Guy F. Robbins

Recurrent cystosarcoma phyllodes. A clinicopathologic study of 32 cases

A retrospective study was made of recurrent mammary cystosarcoma phyllodes seen at Memorial Sloan‐Kettering Cancer Center from 1932 to 1972. Clinicopathologic findings, clinical course, treatment, and survival are described. It is apparent that cystosarcomas may recur and several years may elapse between recurrences. We found that 18% of the benign and 8% of the malignant cystosarcomas recurred and malignant “transformation” occurred in two of the 28 recurrent benign cystosarcomas.

Physical and psychologic readjustment after mastectomy: an evaluation of Memorial Hospitals' PMRG program.

Memorial Hospital in New York City, the clinical section of the Memorial Sloan‐Kettering Cancer Center, has developed a Post‐Mastectomy Rehabilitation Group (PMRG) Program. The PMRG Program is comprised of a series of structured exercise, information, discussion, and group therapy sessions conducted by a social worker, nurse, physical therapist, and a volunteer from Reach to Recovery. The specific purposes of the program are to help a patient to begin to regain functional use of her arm and shoulder on the affected side, and to adapt functionally, psychologically, and emotionally to the loss of her breast and to the diagnosis of cancer in the shortest time possible. Approximately 1,700 women who underwent mastectomy participated in the program between 1970 and 1974. Some results and conclusions are: the patients age and type of operation are related to physical recovery, resumption of normal activities, return to work, and emotional stress; 84% (661 of 790 patients) resumed normal activities within the four‐month postoperative period; 74% (237 of 317 patients) returned to work (full time) within three months of their mastectomies; 13% (52 of 406 patients) experienced moderate or severe emotional stress; activity per se (any activity, doing something, keeping busy) affects readjustment; the apparent disadvantage of greater trauma with more extensive surgery may be more than compensated for by the relatively young age of that population, and the relatively less physical trauma and injury resulting from simple mastectomies may be overshadowed by the patients age and general physical condition; 98% (284 of 291 patients) reported the PMRG program helpful.

IMMUNOLOGIC REACTIVITY IN PATIENTS WITH PRIMARY OPERABLE BREAST CANCER

Immune reactivity was measured in 134 patients with operable breast cancer and 63 patients with benign breast disease who were tested at the time of breast surgery. The DNCB response was essentially normal in patients who had infiltrating cancer but no regional node metastases (89% were DNCB positive) and was only slightly but not significantly depressed in patients with infiltrating cancer who had nodal metastases (80% were DNCB positive). There was impairment of certain in vitro tests of cellular immune function. There were no significant differences between the patients with cancer and benign breast disease in the mean lymphocyte responses to mitogens and antigens but there were significantly larger proportions of cancer patients with lymphocyte responses below selected cutoff values for several lymphocyte stimulants. The absolute lymphocyte and T cell counts were normal, but there was a small but significant increase in B cells bearing surface immunoglobulins in the breast cancer patients. Serum immunoglobulin levels (IgA, IgG and IgM) were normal in both patient groups. Immune function was also correlated with the pathologic extent of disease or „risk of recurrence.”︁ Only lymphocyte stimulation with PHA showed a continued decrease with increasing extent of disease (p < .05), whereas lymphocyte stimulation with other mitogens and antigens showed a decrease from benign to low risk patients and then a paradoxical increase with increasing amount of disease. There were no distinctive correlations of lymphocyte levels nor of lymphocyte subpopulations, nor of skin test results when these were analyzed according to the prognostic categories of risk.

The Post-Mastectomy Rehabilitation Group program. Structure, procedure, and population demography.

Memorial Hospital, New York City, clinical section of the Memorial Sloan-Kettering Cancer Center, has developed a Post-Mastectomy Rehabilitation Group (PMRG) which provides a comprehensive structure program to enable the mastectomy patient to regain functional use of her arm and shoulder on the affected side, and to adapt functionally, psychologically, and emotionally to the loss of her breast and the diagnosis of cancer in the shortest time possible. This first segment of an evaluation of the program outlines the PMRG structure and operating procedures and presents basic demographic data (age, type of mastectomy, preoperative activity status) for 863 of the 1,400 mastectomy patients who attended the program since inception in 1970. Additional reports will focus on the physical and psychologic aspects of recovery and readjustment.

The Rationale for the Treatment of Women with Potentially Curable Breast Carcinoma

The multicentricity of origin of breast carcinoma and our current inability to determine clinically the histologic status of axillary and internal mammary nodes should be of prime consideration in structuring the treatment plan for women with potentially curable carcinoma of the breast.