Current Approaches to Therapy

ISBN-13: 9781475704822 / Angielski / Miękka / 2012 / 383 str.

William McGuire

Opis

The enormous impact of both clinical and basic research on the field of breast cancer can now be readily appreciated. It is the purpose of this new series of books to bring together the recent major advances in our understanding of the disease. The first volume is devoted exclusively to treatment. It is written by scholars who are actually investigating the biological principles which underlie our current approaches to therapy. For example, countless articles have appeared proposing some ad- vantage for one surgical approach to primary breast cancer compared with another. The new message is that these arguments for the superior- ity of one surgical approach over a.nother are valid only in that minority of patients whose disease is absolutely confined to the primary tumor site. It is far less important which surgical approach is selected for the larger group of patients who present with occult distant metastases. The whole subject of adjuvant therapy is still in its infancy. We have progressed from single-agent adjuvant chemotherapy to combined modality regimens consisting of combination chemotherapy plus im- munotherapy, plus radiotherapy, plus endocrine therapy. It will un- doubtedly take many years to sort out the proper use of these agents.

Spis treści

1. Surgery of Primary Breast Cancer.- 1. Principles of Breast Cancer Surgery: From Halsted to the Present.- 2. Factors Prompting Redefinition of the Basis for Breast Cancer Surgery.- 2.1. Breast Cancer as a Systemic Disease.- 2.2. Effects of Primary Tumor Removal.- 2.3. Redefinition of the Role of Lymphatics and Lymph Nodes.- 2.4. The Significance of Multicentricity.- 3. A Biologic Basis for Cancer Surgery.- 4. An Overview of Presently Employed Operations.- 4.1. Radical Mastectomy.- 4.2. Extended Radical Mastectomy.- 4.3. Total (Simple) Mastectomy.- 4.4. Segmental Mastectomy.- 5. Considerations Regarding Special Surgical Problems.- 5.1. Page?s Disease.- 5.2. Inflammatory Carcinoma.- 5.3. Management of Noninvasive Breast Cancer.- 5.4. Management of the Uninvolved Breast.- 6. Surgery in Conjunction with Other Therapeutic Modalities.- 7. Comments and Prospects for the Future.- 8. References.- 2. Pathology of Breast Cancer.- 1. Introduction.- 2. Histologic Types of Breast Cancer.- 2.1. Infiltrating Ductal Carcinoma, Not Otherwise Specified (NOS).- 2.2. Medullary Cardinoma.- 2.3. Lobular Invasive Carcinoma.- 2.4. Mucinous Carcinoma.- 2.5. Tubular Carcinoma.- 2.6. Adenocystic Carcinoma.- 2.7. Papillary Carcinoma.- 2.8. Page?s Disease.- 2.9. Rare Cancers of the Breast.- 3. Histologic Grading.- 4. Nuclear Grading.- 5. Circumscription.- 6. Tumor Size.- 7. Cell Reaction.- 8. Stromal Change.- 9. Elastica.- 10. Mucin.- 11. Calcium.- 12. Glycogen.- 13. Squamous Metaplasia.- 14. Apocrine Change, Oxyphilia.- 15. Necrosis.- 16. Relationship of Fibrocystic Disease to Cancer.- 17. Noninvasive Cancer in the Vicinity of the Dominant Tumor.- 18. Lymphatic Invasion.- 19. Blood Vessel Invasion.- 20. Perineural Space Invasion.- 21. Multicentric Cancer and Changes in Quadrants Remote from the Primary Tumor.- 22. Nipple Involvement.- 23. Relationship of Florid Papillomatosis of the Nipple to Cancer.- 24. Involvement of Skin over the Tumor.- 25. Alterations of Regional Lymph Nodes in Breast Cancer.- 25.1. Sinus Histiocytosis.- 25.2. Significance of Regional Node Histology Other Than.- Sinus Histiocytosis.- 25.3. Nodal Status.- 25.4. Significance of Extranodal Axillary Metastases.- 26. Multiple Cancers (Dominant Masses) in the Same Breast.- 27. References.- 3. Systemic Adjuvant (Combined Modality) Therapy in the Treatment of Primary Breast Cancer.- 1. Introduction.- 2. Tumor Cell Kinetics and Adjuvant Chemotherapy.- 3. Surgical Adjuvant Therapy in Animal Model Systems.- 4. Early Trials of Systemic Adjuvant Therapy.- 5. Recent and Present Trials of Systemic Adjuvant Therapy.- 5.1. L-PAM Protocol.