Treatment of Malignant Breast Tumors: Indications and Results a Study Based on 1174 Cases Treated at the Institut Gustave-Roussy Between 1954 and 1962

ISBN-13: 9783642999833 / Angielski / Miękka / 2012 / 94 str.

Pierre Denoix; Barbara Crook

Opis

One of the chief concerns of the medical staff of the Institut Gustave-Roussy is to find the right indications for treating every cancer site, and particularly cancer of the breast. The best treatment is the one which offers the patient the best chance of recovery, yet is at the same time the simplest and least mutilating [36]. It is our policy at the Institut, rather than to lay down a series of therapeutic measures which are applied systematically to all patients, to be selective, that is, to determine the best treatment for each individual patient. We make extensive use of prognostic factors, not merely for retrospective assessment when the treatment is completed, but very early on-during treatment or even before it is begun; thus, the treatment may be changed as a result, or simplified from the outset, when it is thought the outcome will be equally satisfactory. Our appreciation of the prognostic value of this or that clinical or biological factor is still far from complete, and we are continuing our studies in this direction.

Spis treści

I. The Institut’s Contribution to the Definition of Factors Guiding the Choice of Treament.- A. Phase of Development.- 1. Acute Developing Growths (PEV 3).- 2. Subacute Developing Growths (PEV 2).- 3. Developing Growths (PEV 1).- B. Determining the Condition of the Lymph Nodes.- Anatomical-Pathological Methods of Examination.- 1. Macroscopic Examination and Dissection of Specimens.- 2. Immediate Histological Examination.- 3. Histological Examination After Fixing and Staining.- Classification of Breast Tumors.- C. Recurrence and Invasion of Lymph Nodes.- 1. Bone Metastases.- 2. Disseminated Metastases.- 3. Local/Regional Recurrences.- D. Metastases of Breast Cancers.- E. Other Factors Having Prognostic Value and Providing Criteria for the Orientation of Therapy.- 1. How to use the Idea of Prognosis.- 2. Histological Grading of Breast Carcinomas for Prognostic Purposes.- 3. Biochemistry.- 4. Mastography.- 5. Invasion of the Nipple.- 6. Number of Lymph Nodes Invaded.- 7. Clinical Dimensions and Radiological Dimensions.- F. Extent of Surgical Intervention.- 1. Simple Mastectomy.- 2. Mastectomy with Axillary Dissection (Patey’s Technique).- 3. Radical Amputation of the Breast or Halsted’s Technique.- 4. Extended Operation: Halsted + Internal Mammary Dissection.- G. The Techniques of Radiotherapy.- 1. Post-operative Radiotherapy.- 2. Pre-operative Radiotherapy.- 3. Regional Radiotherapy alone.- 4. Castration by Irradiation.- H. Hormone Therapy.- 1. Androgens.- 2. Estrogens.- 3. Progesterone.- 4. The Steroids.- 5. Combined Therapy.- I. Direct Action on the Endocrine Glands.- 1. Biological Comparison of Oophorectomy and Ovarian Irradiation.- 2. Irradiation of the Ovaries Versus Oophorectomy.- 3. Hypophysectomy.- J. Chemotherapy.- 1. Nitrogen Mustards.- 2. Antimetabolites.- 3. Products Whose Mechanism of Action Has Not Been Clearly Established.- K. Immunotherapy.- Combined Treatments.- II. Team Work—the Committee.- III. The Treatment Protocol—its Various Parts.- A. The TNM Classification.- 1. T—the Primitive Tumor.- 2. N—the Regional Lymph Nodes.- 3. M—Distant Metastases.- B. The Therapeutic Categories.- 1. Category A.- 2. Category B.- 3. Category C.- C. Techniques.- D. Therapeutic Indications.- 1. Category A.- 2. Category B.- 3. Category C.- E. Treatment of Recurrences.- 1. False Recurrences.- 2. Treatment of Distant Metastases.- 3. Special Cases.- F. Cancer during Pregnancy.- IV. Results.- References.