Charles A. Hubay

Progesterone Receptors as a Prognostic Factor in Stage II Breast Cancer

Abstract The presence of estrogen receptors in breast cancers is now accepted as a predictor of extended disease-free survival, but the relative value of progesterone receptors for this purpose has not been established. We have examined both receptors along with other risk factors in 189 patients receiving adjuvant therapy for Stage II breast cancer. The presence of either estrogen receptors or progesterone receptors was positively correlated with disease-free survival when analyzed separately, whether or not the adjuvant regimen included an endocrine component. However, when estrogen receptors and progesterone receptors were analyzed together in multivariate models, the presence of progesterone receptors was more significant than that of estrogen receptors for predicting time to recurrence, regardless of what other variables were included in the model. These data suggest that determination of the progesterone-receptor concentration is of equal or greater value than determination of the estrogen-receptor ...

Pathogenesis of post-traumatic sympathetic dystrophy

Abstract 1. 1. Sixty-one cases of sympathetic dystrophy are reviewed with reference to the wide disparity in clinical description and concepts of pathogenesis found in the literature. The only symptom found consistently is pain in the injured extremity. 2. 2. Sympathetic dystrophy is considered to be fundamentally the same entity as causalgia. The only significant difference between them is that causalgia is initiated by an injury to a mixed peripheral nerve whereas in sympathetic dystrophy there may have been no such demonstrable injury. The term, Sudecks atrophy, should be reserved to describe the osteoporosis occasionally found in causalgic states. 3. 3. The pathogenesis of causalgia and causalgic states is represented as a vicious circle of reflexes under the modifying influence of hypothalamic and environmental factors. Pathogenesis is discussed with reference to pertinent neurophysiological experiments. 4. 4. Causalgic pain which is unresponsive to a short trial of conservative measures should be treated by sympathetic denervation of the involved extremity. Failure to institute prompt therapy may result in intractable pain and irreversible structural changes.

Estrogen receptor status as a prognostic indicator for stage I breast cancer patients

SummaryThe prognostic value of estrogen receptor determination was studied for 510 stage I (axillary node negative) breast cancer patients treated by mastectomy alone.Results at 60 months after mastectomy indicate that stage I patients whose tumors lack estrogen receptors fall into a significantly poorer prognostic group for both recurrence and survival than those whose tumors contain estrogen receptors.Within the postmenopausal group, estrogen receptor negative (ER −) patients are recurring more rapidly than estrogen receptor positive (ER +) patients. Within the premenopausal group, ER + patients have a recurrence rate identical to ER− patients, which is apparent only after prolonged follow-up.In contrast to postmenopausal ER + patients, premenopausal ER + patients appear to have no prognostic advantage over the ER − patients, and thus constitute a high risk group for which adjuvant endocrine therapy might prove beneficial.

Initial experience with nuclear magnetic resonance (NMR) imaging of the human breast.

Two patients with breast abnormalities, one malignant and one benign, were studied with nuclear magnetic resonance (NMR) imaging utilizing a cryogenic superconducting magnet. Three-dimensional NMR images were obtained in one case and single slice planar images were obtained in the other. The NMR images correlated well with the corresponding mammograms. Although both conditions exhibited a different signal intensity for the area of abnormality compared to adjacent ductal and fatty tissue, the configuration of the abnormal areas allowed distinction between benign and malignant process.

Hormone Receptors: An Update and Application

The introduction of measurements of hormone receptors in breast cancer tumor specimens provides a major advance in selection of patients likely to have hormone-dependent cancers. Endocrine adjuvant treatment for estrogen-positive breast cancers in both pre- and postmenopausal women has been shown to be effective in delaying recurrence. Whenever possible, estrogen and progesterone receptors should be measured in tumor tissue from all patients with breast cancer.

