Purpose: Evaluation of remission- and breast preservation-rates following neoadjuvant chemotherapy alone (CT) or combined preoperative chemo-radiotherapy (CT-RT). Patients and methods: One-hundred-ninety-four women with 198 biopsy-proven breast tumors entered the protocol. Of the 198 tumors evaluated, 64 underwent neoadjuvant CT followed by surgery and adjuvant radiotherapy (CT group) and 134 were treated by preoperative CT-RT followed by surgery (CT-RT group). Mostly EC- or CMF-regimes were used. In case of positive hormone-receptor-status hormonal treatment was applied after surgery. The whole breast was homogenously irradiated using 2 Gy single fractions up to a total dose of 50 Gy, followed by a boost of 6-11 Gy to the tumor. Median time interval between end of neoadjuvant treatment and surgery was 8 weeks (4-24 weeks) and 16 weeks (3-38 weeks) in the CT- and CT-RT group. Results: A histologically proven complete remission (pCR) could be achieved in 2 out of 64 tumors (3%) in the CT- and in 56 out of 134 tumors (42%) in the CT-RT group. The logistic regression analysis including clinical tumor-(cT), lymph node(cN)- and metastasis-status (cM), grading (G), hormone receptor-status (HRS), number of applied preoperative chemotherapy cycles (n preop CT), preoperative tumor volume (preop V) and treatment group (TG) revealed that the hormone receptor status (p= 0.0223) and TG (p<0.0001) were significant factors for achieving pCR. Breast preservation was possible in 55% (74/134) and 41% (26/64) in the CT-RT- and CT group, respectively. The multivariate analysis showed that cT (p=0.0024) and TG (p=0.018) had statistical relevance for breast preservation. Conclusions: Combination of neoadjuvant chemo- and radiotherapy results in a significantly higher rate of complete remission than neoadjuvant chemotherapy alone. The significance for tumor-free-and overall survival has to be evaluated by further follow-up. Tabled 1CT-groupCT-RT-groupTumors (n)64134Median age (yrs)6254Tumor size (cm)3.35preop CT (n)47pCR (n)256Residual invasive tumor (n)6278Breast preservation (n)2674 Open table in a new tab

Conventional-dose Ara-C (200 mg/m(2) d 1-5) combined with idarubicin (12 mg/m(2) d 1-3) was employed as remission induction and consolidation therapy in 23 elderly AML patients with a median age of 66 years (range, 60-75) with AML according to the FAB criteria (M1 n = 3, M2 n = 10, M4 n = 6, M5 n = 2, M6 n = 2), eligible for the study. In seven patients earlier MDS had been documented by previous bone marrow aspirates. The CR rate after one induction course was 65% (15/23). Toxicity was acceptable, with four patients dying during the chemotherapy-induced hypoplasia (4/23). Although 80% of the CR patients received two additional cycles of Ara-C and idarubicin as consolidation therapy, only two patients are still in continuous complete remission more than 12 months after achieving CR. The median disease-free survival of the CR patients was 11.5 months and the median survival of the entire group was 10 months. We conclude that conventional dose Ara-C/idarubicin is an effective protocol for inducing complete remission in elderly patients with AML, but that consolidation therapy consisting of two courses of the same regimen does not produce a relevant rate of long-term disease-free survival.

Adult respiratory distress syndrome (ARDS) in patients suffering from acute leukemia usually occurs during chemotherapy-induced neutropenia. In addition, intensified chemotherapy with high-dose cytosine arabinoside and mediastinal irradiation may contribute to the development of ARDS. This complication is usually refractory to conservative treatement with antibiotics, steroids, and mechanical ventilation. In this report, we describe a 25-year-old patient with acute lymphoblastic leukemia who developed ARDS during the phase of chemotherapy-induced neutropenia. Subcutaneous administration of granulocyte colony-stimulating factor (G-CSF) at doses of 300–600 μg/day led to a prompt increase of peripheral granulocyte counts. With resolution of neutropenia, respiratory function gradually improved, and mechanical ventilatory support was stopped after 2 weeks. From this observation we surmise that the application of G-CSF may be an effective therapeutic approach for preventing the fatal outcome of ARDS in leukemia patients with bone marrow aplasia.