Egyptian male breast carcinoma:patients' hormonal profile,management and outcome

Objective:Male breast cancer(MBC) represents < 1% of all breast cancers.Hormone receptors and Her-2/neu status are established prognostic factors in female breast cancer but not yet studied enough in male breast cancer.The aim of the study was to verify the clinico-pathologic profile of male patients with breast cancer including analysis of hormone receptors and Her-2/neu state and its impact on survival rate.Methods:This is a retrospective study carried on a total of 123 male patients presented to the National Cancer Institute(NCI),Cairo University,Egypt-with breast carcinoma from January 1999 to December 2009.Results:The patients had a median age of 58(ranged from 29-92) years.About 39.8% of the patients presented with T4 lesion.At presentation,12.2% of the cases had metastasis with bone represented 86.7% of metastatic sites.About 92.7% of patients were subjected to modified radical mastectomy and radical mastectomy.Invasive duct carcinoma reported in 91.1%,and 76.4% of the patients had grade II pathology.Hormone profile was reported in 74% of the patients with 71.4% positive ER and 69.2% positive PR.Among 57 cases tested for Her-2/neu,10.5% were positive.Luminal A was the most common subtype detected in male breast carcinoma patients constituting 66.7%.Comparison with female patients with breast carcinoma revealed some differences regarding stage,hormone profile,Her-2/neu status and breast cancer subtypes.Chemotherapy as adjuvant,neo-adjuvant and metastatic was given for 73.1%,17.3% and 9.6% of the cases,with 83% of them had an anthracyclin-containing regimen.Sixty-nine patients received radiation treatment,65.2% and 34.8% of them with adjuvant and palliative aim,respectively.Dose of adjuvant radiotherapy had a median value of 4410(3400-5000) cGy.Adjuvant hormonal treatment(Tamoxafin) was given for 47 patients all of them with ER and/or PR positive for a median period of 33.5(4-60) months.The 5-year overall survival(OS),loco-regional control(LRC),metastasis-free survival(MFS) rates were 63%,68%,and 62%,respectively.Axillary lymph node metastasis and advanced tumor stage significantly worsen all survival rates.While,higher grade was associated with a poor overall survival,this was not reflected on LRC and MFS rates.Adjuvant radiotherapy and chemotherapy had significantly improved all survival rates.Conclusion:Some gender differences were detected regarding stage,hormone profile,Her-2 state,and tumor subtypes.

Adjuvant postoperative radiochemotherapy for patients with gastric carcinoma:a single institution experience

Objective： The suboptimal outcome after surgery alone for gastric cancer indicated the necessity of adjuvant treatment for potentially resectable carcinoma of the stomach. In 2001, postoperative adjuvant radiochemotherapy started to be implemented in the NCI, Cairo, Egypt. However, the fear of the acute complication hindered its use as a standard treatment with some staff didn＇t follow the SWAG＇s adjuvant protocol. The aim of this report is to verify this issue. Methods： In the period from 1999 to 2009, 320 out of 581 patients with gastric carcinoma, underdid potentially curative surgery. Adjuvant postoperative radiochemotherapy for stage ≥ IIA started since 2001. Radiation （45 Gy, 1.8 Gy/f） was targeted to the tumor bed, anastomosis site, duodenal stump, remnant stomach and regional lymph node together with 4-5 cycles chemotherapy （SWOG protocol）. Survival analysis was performed and comparison between survival curves was done to analysis different prognostic factors. Results： The patients＇ age ranged from 17 to 86 years [mean （54 ± 12.5） years]. About 1/3 of the patients had a diffuse lesion. Adenocarcinoma was the most common pathology （60.4%）. High grade pathology constituted 59.1% of the cases. About one fifth of the patients had metastatic disease at presentation. Only 351 （75%） of the patients had potentially curative gastrectomy. The median number of lymph node （LN） dissected was 12 （ranged from 0-45） with a median number of the positive LN of 3.5 （ranged from 0-40）. Postoperative mortality was 12%. The median follow up period was 21.9 months （ranged from 3-129.4 months）. For the 257 patients who had curative surgery, 164 （62.8%） patients were alive at the end of follow up. During follow up period, 30 patients had Ioco-regional relapse, and 26 patients had metastasis, and 39 patients had both pattern of failure. The overall survival （OS）, Ioco-regionar control （LRC）, and metastasis free survival （MFS） rates, at median follow up period of 22 months, were 61.2%, 66.7% and 71%, respectively. At 3 and 5 years the corresponding values were： OS （42% and 28%）, LRC （64% and 50.4%） and MFS （56.3% and 49%）, respectively. Only stage and degree of nodal involvement had an adverse effect on all survival rates. Proximal lesion had poor OS rates. As regard LR control rate, mucinous cell type, and high grade had a bad effect. Although patients with less than D1 dissection had low OS and LRC rate, it didn＇t reach significant level. There was a significant improved 5-year OS rate for concurrent chemoradiotherapy （CCRTh, 55%） versus no or single adjuvant modality （27%）, P = 0.035. A subgroup analysis according to CTH regimen showed a trend for all survival rates with ECF compared to bolus 5FU/LV. However, none was statistically significant. Conclusion： In operable gastric carcinoma, postoperative concomitant radiochemotherapy with 5FU and LV is feasible with acceptable toxicity with a significant increase of Iocoregional control. A well designed phase III clinical trial - with ECF regimen and conformal radiotherapy - is worth to start to increase local control and decrease toxicity.