O. Le Floch

Low alpha-linolenic acid content of adipose breast tissue is associated with an increased risk of breast cancer

Data derived from experimental studies suggest that alpha-linolenic acid may have a protective effect in breast cancer. Observations obtained from epidemiological studies have not allowed conclusions to be drawn about a potential protective effect of dietary alpha-linolenic acid on breast cancer, possibly because of methodological issues. This case-control study conducted in an homogeneous population from a central area in France was designed to explore the hypothesis that alpha-linolenic acid inhibits breast cancer, using fatty acid levels in adipose breast tissue as a biomarker of past qualitative dietary intake of fatty acids. Biopsies of adipose breast tissue at the time of diagnosis were obtained from 123 women with invasive non-metastatic breast carcinoma. 59 women with benign breast disease served as controls. Individual fatty acids were analysed by capillary gas chromatography. An unconditional logistic regression model was used to obtain odds ratio estimates whilst adjusting for age, menopausal status and body mass index (BMI). No association was found between fatty acids (saturates, monounsaturates, long-chain polyunsaturates n-6 or n-3) and the disease, except for alpha-linolenic acid which showed an inverse association with the risk of breast cancer. The relative risk of breast cancer for women in the highest quartile of adipose breast tissue alpha-linolenic acid level was 0.36 (95% confidence interval=0.12-1.02) compared with those in the lowest quartile (P trend=0.026), suggesting a protective effect of alpha-linolenic acid in the risk of breast cancer. The effects of dietary alpha-linolenic on the risk of breast cancer warrant further study.

Valeur pronostique du nombre de ganglions envahis après curage cervicalpour carcinome de l’oropharynx et de la cavité buccale

PURPOSE To evaluate the relationship between the number of positive nodes and probabilities of locoregional control and survival in patients with invasive squamous cell carcinomas of the oral cavity and oropharynx. MATERIAL AND METHODS Between 1976 and 1993, we treated with curative intent 183 patients (median age: 56 years; standard deviation: 10 years). Seventy-nine patients (43%) had oropharyngeal primary invasive carcinoma and 104 (57%) had oral cavity (excluding the lip) primary invasive carcinoma. Patients with simultaneous primary lesion or visceral metastases were excluded from the analysis. All the patients had neck dissection with at least six nodes to analyse. One-hundred fifty-nine patients (87%) underwent resection of the primary lesion and 158 (86%) were treated postoperatively with external beam irradiation alone or combined with interstitial implant (median dose: 60 Gy; standard deviation: 10 Gy). Average follow-up was 52 months. RESULTS The overall 5-year survival rate using the Kaplan-Meier method was 42.6%. The 5-year survival rates were 60.0% when lymph nodes were histologically negative, 39.5% when one lymph node was positive, 28.0% when two lymph nodes were positive and 24.4% when three or more lymph nodes were positive (P = 0.0004). The number of positive nodes did not significantly influence the specific disease-free survival and locoregional control rates. CONCLUSION Patients with one or more positive neck nodes must have postoperative treatment.

Enhanced acute toxicity in oropharynx carcinoma treated with radiotherapy and concomitant cisplatin, 5-fluorouracil and mitomycin C.