Endocrine versus endocrine plus five-drug chemotherapy in postmenopausal women with stage II estrogen receptor-positive breast cancer

Postmenopausal women who underwent modified radical mastectomy for Stage II, estrogen receptor (ER)‐positive breast cancer were randomized to receive endocrine treatment (tamoxifen [T], 40 mg daily for 3 years) alone versus endocrine treatment plus five‐drug chemotherapy (Cytoxan [cyclophosphamide, C], methotrexate [M], 5‐fluorouracil [F], vincristine [V], and prednisone [P], CMFVP, for 1 year). Chemotherapy consisted of oral P (1 month), oral C (12 months), and intravenous MFV weekly for the first 3 months, biweekly for 3 months, and triweekly for 6 months. Patients were entered into the study from October 1979, to October 1985, and the median follow‐up is 55 months. Results show that with 94 postmenopausal women, disease‐free survival (DFS) is significantly greater (P = 0.04, log‐rank test; P = 0.03, multivariate analysis) in patients receiving CMFVPT as compared to those receiving T alone. These results suggest that intensive chemotherapy combined with T is more effective in delaying recurrence than T alone in postmenopausal patients.

Arterial bypass via the obturator foramen : An alternative in complicated vascular problems

Abstract 1. 1. The indications and technic of arterial bypass via the obturator foramen are reviewed. 2. 2. Experience with this technic and the details of four cases are discussed. 3. 3. The procedure is a useful alternative in the patient with a complicated vascular problem, and extends the surgeons role in femoral artery revascularization.

Adjuvant endocrine therapy, cytotoxic chemotherapy, and immunotherapy in stage-II breast cancer: Five-year results

SummaryFive-year results of a prospective, randomized clinical trial of three treatment regimes—(a) cytoxan, methotrexate, and 5-fluorouracil (CMF); (b) CMF plus the antiestrogen drug, tamoxifen (CMFT); and (c) CMFT plus bacillus Calmette-Guerin (BCG) vaccinations—in 312 women with stage-II breast cancer are reported. Estrogen receptors (ER) were measured in all of the primary tumors. Addition of tamoxifen to CMF therapy significantly decreased the number of recurrences at five years in ER positive patients with four or more positive axillary lymph nodes. Addition of tamoxifen to CMF had no effect on disease-free survival in ER-positive patients with 1–3 positive axillary lymph nodes or in patients with ER-negative tumors. Addition of BCG vaccinations had no discernible effect on disease-free survival. ER measurements in the primary tumor provide important prognostic information regardless of treatment, with ER-positive patients having lower recurrence rates and mortality after five years. ER measurements also have predictive value for response to endocrine therapy. Further follow-up is needed to determine whether tamoxifen is delaying recurrence or preventing it in a subset of these patients.

Adjuvant endocrine therapy, cytotoxic chemotherapy and immunotherapy in stage II breast cancer: 6-year result

Six-year results of a prospective, randomized clinical trial of three treatment regimens [(1) cytoxan, methotrexate and 5-fluorouracil (CMF); (2) CMF plus the antiestrogen drug, tamoxifen (CMFT); (3) CMFT plus Bacillus Calmette-Guerin (BCG) vaccinations] in 312 women with stage II breast cancer are reported. Addition of tamoxifen to CMF therapy significantly decreased the number of recurrences at 6 years in ER + patients with greater than or equal to 4 positive axillary lymph nodes, and in those with tumor diameter in excess of 3 cm. The beneficial effect of tamoxifen appeared to be independent of the menopausal status. Addition of tamoxifen to CMF had no effect on disease-free survival in ER + patients with 1-3 positive axillary lymph nodes or in patients with ER--tumors. Addition of BCG vaccinations had no discernible effect on disease-free survival. ER measurements in the primary tumor provide important prognostic information regardless of treatment, with ER + patients having increased overall survival after 6 years. Further follow-up is needed to determine whether tamoxifen is delaying recurrence or preventing it in a subset of these patients.

Appearance of Protein Tagged with Radioactive Iodine in Thoracic Duct Lymph

Conclusions 1. The total lymph volume is not measurable, so that the exact amount of activated protein that is present in the body lymph, following intravenous injection of iodinated protein, cannot be calculated. However, it appears from this experiment that a negligible amount is present in the thoracic duct lymph 10 minutes after injection. 2. During the first hour there is a rapid increase in the lymph content of radioactive protein followed by a more gradual rise.