Arterial perfusion of the breast with cytotoxic drugs

Abstract

SINCEHalsted described his technique of radical operation for cancer of the breast in 1907 there has been little significant improvement in the prognosis of this disease. This mood of complacency is not borne out by even the best figures. It is well to reflect that an 80 per cent 5-year survival in early cancer means that 20 out of every IOO women were probably beyond the stage of routine operative measures, even though the pathological report showed no spread to the axillary lymph-glands. Endeavouring to improve these results Urban (1964) has advocated a supra-radical mastectomy with en bloc resection of one-third of the sternum, the costal cartilages, and underlying lymph-nodes and parietal pleura, in addition to the conventional radical mastectomy.Dahl-Iversen and Tobiassen (1963) combined radical mastectomy with supraclavicular and parasternal dissection, and Haagensen and Cooley (1963)~ in an attempt to select only operable cases for radical mastectomy, have described a method of determining the extent of the disease by means of what they call a triple biopsy. These extended operations have not found favour in England and in the less experienced hands of general surgeons would undoubtedly lead to increased morbidity and operative mortality. Indeed, some surgeons who have advocated these extended procedures have now realized that their results were no better than with radical mastectomy (Cutler, 1965). For perhaps too long a time adjuvant radiotherapy was held to be the answer.When Paterson (1962) published his figures it became clear that radiotherapy following radical mastectomy showed no statistical difference in the crude mortality rate at 5 or 7 years between those so treated and those who were only carefully watched, and that in the long run it was better to withhold radiotherapy until secondary deposits develop. McWhirter (1955) advocates simple mastectomy and radiotherapy, and his initial results appear to be as good as those with radical mastectomy. Unfortunately other centres have not been able to reproduce his figures. It is therefore clear that radical mastectomy has stood the test of time as the best available treatment for operable cancer of the breast. The effect of cytotoxic drugs and hormones in prolonging life in the advanced cases of cancer is well known. Their real value must surely lie in their use in early operable cases. It seems reasonable therefore that their addition to operation is a logical procedure.This communication reports our experience with 62 cases of operable breast cancer treated by radical mastectomy with intra-arterial perfusion of cyclophosphamide. SELECTION AND PREPARATIONOF PATIENTS Only cases of clinical Stage I and Stage I1 breast cancers, i.e., clinically operable cases, are included in this series.Prior to operation haemoglobin, white-cell count, reticulocyte count, platelet count, and liver-function tests are carried out in addition to chest radiographs and routine skeletal screening. In our early cases IOO mg. of cyclophosphamide were administered orally a day b...

Evaluation of Cyclophosphamide Dosage Schedules in Breast Cancer

“…The principle has been confirmed clinically in some tumours, in the increased proportion of responders seen following arterial infusion or perfusion with a cytotoxic agent. The technique is applied more easily in the case of tumours involving the limbs or the head and neck region, but several attempts have been made recently to apply such a technique to breast cancer also (Lentin et al, 1967).…”