The aim of this study was to establish the feasibility of giving concomitant radiotherapy and 3 cycles of chemotherapy with cisplatin (CDDP), 5-fluorouracil (5-FU) and mitomycin C (MMC) in locally advanced inoperable oropharyngeal cancer. From March 1990 to September 1993, 27 male patients (mean age 55 years) were included in this study. 3 patients (11%) were T2N0, 19 (70%) T3 (T3N0: n = 9, T3N1: n = 1, T3N2: n = 5, T3N3: n = 4), and 5 (19%) T4 (T4N0: n = 1, T4N1: n = 1, T4N2: n = 2, T4N3: n = 1). All patients received conventional radiotherapy delivering 70 Gy in 35 fractions and 52 days, and three cycles of chemotherapy starting on day 1, 21 and 42 with CDDP 20 mg/m2 and 5-FU 400 mg/m2 day 1 to day 4, and MMC 10 mg/m2 day 1. With a mean follow-up of 34 months (17-59), 10 patients (37%) were alive and free of disease. Among the 17 other patients, 8 died of cancer. Crude locoregional control rate was 78%, and probability of local control at 1 and 2 years was 85 and 80%, respectively. One- and 2-year survival rates were 48 and 31%, respectively, for both overall and disease-free survival. Grade 3 or 4 mucositis occurred in 22 patients (81%); enteral feeding was necessary for 63%; mean weight loss was 5.7 kg. Grade > 2 thrombocytopenia occurred in 11 patients (41%), grade > 2 neutropenia in 8 patients (29%), grade > 2 anaemia in 4 patients (15%). Febrile neutropenia or aplasia occurred in 5 patients (19%). 2 patients (7%) died during treatment of haematological or infectious complications related to the treatment. Another patient died 1 month after treatment with grade 4 thrombocytopenia and septicaemia. In conclusion, a high complete response rate has been achieved with this concomitant chemo- and radiotherapy, but with severe digestive and haematological toxicity. Addition of MMC to 5-FU and CDDP might have been responsible for this increased toxicity. This therapeutic combination is therefore not routinely feasible.

Évaluation de la dose cutanée mammaire délivrée au cours des irradiations par cobalt 60 pour traitement conservateur des cancers du sein

Resume Une methode simple est proposee pour la determination de la dose definie a la face posterieure du derme, situee a 1 mm de profondeur sous la peau, pour les traitements conservateurs des cancers du sein traites par cobalt 60. Elle consiste a evaluer la dose cutanee a partir de la dose maximale delivree par chacun des deux faisceaux tangentiels interne et externe utilises pour le traitement. La dose cutanee, due au faisceau tangentiel interne, est egale a 90 % de la dose maximale delivree par le faisceau tangentiel interne, et la dose cutanee, due au faisceau tangentiel externe, est egale au produit de la dose maximale delivree par le faisceau externe par le rendement en profondeur correctement choisi. La validite de la methode a ete verifiee par des mesures in vivo chez neuf patientes.

707 Prognostic value and predictive factors of tumor sterilization after preoperative radiotherapy for rectal cancer

Between 07/1977 and 10/1993, 147 patients (pts) received preoperative radiotherapy (RT) for rectal adenocarcinoma. There was 64 T2, 56 T3, 25 T4 tumors and 2 relapses after prior surgery. Median total dose of RT was 44 Gy (5–73 Gy), median fractionation 5 fractions (1–5) of 2 Gy (1.5–5 Gy) per week, and median duration of RT 5 weeks (1 day–9 weeks). Seventy-nine pts were treated with a 2-field technique, 66 pts with a 4-field technique and 2 pts with a direct perineal field. Median treated volume was 4.4 liters (1.2–9.4). One hundred and twenty pts were treated with X25 MV, the other 27 pts with 1.25 Mev 60 Co. All irradiated rectal tumors have been reanalyzed by the same pathologist in order to quantify tumor sterilization. Three groups were individualized according to the residual tumor cell density (RTCD): absence or low, intermediate and high. All pts underwent surgery in a median delay of 4 weeks. Fifty-five tumors (37%) showed no (9/147) or low (46/147) RTCD; 51 (35%) showed an intermediate RTCD and 39 (27%) a high RTCD. The distribution of the pts according to age, tumor stage, tumor location, delay before surgery and RT parameters (total dose, fractionation, duration of treatment, 2 or 4-field technique, treated volume, X25 MV or 1.25 Mev 60 Co photons) was not statistically different in the 3 groups. Five-year actuarial survival rates were 100% in the group of pts with no RTCD, 54% in the group with low RTCD, 44% in the group with intermediate RTCD and 53% in the group with high RTCO. The difference did not reach significance, probably because of the small number of sterilized tumors. These results suggest however that tumor sterilization is a favorable prognostic factor after preoperative RT in rectal cancer.