- 5.2. CMF Protocol.- 5.3. Additional NSABP Protocols.- 5.4. Other Adjuvant Chemotherapy Trials.- 5.5. Trials of Immunotherapy.- 6. Comments and Speculations.- 7. References.- 4. Combination Chemotherapy for Advanced Disease.- 1. Introduction.- 1.1. Background.- 1.2. Natural History of Advanced Breast Cancer Relative to Chemotherapy Response.- 2. Experimental Background of Chemotherapy of Breast Cancer.- 2.1. Cell Cycle and Chemotherapy.- 2.2. Cell Kinetics.- 2.3. Growth Rates of Human Breast Cancers.- 2.4. Animal Models.- 3. Pharmacology.- 4. Clinical Evaluation of Drugs.- 5. Combinations.- 5.1. Relative Activity Compared to Single Agents.- 5.2. Maximizing Effects of Combinations.- 5.3. The Concept of Alternating Combinations.- 5.4. Useful Combinations.- 5.5. The Role of Adriamycin in Combinations.- 5.6. Response Duration and Survival.- 6. Chemotherapy and Hormonal Therapy.- 7. Immunotherapy.- 8. The Changing Role of Chemotherapy in Breast Cancer Treatment.- 9. Special Problems.- 9.1. Hypercalcemia.- 9.2. Central Nervous System (Brain, Meninges).- 9.3. Pulmonary.- 9.4. Bone Marrow Failure.- 9.5. Effusions.- 9.6. Inflammatory Cancer.- 9.7. Long-Term Effects of Chemotherapy.- 10. The Future of Chemotherapy.- 10.1. New Drugs.- 10.2. Developing Approaches.- 10.3. Selectivity.- 10.4. Monitoring.- 11. References.- 5. Physiological Principles Underlying Endocrine Therapy of Breast Cancer.- 1. Introduction.- 2. Prolactin.- 2.1. Rat Mammary Tumors.- 2.2. Human Breast Cancer.- 2.3. Mechanism of Prolactin Dependence.- 3. Estrogen.- 3.1. Localization of Estrogens in Responsive Tumors.- 3.2. Measurement of Estrogen Receptor.- 3.3. Rat Mammary Tumors as a Model System.- 3.4. Estrogen Receptor in Human Breast Tumors.- 3.5. Antiestrogens.- 3.6. Systemic Approaches to Reducing Estrogen Production.- 4. Progesterone.- 4.1. Clinical Effects in Breast Cancer.- 4.2. Subcellular Metabolism of Progesterone.- 4.3. Progesterone Receptors.- 4.4. Progesterone Interrelationship with Other Steroid Hormones.- 4.5. Progesterone Receptors in Human Breast Cancer.- 5. Glucocorticoids.- 6. Androgens.- 6.1. Androgens in Mammary Carcinoma.- 7. Conclusions.- 8. References.- 6. The Changing Role of Radiation Therapy in Breast Cancer: A Study in Therapeutic Controversy.- 1. Introduction.- 2. Stage I.- 2.1. The Controversy.- 2.2. Indications for Treatment.- 2.3. Technique of Treatment.- 3. Stage II.- 3.1. The Controversy.- 3.2. Indications for Radiation Therapy.- 3.3. Techniques of Treatment.- 4. Stage III.- 4.1. The Controversy.- 4.2. Inflammatory Carcinoma.- 4.3. Indications for Treatment.- 4.4. Radiation Therapy Techniques, Doses, and Treatment Plans.- 4.5. Studies Under Way and Future Protocols Needed.- 5. Stage IV.- 5.1. The Controversy.- 5.2. Indications for Irradiation.- 6. Conclusions.- 7. References.- 7. Immunology and Immunotherapy of Human Breast Cancer: Recent Developments and Prospects for the Future.- 1. Introduction.- 2. Histologic Evidence for Host Immune Response.- 3. General Immune Competence.- 3.1. Delayed Cutaneous Hypersensitivity.- 3.2. Lymphocyte Counts in Breast Cancer.- 3.3. In Vitro Tests.- 4. Tumor-Associated Antigens.- 4.1. Skin-Test Assays to Detect Antigens in Breast Cancer ...- 4.2. Lymphocyte Stimulation by Breast Cancer Antigens.- 4.3. Cytotoxicity.- 4.4. Measurement of Lymphokines.- 4.5. Human Tumor Serology.- 4.6. Other Evidence for Breast Cancer Antigens.- 5. Immunological Evidence for Viral Antigens in Human Breast Cancer.- 6. Effect of Hormones on Immunity.- 7. Influence of Radiotherapy on the Immune Response.- 8. Immunotherapy.- 8.1. Local Immunotherapy.- 8.2. Active Nonspecific Immunotherapy.- 8.3. Active Specific Immunotherapy.- 8.4. Adoptive Immunotherapy.- 8.5. Immunotherapy with Lymphokines.- 8.6. Thymic Hormones in Immunotherapy.- 8.7. Passive Immunotherapy.- 8.9. Interactions of Chemotherapy and Immunotherapy.- 9. Immunoprophylaxis of Breast Cancer: Outlook for the Future.- 10. Conclusions and Prospects.- 11. References.