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Biomedical subjects

E D Montague

Publications and source records attributed to E D Montague.

At least 19 recordsLinked to original sources
PubMed1991

Results of mastectomy and postoperative irradiation in the management of locoregionally advanced carcinoma of the breast.

Between 1955 and 1984, 376 patients with locoregionally advanced breast carcinoma were treated at The University of Texas M. D. Anderson Cancer Center with mastectomy and irradiation and without adjuvant chemotherapy. Patients with inflammatory carcinoma or synchronous bilateral primary tumors were excluded. There were 202 patients with Stage IIIA disease and 174 patients with Stage IIIB disease (AJC Staging--1983). In 124 patients the surgical management was confined to the breast only--total mastectomy (BR) and in 252 dissection of the axilla was performed--extended total, modified radical, or classic radical mastectomy (BR + AX). All patients had postoperative irradiation. The follow-up period ranged between 8 and 34 years. At 10 years, the actuarial disease-specific, relapse-free survival (DSRFS) rate for the entire group was 40%, and the actuarial locoregional control rate was 82%. For patients with Stage IIIA disease the DSRFS was 48% and locoregional control rate was 88%. For those with Stage IIIB disease, the figures were 30% and 74%, respectively. Most of the failures occurred within 5 years of the mastectomy and essentially all occurred within 10 years. When analyzed by type of surgery, both the locoregional control and DSRFS rates were improved by the axillary dissection, the difference being largely caused by fewer axillary node recurrences after dissection of both the breast and axilla than after removal of the breast alone. In the 252 patients in whom the axilla was assessed, the number of positive nodes was a powerful predictor of both locoregional control and survival. The DSRFS rates at 10 years for patients with 0, 1-3, and greater than or equal to 4 positive nodes were 63%, 48%, and 30%, respectively. The actuarial locoregional control rates at 10 years exceeded 95% for patients with 0-3 positive nodes and 75% for those with greater than or equal to 4 nodes. These results show that locoregionally advanced breast cancer is not a uniformly fatal disease when treated without chemotherapy and provide a baseline upon which to assess the value of adjuvant systemic therapy for this stage of disease.

Adult↗
PubMed1988

Prognostic implications of age in breast cancer patients treated with tumorectomy and irradiation or with mastectomy.

Conservation breast treatment is of particular interest to young women, but whether saving the breast carries a penalty in shorter survival or local-regional recurrent disease has not been well-established. At The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, 1161 patients treated prior to 1983 with Stage I or II breast cancer were reviewed. Of these patients, 378 were treated with tumorectomy plus irradiation, and 783 were treated with radical or modified radical mastectomy. The two patient groups were compared relative to local-regional disease recurrence and overall and disease-free survivals. Local recurrences in the breast appear to be more frequent in patients less than or equal to 35 years of age treated with tumorectomy and irradiation than in patients older than 35 years, but in patients aged less than or equal to 50 or greater than 50 or less than or equal to 35 or greater than 35 years, there was no significant statistical difference between tumorectomy and irradiation or mastectomy nor was there a difference in disease-free survival. Overall survival rates favored patients treated by tumorectomy and irradiation.

Adult↗
PubMed1987

Lack of concordance of growth rates of primary and recurrent breast cancer.

The degree of concordance of growth rates of primary tumors with corresponding recurrences was investigated by using data from 184 patients with breast cancer with measurable recurrences. For conduction of this examination, the detection processes of both the primary tumor and the recurrence were explored. The probability of detection of a recurrence per unit time was found to be nearly proportional to the tumor's diameter. Approximately 60,000 cells initiated the recurrence, and the distribution of doubling times of the recurrences was exponential, with a mean of 2.1 months. The probability of detection of the primary tumor per unit time was approximately proportional to its volume. The distribution of doubling times of primary tumors was nearly exponential; from other evidence, we inferred that the mean doubling time was also close to 2.1 months. Several techniques to measure growth rate agreement between the primary and recurrent tumors within individuals were developed, and all of them yielded the result that the growth rates are nearly unrelated.

Breast Neoplasms↗
PubMed1986

Management of locoregional recurrent breast cancer.

The influence of radiation and/or chemotherapy on locoregional tumor control and survival in patients treated for recurrent breast cancer after radical or modified radical mastectomy is retrospectively evaluated in 164 patients treated between 1972 and 1983 at the University of Texas M. D. Anderson Hospital. Treatment consisted of radiation alone in 57 patients, chemotherapy alone in 50 patients, and a combination of radiation and chemotherapy in 57 patients. Important differences in the composition of these three groups include a preponderance of postmenopausal women (44% vs. 32%) and more patients with four or more positive axillary nodes at the time of initial mastectomy (32% vs. 18%) in the radiotherapy group. Locoregional control of recurrent cancer was achieved in 65% of patients with radiotherapy compared to 46% of patients with chemotherapy (P = 0.049) and 67% with chemotherapy and radiotherapy. The addition of chemotherapy produced a trend toward improved disease-free survival rates. The two prognostic factors affecting tumor control and survival in this study are the tumor burden of the recurrence and the histologic axillary node status at the time of the initial mastectomy.

