RESUMEN
Forty patients with metastatic breast cancer who had received no previous cytotoxic therapy were treated with a combination chemotherapy program CMF (P), which included methotrexate, 60 mg/m2, and 5-fluorouracil, 700 mg/m2 intravenously on the first and eighth days, in addition to cyclophosphamide, 100 mg/m2, and prednisone, 40 mg/m2, by mouth daily from the first to the fourteenth day of a 28-day cycle. Only 2 of 25 patients responded to hormonal therapy or endocrine ablation. Twenty-seven of the 40 patients (68%) had a complete response (8 patients) or partial response (19 patients). Lung, soft tissue, and nodal metastases were the most responsive sites. The median survival of 18 months for the responding group. The nonresponders had a median survival of 4 months. The toxicity was primarily hematologic and was especially severe in patients with functional liver impairment due to metastatic disease.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Fluorouracilo/uso terapéutico , Metotrexato/uso terapéutico , Adulto , Neoplasias Óseas/tratamiento farmacológico , Neoplasias de la Mama/mortalidad , Quimioterapia Combinada , Femenino , Fluorouracilo/efectos adversos , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Metotrexato/efectos adversos , Persona de Mediana Edad , Metástasis de la Neoplasia , Prednisona/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
Attention is called to the development of coronary heart disease in two patients several years after they received mediastinal irradiation for Hodgkin's disease. One patient, a 33 year old man, died suddenly eight years after irradiation; necropsy disclosed marked narrowing of all three major coronary arteries. In addition to severe intima fibrous thickening, there also was considerable adventitial scarring of the coronary arteries. This type of coronary sclerosis is different from that seen in the usual patient with coronary heart disease. The second patient, a 42 year old man, had an acute myocardial infarction on two occasions, the first six years after mediastinal irradiation. Observations in previously described patients with coronary heart disease almost surely induced by therapeutic irradiation for Hodgkin's disease are reviewed.
Asunto(s)
Enfermedad Coronaria/etiología , Enfermedad de Hodgkin/radioterapia , Neoplasias del Mediastino/radioterapia , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Adulto , Enfermedad Coronaria/patología , Vasos Coronarios/efectos de la radiación , Humanos , Masculino , Dosificación Radioterapéutica , Factores de TiempoAsunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Quimioterapia Combinada , Médula Ósea/fisiopatología , Neoplasias de la Mama/fisiopatología , Ciclofosfamida/uso terapéutico , Femenino , Fluorouracilo/uso terapéutico , Humanos , Hígado/fisiopatología , Metotrexato/uso terapéutico , Prednisona/uso terapéuticoRESUMEN
Twenty-five patients with advanced metastatic breast cancer were treated with the combination of methotrexate 60 mg/M(2) and 5-fluorouracil 700 mg/M(2) intravenously on the first and eighth days, and cyclophosphamide 100 mg/M(2) and prednisone 40 mg/M(2) by mouth daily for the first 14 days of a 28-day cycle. The patients had had no previous chemotherapy or extensive radiotherapy and all but two had not responded to hormonal therapy or endocrine ablation. The major metastatic lesions were: lung (12 patients), liver (four patients), bone (four patients), soft tissue (three patients), nodes (two patients). Seventeen of the 25 patients (68%) responded to treatment with seven complete remissions; these included patients suffering metastatic lesions in the lung, nodes, and soft tissue. The overall median duration of response was nine months (range 6-26 months). Toxicity was primarily haematological, but the group received an average of at least 75% of their calculated dose for each monthly cycle. Haematological toxicity was most pronounced in patients with liver dysfunction and bone marrow involvement. Out of eight nonresponders seven died, with a median survival of six months. Only six of 17 responders died, and the median survival in this group will exceed thirteen months. There was no correlation between the length of the metastasis-free interval after previous treatment and subsequent response to chemotherapy.