THE TREATMENT OF METASTATIC BREAST CANCER IN BONE

The author report clinical experience with 212 cases of mammary cancer metastatic to bone, in 186 of which radiotherapy was given, and in 26 steroid hormone therapy.At least 70 per cent of patients with bone metastasis from breast cancer were relieved of pain by adequate roentgen therapy, the relief lasting for most of the survival time in many instances.About 25 per cent of patients had recalcification or reossification of bony lesions with roentgen therapy; while dramatic, this is not always an indication that relief of pain will continue or that survival time will be lengthened.If and when adequate radiotherapy has not been effective or cannot be administered (for example, in a patient with extremely widespread metastasis, or one residing at a considerable distance from radiotherapeutic service) steroid hormone therapy in adequate dosage is frequently beneficial. From 40 per cent to 75 per cent of patients with bone metastases from breast cancer are relieved of pain by steroid hormone therapy. In about 15 per cent of cases recalcification of the lesion occurs.Effective roentgen therapy may usually be given in a relatively brief period of time (one to two weeks). Effective steroid hormone therapy usually requires from 12 to 24 weeks.Complications of steroid hormone therapy are numerous. Some patients are made considerably worse by such therapy. These complications may only be controlled by reduction or discontinuation of the hormones. For this reason, it is recommended that irradiation always be used as the initial method of palliation.     

HORMONAL TREATMENT OF DISSEMINATED CANCER OF THE FEMALE BREAST

1. The University of California Medical Center at San Francisco is participating in a nationwide cooperative study attempting to improve hormonal therapy of disseminated breast cancer. A prospective protocol is followed in which the antitumor efficacy of an investigational compound is compared with that of a reference standard of known efficacy. Known variables (menopausal age and site of most significant metastasis) are randomized to distribute similar patients into experimental and control groups. Assignment of the therapeutic agent is made at random to avoid bias, and where feasible, neither patient nor investigator knows which compound is given.2. Primary hormonal therapy of objectively progressing disseminated breast cancer yields objective regressions in approximately 22 percent of patients treated with any of the following: testosterone propionate, 2-alpha methyldihydrotestosterone propionate (a derivative which produces less virilization) and oral diethylstilbestrol. The average duration of regression is 10 months.3. After primary hormonal therapy has ceased to be effective, secondary hormonal therapy produces fewer than 12 per cent objective regressions when conventional estrogens, androgens, corticoids, or surgical hypophysectomy are employed. The rate rises to 19-26 per cent if corticoids are combined with triiodothyronine, or if the less virilizing androgen, 2-alpha methyldihydrotestosterone propionate is used instead of other androgens. Surprisingly, hydrocortisone 30 mg. plus triiodothyronine 50 micrograms—an innocuous combination—proved as effective as doses producing Cushing''s phenomena.     

THE MANAGEMENT OF CANCER OF THE BREAST

Radical mastectomy is excellent only for cases of operable breast cancer in which the tumor is limited to the breast or to the nodes in the axilla. That there is metastasis to the internal mammary lymph nodes in a high proportion of cases has been “overlooked” for many years. Also it is probable that metastasis occurs to the supraclavicular lymph nodes more often than is suspected. Hence the extended radical mastectomy operation leaves much to be desired. There has been no significant improvement in recent years in the mortality rate of mammary cancer.Simple mastectomy and thorough adequate postoperative radiation therapy have much to offer.Treatment of “operable” breast cancer should be a cooperative effort of surgeon, radiation therapist and pathologist.