perform sentinel node biopsy to identify melanoma patients with early lymphatic dissemination who may benefit from regional node dissection or adjuvant therapy. The addition of lymphoscintigraphy and intraoperative gamma-ray detection with a hand-held probe increases the sensitivity of the surgical technique substantially. Methods. The value of lymphoscintigraphy is discussed. The operative technique of lymphatic mapping and sentinel node biopsy is described, including the use of a vital dye and a gamma-ray probe. Conclusions. Close to 100% of first-tier lymph nodes can be identified with this combined approach without the unnecessary removal of too many higher-echelon nodes.

Prognostic role of lymph-node level involvement in patients undergoing axillary dissection for breast cancer.

Abstract: AIMS Clinical records of patients undergoing surgery for breast cancer were reviewed in order to evaluate the prognostic role of lymph-node level involvement. METHODS From 1982 to 1991, 1143 patients had radical mastectomy or conservative surgery with total axillary dissection: 461 patients of mean age 57.1 years (range: 25-89 years) were lymph-node positive (pN1); 369 patients (80%) had radical mastectomy; and 92 patients (20%) had conservative treatment plus post-operative radiotherapy, with the same mean number (n = 16) of lymph nodes collected in the surgical specimen. Data were analysed for the number of positive lymph nodes and level of involvement. RESULTS Level I, Levels I + II and Levels I + II + III were involved in 44.9, 18 and 21.4% of patients, respectively; 'skip metastases' occurred in 72 of 461 pN1 patients (15.5%). A univariate analysis showed that prognosis was directly related to the number of levels involved (P < 0.001), and skip metastases had the same prognostic role as Level I involvement. The numbers of involved lymph-node levels and metastatic lymph nodes were well correlated; multivariate analysis showed that involvement of Levels I and III was independently correlated with prognosis. After adjustment for age and number of positive lymph nodes, the number of involved lymph-node levels was an independent prognostic factor, with highest predictability when all three lymph-node levels were positive (P = 0.009). CONCLUSIONS The prognostic value of lymph-node status should be defined not only by the number of metastatic lymph nodes, but also by the number of levels of involvement.

Metastasis in a benign duodenal stromal tumour.

Abstract: Gastro-intestinal stromal tumour (GIST) is increasingly recognized as a distinct entity within the group of soft tissue tumours. Mostly, GIST arises from the muscular components of the stromal layer, but the tumour may also originate from the autonomic nerve system, recently designated as gastro-intestinal autonomic nerve tumour (GANT). The majority of GIST is located in the stomach and small intestine; only 4% of GIST is found in the duodenum. Clinical and pathological criteria to differentiate benign from malignant GIST are not well established. Tumour size and mitotic activity are commonly considered as important features, predicting biological behaviour and outcome. It has been suggested that the clinical course of the GANT-type tumours may be more aggressive. We present a case of a radically resected duodenal stromal tumour with benign features, in a young woman, with metastases to the liver and peritoneum occurring 8 years after the initial diagnosis.

Complications in connection with venous port systems: prevention and therapy

Abstract: Post-operative difficulties apart, venous thrombosis, extravasation and dislocation, obstruction, catheter leakage and local and systemic infections are the typical complications associated with venous port systems. Such complications considerably reduce the benefits otherwise accruing from a reliable access to the venous system of patients with malignant tumours. The vast majority of such disadvantages are attributable to the inexpert handling of ports and, therefore, should be avoidable. This applies to such areas as selecting the right port system, the proper installation of the port chamber and catheter and also to efficient handling and maintenance by trained staff. In many cases it will be possible, with the help of a specific diagnostic investigation, to identify and correct a fault and thus ensure that the system installed continues to function. Typical and frequent complications observed (with specific examples) in connection with port systems are described together with preventative measures, diagnosis and therapy.

Breast carcinoma in residual breast tissue after prophylactic bilateral subcutaneous mastectomy

Abstract: We report a case of breast carcinoma 6 years after a prophylactic subcutaneous mastectomy. The incidence of breast carcinoma after prophylactic mastectomy is probably less than 2%. If removal of breast tissue is performed to prevent breast cancer, we advocate a complete simple bilateral mastectomy, including nipple-areola complex, axillary tail and pectoral fascia.

Role of serum thyroglobulin in the pre-operative evaluation of follicular thyroid tumours.

