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OBJECTIVES: With effective screening programmes, the global incidence of in situ ductal carcinoma of the breast has risen to 15%, representing 20 to 30% of the mammographically detected T0 tumours. Prognosis is generally good in these tumours, but treatment has in the past, paradoxically, relied on extensive surgery. We report our experience with conservative radiosurgery performed in such cases from 1980 to 1990. METHODS: There were 86 patients with a mean age of 52 years. Initial TNM classification was T0 = 57, T1 = 17, T2 = 9 and Tx = 3. All underwent limited surgery (quadrantectomy: 17; lumpectomy: 69) and 49 had axillary dissection. All received breast irradiation with scar boost (46-50 Gy + 10-14 Gy with classical fractionation). Thirty one postmenopausal women received adjuvant tamoxifen. The quality of the resection was good in 77 cases, doubtful or incomplete in 9. In one case axillary nodal involvement was found. The histological subtype was clearly identified in 63 cases. With a median follow-up of 58 months, 3 local relapses occurred (3.4%), at 27, 48 and 52 months respectively. One was in situ and two invasive. All were clinical lesions (2 T1 and 1 T2); two had incomplete or doubtful excision and all received less than 60 Gy on the tumour bed. All had mastectomy. Two are alive and well but one developed multiple metastasis. Five other women had subsequent surgery for suspicion of local relapse but all had benign disease. One developed contralateral disease 20 months later. Two women died subsequently due to a second cancer. CONCLUSION: These results confirm the importance of the excision quality and suggests a possible dose-effect in the control of in situ ductal carcinoma by radiotherapy. The recent results of the B-17 NSBAP trial also conclude that the radiosurgical conservative treatment, for limited in situ ductal carcinoma, is a reasonable alternative to mastectomy.

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We screened thirteen male breast cancers for the presence of germline mutations in exons 2 and 3 encoding the DNA-binding domain of the androgen receptor. These two exons were amplified from genomic DNA extracted from patients' white blood cells. In one of these thirteen patients, single strand conformation polymorphism and direct sequencing detected a guanine-adenine point mutation at nucleotide 2185 that changes Arg608 into Lys in a highly conserved region of the second zinc finger of the androgen receptor. This mutation occurred in a 38 year old man with partial androgen insensitivity syndrome and normal androgen-binding capacity in cultured genital skin fibroblasts. To our knowledge, only one germline Arg to Gln androgen receptor gene mutation has been previously reported at position 607 in male breast cancer. This androgen receptor mutation along with the Arg608 into Lys mutation we describe, suggests that this genetic abnormality is not fortuitous: a decrease in androgen action within the breast cells could account for the development of male breast cancer by the loss of a protective effect of androgens on these cells. Activation of estrogen regulated genes by the change of DNA-binding characteristics of the mutant androgen receptor cannot, however, be ruled out.

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In a retrospective and multicentre study 106 cases treated from 1970 to 1985 were analysed. The patients' median age was 64 years. TNM classification showed 20 T1, 48 T2, 2 T3, 32 T4 and 4 Tx. Twenty one patients had clinical gynaecomastia; 99 underwent surgery and 85 radiotherapy; 32 received adjuvant chemotherapy or hormonal therapy. The main histological type was ductal infiltrating carcinoma; 82 axillary dissections were performed, and positive lymph nodes were found in 67 percent of the cases. Hormone receptors were positive in 15 out of 20 measured cases. Five and 10 years overall survival rates (Kaplan-Meier) were 57 and 37 percent, and corrected survival rates 68 and 55 percent respectively. The main prognostic factor remains the clinical size of the tumour (T) and histologically axillary node status (pN). Eleven patients developed a second metachronous cancer. The aetiology of male breast cancer is a poorly known as that of female breast cancer. Nevertheless, imbalance among oestrogens and androgens due to metabolic, infectious or pharmacological causes is probably responsible, at least in part, for this cancer. An on-going multicentre prospective national trial tries to address this question.

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Male breast cancer represents about only 1% of all breast cancers. We have analysed a retrospective, multicentric series of 404 patients, initially non-metastatic, with mean age of 63 years. The 5 and 10-year overall survival rates were 65 and 36% respectively. Sixty-eight patients developed secondary cancer. From ten patients who already presented with cancer (2.5%) 3 cases corresponded to prostatic cancer treated by estrogen. Four had synchronous cancer (1%). Three and eight patients respectively had a synchronous and metachronous contralateral breast cancer (2.7% of bilateral cancer). Forty-three other patients (10.6%) developed metachronous cancer. The main tumor types were: prostate (9), lung (6), colon and rectum (6), esophagus (4). Four patients developed various hematologic malignancies and 14 patients, various types of solid tumors. From these 43 patients, 27 died; 19 as a result of secondary cancer. This represents 9% of all deaths among the 404 patients. While the bilateral cancer rate is similar to women, the second cancer rate appears to be higher in men. From hematological malignancies, chemotherapy and radiotherapy do not seem to contribute to this high incidence of second cancer.

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Ductal carcinoma in situ of the breast is very rare in men, representing 0-7% of all male breast cancers. We analysed 15 cases from a retrospective multicentric series of 404 patients (3.7%). It occurs earlier than infiltrating carcinoma (mean age: 55 years), sometimes before 40 years of age. The main symptoms are bloody nipple discharge or retro areolar mass. Modified radical mastectomy constitutes the basic treatment. Lower axillary dissection can eventually be indicated in comedocarcinoma or in tumors larger than 25 mm. The main histologic subgroup is papillary carcinoma, pure or intracystic. As is the case in women, local recurrence, invasive or not, rarely occurs. Theoretically, the cure rate approaches 100%. However, as in all cases of breast cancer in men, an important number of deaths due to secondary cancer or intercurrent disease have been noted. Until now, no clear etiologic factors have been found.

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Used in 13 cases of advanced gynecological and gastrointestinal carcinoma, pelvic exclusion using a suspension of the small intestine above the pelvis using absorbable material. The low-level of morbidity, value in dosimetric estimation, perfect feasibility and low cost of this technique should lead to its more widespread use whilst strictly respecting its indications. Nuclear magnetic resonance has been found to be a particularity novel and valuable method of post-operative investigation in visualisation and assessment of resorption of the polyglactine 910 trellis. Results in this series are analyzed at the end of a 5 to 14 month follow-up period and compared with data from experimental and clinical studies in the recent world literature.

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