Barry W. Feig

Classifying local disease recurrences after breast conservation therapy based on location and histology: New primary tumors have more favorable outcomes than true local disease recurrences

To distinguish true local recurrences (TR) from new primary tumors (NP) and to assess whether this distinction has prognostic value in patients who develop ipsilateral breast tumor recurrences (IBTR) after breast‐conserving surgery and radiotherapy.

Response to preoperative chemoradiation increases the use of sphincter-preserving surgery in patients with locally advanced low rectal carcinoma.

Although controversial, some believe that preoperative chemoradiation increases the use of sphincter‐preserving surgery in low rectal carcinoma patients. This article investigates the relationship between objective tumor response and sphincter preservation in low rectal carcinoma patients.

CPT-11 plus cisplatin in patients with advanced, untreated gastric or gastroesophageal junction carcinoma: results of a phase II study.

This Phase II study assessed the response rate and toxicity profile of the combination CPT‐11 and cisplatin administered weekly to patients with untreated, advanced adenocarcinoma of the stomach or the gastroesophageal junction.

Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast-conserving therapy

Meric et al. recently concluded that currently available data are not sufficient to determine conclusively whether distant metastases are caused by the development of ipsilateral breast tumor recurrence (IBTR). The authors of at least four randomized, prospective trials do not agree. For example, the National Surgical Adjuvant Breast and Bowel Project (NSABP) concluded that local recurrence is a marker for risk (and not a cause) of distant metastases. Meric et al. also concluded that it would be difficult to argue biologically that malignant cells in the primary tumor could metastasize and affect survival while arguing that malignant cells in the recurrent tumor could not. I have offered this explanation. It is likely that cancer cells begin to circulate when a tumor is very small. Cells shed from a small tumor may succumb to a variety of host defense factors—mechanical, biochemical, immunologic, etc. After breast-conserving surgery, cancer may recur locally. (Here, I prefer the term local persistence.) Patients who survive their first cancer without developing distant metastases may be expected to survive the recurrence of a similar volume of tumor, because the host defense factors that killed tumor cells from the primary tumor can be expected to kill tumor cells shed from the recurrence (persistence). Local recurrence after radical surgery has always been an ominous event. It may represent the return of malignant cells from a distant organ to the site of surgery. Local recurrence also may occur after breast-conserving surgery. This is one reason why patients who develop IBTR have a poorer prognosis compared with patients who do not. In NSABP trial B-06, patients who developed local recurrence were 3.41 times as likely to also develop distant metastases. This is not evidence that IBTR is the cause of tumor spread. Investigators from the NSABP trial B-06 recently reported a marginally significant decrease in breast cancer deaths among women who received postoperative radiotherapy. This finding is fully compatible with the above hypothesis. The excess deaths in the unirradiated group may have occurred in women whose recurrences exceeded their primary tumors in terms of volume. I asked the NSABP for data on the size of tumor recurrences and was told that such data are not available. Meric et al. discussed the possible survival advantage associated with local control. They cited important studies that will help us fine-tune our understanding of this dilemma. However, the past 15 years have witnessed a dramatic change in our understanding of local recurrence. Local persistence seldom metastasizes in patients with the soft tissue sarcomas, rectal carcinoma, melanoma, and other solid tumors. Investigators at The University of Texas M. D. Anderson 2522

Breast conservation after neoadjuvant chemotherapy: A prognostic index for clinical decision-making

The appropriate selection criteria for breast‐conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision‐making for patients treated by this multimodality approach.

Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas

Downstaging of large soft tissue sarcomas can be accomplished by the use of neoadjuvant chemotherapy (NeoCT). The authors tested the hypothesis that radiographic response to NeoCT predicts improved local control and survival.

Patterns of recurrence in extremity liposarcoma: Implications for staging and follow-up

Liposarcoma is one of the most common histologic types of soft tissue sarcoma and presents a wide spectrum of clinical behavior. The authors examined the correlation among histologic subtypes, outcomes, and patterns of recurrence among patients with extremity liposarcomas.

Contralateral prophylactic mastectomy: Predictors of significant histologic findings

Women with unilateral breast carcinoma are at increased risk for developing contralateral breast carcinoma (CBC). The authors sought to identify predictors of malignant or moderate to high‐risk histologic findings in contralateral prophylactic mastectomy (CPM) specimens, and to determine the efficacy of CPM.

Clinical outcome of patients with lymph node-negative breast carcinoma who have sentinel lymph node micrometastases detected by immunohistochemistry

The ideal pathologic assessment of sentinel lymph nodes (SLNs) in patients with breast carcinoma remains controversial. The authors evaluated how detailed assessment of SLNs using immunohistochemistry (IHC) and serial sectioning would affect treatment decisions and outcomes in patients with breast carcinoma who had negative SLNs on standard hematoxylin and eosin staining.

Surgical management of soft tissue sarcomas of the hand and foot

Soft tissue sarcomas of the hand and foot present unique management challenges. The purpose of the current study study was to determine oncologic outcome, particularly with respect to factors affecting local recurrence, distant recurrence, and disease‐specific survival.