Abstract: Aims. There is no reliable diagnostic test for pre-operative differentiation between benign and malignant follicular and Hurthle cell neoplasms. Measurements of serum thyroglobulin (Tg) are currently only used post-operatively as a marker of recurrent disease or distant metastases in the follow-up of patient with diffentiated thyroid cancer. In this study pre-operative serum Tg measurements were performed with the aim of investigating whether Tg levels differ in benign and malignant follicular and Hurthle cell neoplasms. Methods. In 516 patients who underwent thyroid surgery at the Institute of Oncology in Ljubljana, Slovenia, from 1990 to 1996, serum Tg concentration was measured in addition to the standard pre-operative tests (fine-needle aspiration biopsy, ultrasonography, 99m Tc scanning and hormonal profile). After the operation, patients were divided into 11 groups based on their histological diagnosis (papillary cancer-classic, papillary cancer-follicular variant. papillary cancer-oncocytic variant, occult papillary cancer, follicular adenoma, follicular cancer, Hurthle cell adenoma, Hurthle cell cancer, anaplastic cancer, medullary cancer, nodular goiter) and the serum Tg values of the different groups were compared. Results. In groups of patients with follicular and Hurthle cell cancer, median Tg values were higher (2895 and 638.5 ng/ml) and, statistically, differed significantly from the serum Tg values in all other groups (P<0.01). Sensitivities and specificities of the tests were 71.8% and 80.4% for follicular cancer and 55.6% and 83.8% for Hurthle cell cancer, while positive and negative predictive values were 75.6% and 77.1% for follicular cancer and 75% and 68.4% for Hurthle cell cancer. Conclusions. These results indicate that pre-operative serum Tg measurements might be an important additional diagnostic tool in the pre-operative work-up of patients with thyroid tumours.

Radiotherapy in the elderly

Abstract: Older patients with cancer are frequently victims of discriminatory treatment strategies according to parameters unrelated to the tumour itself. The general approach is influenced by the belief that good tolerance to radiotherapy might be compromised in older patients and that the course of cancer might be less aggressive in this age group. Substandard treatment is therefore often offered to older patients, although this attitude is supported neither by clinical nor by scientific evidence, but rather stems from a lack of specific knowledge of the actual cancer prognosis and the tolerance to radiotherapy in the elderly. In clinical practice advanced age may result in undertreatment, even though patients may have no other medical illness and no functional impairment. Some comorbid conditions which are more frequent in older patients may complicate the outcome of treatment. However, these impaired vital functions are not an intrinsic feature of the elderly. Overall, noncompliance in radiotherapy, related to comorbidity or technical condition, is rare. Short-term radiotherapy using a large daily fraction is often advocated in elderly patients; however, this should only be considered if a palliative treatment option has previously been selected due to the high risk of late side-effects. Acute side-effects often result in decreasing doses of radiotherapy. Data on acute tolerance of radiotherapy for different types of tumours did not demonstrate a radical difference in occurrence of toxicities. 'Reducing' radiotherapy is never a solution, unless the life expectancy of the patient is obviously so short that the tumour recurrence is unlikely to occur or at least to produce substantial morbidity before the patient has died from other causes.

C-erbB-2 protein expression in oesophageal squamous epithelium from oesophageal squamous cell carcinomas, with special reference to histological grade of carcinoma and pre-invasive lesions

Abstract: Aims: C-erb B-2, an oncogene, is member of the growth factor receptor family. Its role in activation of oesophageal squamous cell carcinoma is poorly understood. The aim of this study was to evaluate the part played by c-erb B-2 in oesophageal squamous cell carcinoma in Hong Kong Chinese patients. Methods: We examined the expression of the c-erbB-2 oncoprotein in 104 oesophageal squamous cell carcinomas from 89 men and 15 women, ranging in age from 41 to 89 years (mean 63). C-erb B-2 expression was studied with monoclonal antibody, using an antigen retrieval method. Results: Focal c-erbB-2 membrane staining was present in 10 (10%) of 104 squamous cell carcinomas. Staining was also noted in the adjacent dysplastic epithelium ( n = 2) and non-tumour inflamed epithelium ( n = 2). In carcinomas, the c-erbB-2 membrane staining was identified only in superficial well-differentiated tumour cells and the expression did not predict biological behaviour. Conclusions: We conclude that the c-erbB-2 oncoprotein is expressed in a portion of oesophageal squamous cell carcinomas and precursor lesions. This suggests that c-erb B-2 activation plays a certain role, mostly probably during the early stages, in carcinogenesis in oesophageal squamous cell carcinomas from Hong Kong Chinese patients.