RE: [MOL] my mail- Ben [00988] Medicine On Line


[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]

RE: [MOL] my mail- Ben



A ok.

> -----Original Message-----
> From:	Benjamin Epstein [SMTP:ben91123@hotmail.com]
> Sent:	Saturday, July 24, 1999 11:50 AM
> To:	mol-cancer@lists.meds.com
> Subject:	[MOL] my mail
> 
> I am testing to see if my mail is going through to MOL.  Have tried over
> the 
> past several days with no avail.
> 
> Ben
> 
> 
> >From: "Lillian" <firefly@islc.net>
> >Reply-To: mol-cancer@lists.meds.com
> >To: "mol-cancer" <mol-cancer@lists.meds.com>
> >Subject: [MOL] DCIS Management
> >Date: Fri, 23 Jul 1999 22:49:50 -0700
> >
> >Management of DCISManagement of ductal carcinoma in situ (DCIS, or 
> >intraductal carcinoma) remains a clinical challenge. The recent report of
> 
> >the results of NSABP B-24 , published in The Lancet[1] on June 2, 1999, 
> >will certainly have an impact on clinical practice for DCIS. This study 
> >randomized more than 1800 women with DCIS to treatment with either 
> >lumpectomy and radiation therapy, or lumpectomy, radiation therapy, and 
> >tamoxifen taken for 5 years. Eligible patients had DCIS with or without 
> >lobular carcinoma in situ (LCIS) who were treated with lumpectomy.
> Patients 
> >with microscopic involvement of surgical margins were eligible. All 
> >patients received 5000cGy of breast irradiation and then received either 
> >tamoxifen 10mg PO BID or placebo. The data were reported for median 
> >follow-up of 74 months.
> >The patient population included women from a wide age distribution. Most 
> >(>80%) had small DCIS lesions (< 1cm), which were nonpalpable and 
> >mammographically detected (>80%). Three fourths of patients had negative 
> >margins, and half the DCIS lesions were without comedonecrosis (ie, were 
> >not high-grade).
> >
> >Treatment with tamoxifen reduced the incidence of all breast events, 
> >including both ipsilateral and contralateral cancers, and both invasive
> and 
> >noninvasive tumors. The principal benefit was in the reduction of 
> >ipsilateral invasive tumors, though there was also a reduction in risk of
> 
> >invasive contralateral tumors. The magnitude of these benefits was small 
> >when expressed in absolute terms: the reduction in invasive cancers went 
> >from 7.2% risk at 5 years to 4.1%, with two thirds of this risk reduction
> 
> >seen in the ipsilateral breast. The incidence rate of noninvasive cancer 
> >went from 6.2% to 4.2% with tamoxifen, although this difference was not 
> >statistically significant.
> >
> >Subgroup analysis indicated that tamoxifen was effective in reducing the 
> >rate of breast cancer events irrespective of age, tumor margin status, or
> 
> >presence/absence of comedonecrosis, or whether the tumor was originally 
> >clinically palpable. However, the magnitude of any benefit is smaller in 
> >the more favorable subgroups (age > 50, negative tumor margins, absent 
> >comedonecrosis, mammographically detected) as recurrence rates among
> these 
> >subsets of patients were much lower.
> >
> >As in previous large studies of tamoxifen, the treatment was generally 
> >well-tolerated. There were slightly more side effects in the 
> >tamoxifen-treated group, including a 1% risk of thromboembolic event 
> >(either deep vein thrombosis or pulmonary embolism), and increased 
> >incidence rates of hot flashes, vaginal discharge, fluid retention, and 
> >menstrual dysfunction. These were all generally mild. Psychological
> surveys 
> >revealed no significant differences in mood among patients receiving
> either 
> >placebo or tamoxifen.
> >
> >This large, well-controlled trial demonstrates that tamoxifen can prevent
> 
> >ipsilateral invasive cancers and reduce the rate of contralateral cancers
> 
> >in women with DCIS also treated with lumpectomy and radiation. These 
> >findings are in accord with the results of the NSABP P-1 prevention 
> >trial,[2] which showed that tamoxifen could reduce the incidence of 
> >invasive breast tumors among women at high risk for developing breast 
> >cancer, including women with a history of LCIS.
> >
> >Some patients may require mastectomy for management of DCIS. For those in
> 
> >whom lumpectomy achieves adequate tumor resection, radiation therapy has 
> >been shown to reduce the rate of ipsilateral recurrence,[3] and now 
> >tamoxifen may be recommended as an additional adjuvant measure. But does 
> >every patient with DCIS require these adjuvant treatments? A provocative 
> >single-institute experience was recently reported in The New England 
> >Journal of Medicine by Dr. Silverstein and colleagues in California.[4] 
> >Although this was not a randomized trial, but rather an historical review
> 
> >of a single center's experience, it may help refine future trials for
> DCIS. 
> >In this study, the likelihood of cancer recurrence after DCIS was 
> >determined as a function of the margin widths of the excised lesion.
> Among 
> >patients with margins in excess of 10mm, there did not appear to be any 
> >benefit to the addition of radiation therapy to surgery in control of 
> >cancer recurrence. For patients with margins between 1mm and 10mm, the 
> >difference in outcome between patients who did or did not receive
> radiation 
> >was not statistically significant. For patients with margins less than
> 1mm, 
> >there was a clear benefit for adding radiation to surgery in improving 
> >local control.
> >
> >Collectively, these reports lead the way for future trials in management
> of 
> >DCIS. While "standard of care" remains lumpectomy followed by radiation 
> >therapy, it is now reasonable to consider adding tamoxifen to the
> adjuvant 
> >care of women with DCIS. Inevitably, these therapies mean "overtreatment"
> 
> >for a large number of women. Randomized trials will be needed to
> establish 
> >the clinical characteristics of patients and tumors that allow for less 
> >treatment. It is possible that in the future, research trials may show
> that 
> >patients with generous margins do not benefit from additional radiation 
> >therapy.
> >
> 
> 
> _______________________________________________________________
> Get Free Email and Do More On The Web. Visit http://www.msn.com
> ------------------------------------------------------------------------
> This is an automatically-generated notice.  If you'd like to be removed
> from the mailing list, please visit the Medicine-On-Line Discussion Forum
> at <http://www.meds.com/con_faq.html>, or send an email message to:
> majordomo@lists.meds.com
> with the subject line blank and the body of the message containing the
> line:
> unsubscribe mol-cancer your-email-address
> where the phrase your-email-address is replaced with your actual email
> address.
> ------------------------------------------------------------------------
------------------------------------------------------------------------
This is an automatically-generated notice.  If you'd like to be removed
from the mailing list, please visit the Medicine-On-Line Discussion Forum
at <http://www.meds.com/con_faq.html>, or send an email message to:
majordomo@lists.meds.com
with the subject line blank and the body of the message containing the line:
unsubscribe mol-cancer your-email-address
where the phrase your-email-address is replaced with your actual email
address.
------------------------------------------------------------------------