Adult↗
PubMed1986

Tumor volume, nodal status, and metastasis in breast cancer in women.

The relationship between primary tumor volume at detection, number of positive nodes, and probability of and time until first distant metastasis was examined for a group of 2,663 women with breast cancer. Time until metastasis was shown to decrease and probability of metastasis to increase as tumor volume and number of nodes increased. Either factor remained significant after correction for the other. Simple proportional hazards models were shown to be inadequate to describe the data. Graphic techniques were used to obtain nonparametric estimates of the forms of the relationships between tumor volume, nodal status, and the time course of the occurrence of metastasis. A simple calculation demonstrated that the average contribution per cell to the probability of metastasis decreased with increasing volume.

Breast Neoplasms↗
PubMed1985

Local regional effectiveness of surgery and radiation therapy in the treatment of breast cancer.

Although gross tumor can be controlled with high doses of radiation therapy, control is achieved at the expense of severe radiation sequelae. In order to improve tumor control with minimum complications, the field of treatment should contain only subclinical disease. This article reviews the successful combination of surgery for the removal of gross cancer and radiation of moderate dose for the treatment of subclinical disease in patients with breast cancer. In patients with clinically favorable and operable disease, the combination of a radical or modified radical mastectomy and postoperative radiation therapy of 5000 rad to the peripheral lymphatics and chest wall can secure 90% of the treated areas. For patients with locally and regionally advanced breast cancer, the combination of a simple mastectomy and dissection of the lateral axilla followed by postoperative irradiation of 5000 rad in 5 weeks to the chest wall, axilla, and peripheral lymphatic areas will control more than 85% of the patients treated as compared with approximately 70% control when surgery or radiotherapy alone is used, even with chemotherapy. Yet another clinical application of the subclinical disease concept is the successful combination of conservation surgery (whether segmental mastectomy, quadrantectomy, or wide excision) for gross tumor in the breast and axilla and irradiation for residual microscopic and multiple foci of tumor, yielding more than 90% control of locoregional disease with survival rates equal to those patients treated with radical or modified radical mastectomy. Results of multiple clinical trials and reported series are reviewed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Management of inflammatory carcinoma of the breast. A combined modality approach.

From May 1973 to December 1981, 63 patients with inflammatory carcinoma of the breast were treated with a doxorubicin-containing chemotherapy regimen (FAC). After a median of three cycles of FAC, 41 patients received primary therapy with irradiation; more recently, 21 had mastectomy as primary therapy. One patient relapsed following a treatment delay and did not receive local therapy. Fourteen of 21 patients who underwent mastectomy had subsequent consolidation therapy with irradiation. At median follow-up of 60 months, median relapse-free survival (RFS) and survival were 24 and 43 months, respectively. The initial site of recurrence was locoregional in eight patients (20%). In addition, two of seven uncensored patients (18%) who suffered initial recurrence in the contralateral breast remained disease-free at 28 and 55 months with further surgery. While no locoregional recurrences were seen in the 14 mastectomy patients who completed comprehensive irradiation, no RFS nor survival advantage was noted for either initial local therapy. Sixteen patients with dermal lymphatic carcinomatosis and 10 patients with negative skin biopsies had median RFS of 31 and 46 months, respectively (p = 0.45). Median RFS was 36 months in patients greater than or equal to 50 years of age and 19 months in patients less than 50 (p = 0.05). Response to FAC was the most significant predictor of RFS and survival. Patients who achieved complete or partial remission (PR) with induction FAC as compared to patients who achieved less than PR had median RFS of 31 vs. 19 months (p = 0.01) and median survivals of 60 vs. 27 months (p = 0.05), respectively. Categorization of patients according to clinical, mammographic, and pathologic criteria facilitated identification of potential long-term responders. With combined modality approach to inflammatory carcinoma of the breast, we can expect an estimated 31% of patients to be relapse-free at 5 years after treatment.

Adult↗
PubMed1985

Radiation therapy and breast cancer. Past, present, and future.

After radical mastectomy, postoperative irradiation unquestionably diminishes the incidence of local-regional failures, and there are series in which the survival rates are improved for a subset of patients. The comparative survival rates shown in Table 6 suggest that adjuvant postoperative irradiation produces survival benefits. For more advanced tumors, simple mastectomy and axillary dissection with chemotherapy and irradiation is effective, with the optimal sequence still to be determined. In selected patients, tumorectomy and irradiation produce survival rates equivalent to radical mastectomy with very satisfactory cosmetic results. In all situations, gross masses in the breast and axilla should be removed leaving for irradiation only subclinical disease that is controlled with doses that do not produce significant sequelae.

