Magdi Mohamed Mashly

The effectiveness of breast-conserving surgery for patients with locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NACT) is still a controversial issue, and variable incidences of locoregional failures have been reported. The present study was conducted to pathologically assess the response of LABC to NACT, and also to evaluate the efficacy of preoperative clinical examination and mammography in detecting these pathological changes. A total of 38 patients with LABC received NACT in the form of three cycles of fluorouracil/adriamycin/cyclophosphamide and were then subjected to a mastectomy. The residual tumors in the mastectomy specimens were measured, mapped, and compared to the pretreatment and preoperative clinical and mammographic findings for evaluation. An objective response to NACT was observed in 70.4% of the patients; however, only 26.7% of them were suitable candidates for conservative surgery. The rest of the responders showed an increased incidence of multifocality and in situ lesions localized within the original tumor-bearing area. Both clinical examinations and mammography were inadequate for the selection of candidates for breast conservation. Tumor regression by NACT is probably induced by a process of tumor segmentation. It is also associated with an increased incidence of multifocality and in situ lesions.

The effectiveness of breast-conserving surgery for patients with locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NACT) is still a controversial issue, and variable incidences of locoregional failures have been reported. The present study was conducted to pathologically assess the response of LABC to NACT, and also to evaluate the efficacy of preoperative clinical examination and mammography in detecting these pathological changes. A total of 38 patients with LABC received NACT in the form of three cycles of fluorouracil/adriamycin/cyclophosphamide and were then subjected to a mastectomy. The residual tumors in the mastectomy specimens were measured, mapped, and compared to the pretreatment and preoperative clinical and mammographic findings for evaluation. An objective response to NACT was observed in 70.4% of the patients; however, only 26.7% of them were suitable candidates for conservative surgery. The rest of the responders showed an increased incidence of multifocality and in situ lesions localized within the original tumor-bearing area. Both clinical examinations and mammography were inadequate for the selection of candidates for breast conservation. Tumor regression by NACT is probably induced by a process of tumor segmentation. It is also associated with an increased incidence of multifocality and in situ lesions.

Bilharzial bladder cancer represents a distinct clinicopathological entity. To investigate whether gemcitabine-cisplatin is also active against bladder cancer of bilharzial origin, we performed a phase II study of previously untreated patients with stage III/IV disease. Standard eligibility criteria were used. Patients received gemcitabine (1000 mg/m2) on days 1, 8 and 15 and cisplatin (70 mg/m2) on day 2 of every 28-day cycle. The 32 males and 5 females had a median age of 59 years (range: 29-81 years). Of 33 evaluable patients, 8 (24%) achieved complete responses, and 10 (30%) partial responses, for an overall response rate of 55%. 3 patients had minor responses. Responses were observed at all disease sites including lung and liver lesions. Myelosuppression was significant but manageable. Non-haematological toxicity was limited mainly to nausea and vomiting and raised liver enzymes. Thus, these data suggest that gemcitabine plus cisplatin induces high response rates in patients with bilharzial bladder cancer with a moderate toxicity profile. Copyright (C) 2000.

Bilharzial bladder cancer represents a distinct clinicopathological entity. To investigate whether gemcitabine-cisplatin is also active against bladder cancer of bilharzial origin, we performed a phase II study of previously untreated patients with stage III/IV disease. Standard eligibility criteria were used. Patients received gemcitabine (1000 mg/m2) on days 1, 8 and 15 and cisplatin (70 mg/m2) on day 2 of every 28-day cycle. The 32 males and 5 females had a median age of 59 years (range: 29-81 years). Of 33 evaluable patients, 8 (24%) achieved complete responses, and 10 (30%) partial responses, for an overall response rate of 55%. 3 patients had minor responses. Responses were observed at all disease sites including lung and liver lesions. Myelosuppression was significant but manageable. Non-haematological toxicity was limited mainly to nausea and vomiting and raised liver enzymes. Thus, these data suggest that gemcitabine plus cisplatin induces high response rates in patients with bilharzial bladder cancer with a moderate toxicity profile. Copyright (C) 2000.