Eight of 46 (17.4%) patients treated in our trial of continuous hepatic artery infusion (CHAI) of fluorodeoxyuridine (FUDR) by Infusaid pump developed biliary strictures. The lesions were clinically, radiographically, and pathologically identical to the idiopathic sclerosing cholangitis frequently seen in association with inflammatory bowel disease. Treatment included immediate cessation of intraarterial FUDR, and surgical or percutaneous drainage of the biliary tree if it was dilated. Two of the eight patients died of the complication. Three patients stabilized after biliary system drainage, and two patients improved on observation only. The pathogenesis of this complication is not understood. This report details the clinical and pathological features of this entity.

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The role of high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell rescue in breast cancer is still controversial. We analyzed the outcomes of 1111 consecutive patients with histologically proven breast cancer who underwent HDCT at 5 major California medical centers. The overall treatment-related mortality (TRM) was 2.3%. TRM was not influenced by disease stage or the HDCT regimen delivered, but it was influenced by hematopoietic graft source. The TRM was 6.1% when bone marrow with or without blood stem cells was used, but only 1.4% when blood stem cells alone were used (P < .001). With a median follow-up of 2.8 years (range, 0.1-8.2 years) after HDCT and autologous hematopoietic stem cell rescue, the estimated 5-year event-free survival (EFS) and overall survival (OS) for stage II/IIIA patients with > or =10 involved axillary lymph nodes were 67% and 76%, respectively. Patients with metastatic breast cancer (MBC) (median follow-up, 1.9 years [range, 0.03-8.3 years]) achieving a complete response (CR) to conventional-dose chemotherapy or rendered to a "no evidence of disease" status before HDCT had significantly better estimated 5-year EFS and OS (28% and 57%, respectively) than those achieving a partial response before HDCT (19% and 27%, respectively; P < or = .0001). Our data suggest that HDCT with hematopoietic stem cell rescue is safe and can be beneficial to patients with high-risk primary breast cancer and for those with MBC achieving CR/no evidence of disease.

Summary:We designed and implemented a new mitoxantronebased high-dose chemotherapy regimen to minimize pulmonary injury (seen in carmustine-based regimens) in patients with breast cancer. One hundred and ninetyone breast cancer patients (99 stage II/IIIA; 27 stage IIIB; 65 stage IV responsive to conventional-dose chemotherapy) were treated with high-dose chemotherapy (CTM) delivered over 4 days (cyclophosphamide (6 g/m 2 ), thiotepa (600 mg/m 2 ), and mitoxantrone (24-60 mg/m 2 )) followed by autologous hematopoietic stem cell rescue. Stage II/III patients received chest wall radiation and tamoxifen (if hormone-receptor positive) after CTM. The 5-year event-free survival (EFS) for stage II/IIIA patients with 10 or more involved axillary lymph nodes (n = 80) was 62 ؎ 12%. Hormone receptor-positive patients with 10 or more nodes did significantly better than negative patients. The EFS for stage IIIB patients at 5 years was 44 ؎ 19%; for stage IV patients at 5 years was 17 ؎ 10%. Stage IV patients achieving complete response in viscera and/or soft tissue prior to CTM did significantly better than those achieving a partial response. There were six (3%) treatment-related deaths including two due to diffuse alveolar hemorrhage. There were no episodes of delayed interstitial pneumonitis. There were six severe cardiac events in 91 patients (6.6%) but none after instituting mitoxantrone dose-adjustment in the final 100 patients. We conclude that CTM is associated with a low treatment-related mortality and little pulmonary toxicity. CTM produces excellent outcomes in stage II/IIIA patients with 10 or more involved axillary lymph nodes. Bone Marrow Transplantation (2000) 26, 257-268.

Breast cancer is the most prevalent malignancy among women worldwide. Increased oxidative stress and poor subjective health outcomes have been associated with increased risk of cancer recurrence and metastasis, but few studies until now have explored the relationship between oxidative stress and chronic stress/anxiety. This study aims to examine the association between anxiety and a potential dermal correlate of oxidative stress in patients with breast cancer. 102 breast cancer patients were enrolled in a cross-sectional study at Highland Hospital, a county hospital in Oakland, California. Each participant’s skin carotenoid score (SCS), a potential dermal correlate of oxidative stress, was recorded via Raman spectroscopy. Patient demographics, breast cancer stage, and subjective health measures (anxiety and self-rated health) were ascertained. Multivariate linear regression analysis was performed to quantify any associations between SCS and the above health correlates. Higher levels of skin carotenoids were associated with decreased severity of anxiety, lower BMI, increased servings of vegetables/fruits in daily diet, Hispanic race, lower educational status, and nonsmoking status. Severity of anxiety as graded by the GAD-7 was inversely associated with dermal carotenoid measurements via SCS. Conclusions. Increased levels of oxidative stress as quantified by SCS is associated with greater severity of anxiety. Because chronic stress has been associated with tumor progression, increased recurrence rates, and increased metastatic risk in breast cancer, non-invasive dermal carotenoid measurements could be used as a novel objective correlate of subjective health during cancer treatment.