Axilla↗
PubMed1979

Conservation surgery and irradiation for the treatment of favorable breast cancer.

The results in 162 patients with clinically favorable breast cancer treated with conservation surgery and radiation therapy are presented. The surgical procedures were simple excision with and without positive microscopic margins, segmental mastectomy, and segmental mastectomy with axillary dissection. Details of the radiation techniques are described with an explanation of the modifications in technique depending on the prior surgical procedure. Excellent control of local and regional tumor (96%) gives support to the combined treatment without removing the breast.

Adult↗
PubMed1978

Skin thickness in the therapeutically irradiated breast.

Skin thickening of the breasts of 22 women undergoing excision biopsy of a breast cancer and subsequent radiation therapy to 5,000 rad is considered. The skin thickness of the treated breast returned to normal in 17 of 22 patients studied. Of the 17, nearly 60% returned to normal in 2 years, over 80% in 3 years, and the rest by 4 years. The period of follow-up was less than 4 years in the five patients with residual skin thickening. The alterations in skin thickness are consistent with the histopathologic changes seen in radiation dermatitis.

Breast Neoplasms↗
PubMed1977

Calcifications and the therapeutically irradiated breast.

Mammograms of 81 patients who received radiation therapy to the breast were analyzed for patterns of pre- and postirradiation calcifications. Malignant calcifications may remain stable, diminish, or completely disappear following irradiation. The persistence of calcifications need not indicate residual cancer. Calcifications can develop following irradiation which are similar to either intraductal or secretory calcifications. Unusual calcifications may develop at the site of an irradiated cancer. It is important to recognize that benign calcifications can develop so that they will not be confused with recurrent malignancy.

Breast Neoplasms↗
PubMed1976

Managing primary breast cancer.

Management of breast cancer by surgery combined with irradiation can only affect disease within the treated area. In patients who have distant metastases at the time of therapy, there is no evidence of improved overall survival rates by the use of irradiation, either preoperatively or postoperatively. Survival may be affected by these measures, as well as by extensive surgical procedures, in only a very small subset of the patient population with breast cancer. A study of adjunctive systemic therapy with thiotepa has also failed to show a change in overall survival. Control of local and regional disease is the realistic goal of surgical and radiotherapeutic treatment. This goal can be best achieved by the use of surgical procedures ranging from radical mastectomy to excisional biopsy combined with a tumor dose of 4,500 to 5,000 rads to the areas of potential subclinical disease. Elective chemotherapy, immunotherapy, or both may be beneficial in preventing or retarding the development of distant metastases. However, use of these modalities should be restricted to controlled clinical trials to determine their actual effectiveness. It is not appropriate to institute such treatment as a substitute for established methods of controlling regional disease.

Breast Neoplasms↗
PubMed1976

Inflammatory carcinoma of the breast.

Eighty-six patients with the clinical features of inflammatory carcinoma of the breast (erythema, peau d'orange, wheals or ridges) were treated with irradiation for potential cure between July 1948 and December 1970. Long protracted irradiation alone with a strong skin reaction offers 50% local control, which is the best rate yet reported. Any surgical procedure beyond biopsy is probably damaging: all patients subjected to mastectomy developed distant metastases and died. Ninety per cent of the patients were dead by five years and only 3 patients remain alive without evidence of disease 7, 10 and 14 years after radiotherapy. Analysis of survival rates, incidence, sites and times of appearance of local recurrences, and distant metastases is presented.

Breast Neoplasms↗
PubMed1976

Elective irradiation with the electron beam after mastectomy for breast cancer.

From 1963 to 1970, 380 patients have received elective treatment with the electron beam after radical mastectomy for breast cancer. One hundred and twenty-nine patients received treatment to the supraclavicular and internal mammary lymph node areas only, and 251 patients received treatment to the chest wall as well as to the areas of peripheral lymphatic drainage. Analysis of the results shows the value of elective irradiation of occult deposits of disease since the incidence of local recurrences is significantly less than would be anticipated in this group of patients.

Breast Neoplasms↗
PubMed1976

Experience with twice-a-day fractionation in clinical radiotherapy.

Theoretical reasons have led to the treatment of 24 patients with advanced, rapidly growing squamous cell carcinomas of the head and neck, and 17 patients with inflammatory carcinoma of the breast with twice-a-day fractionation. After initial reduction in dose in both series, acute reactions and sequelae are similar to those in conventionally treated patients. The relative control rates are better than would be expected from conventional irradiation.

Breast Neoplasms↗