130 Abstracts

and 23 (mean age 78 years) received phase 1 alone; 37 of the 53 completing treatment had a 6-month cystoscopy; 25% of all patients, 36% of those completing treatment and 50% of those cystoscoped achieved a complete response. The reasons for not completing treatment (23/76) were either frailty, intercurrent illness, or acute bowel or bladder toxicity. Neither age nor tumonr stage were predictors of tolerability of treatment. Reasons for not being cystoscoped, survival and management of recurrent disease were also examined, as were patterns of early and late toxicity.

We feel this policy has a role to play in selected patients, who the clinician might otherwise choose not to treat radically.

A Study of Structural and Functional Changes After Conservation Therapy in Early Breast Cancer

W. L. J. Jack, C. Tyler, U. Chetty, J. M. Dixon, A. Rodger, N. A. Boon, G. R. Kerr, L. M. Matheson and I. H. Kunkler, Department of Clinical Oneology and Edinburgh Breast Unit, Western General Hospital and Department of Cardiology, Royal Infirmary, Edinburgh, UK

The surviving disease-free patients from a series of 289 Stage I and II breast cancer patients treated in the Department of Clinical Oncology, Western General Hospital, between October 1981 and December 1987 by conservation surgery and postoperative breast irradiation were invited to attend a special clinic to ascertain the cosmetic results of treatment and the late effects of surgery and radiotherapy. Of the original 289 patients, 282 had received a boost to the tumour bed, 147 by iridium implant and 135 by external beam therapy (10 MeV electrons).

At the special clinic, scar length and volume of surgical tissue loss were measured by one clinician, who also assessed breast oedema and late radiation changes (telangiectasia, fibrosis). A single anterior clinical photograph was taken of both breasts. A physiotherapist measured arm swelling, and power and range of shoulder movement. The incidence of pain in the breast, and numbness, pain and paraesthesia in the arm, was also noted. In addition, a questionnaire about cardiac symptoms was completed and a chest radiograph was carried out to allow the assessment of late effects in heart, lungs, ribs and shoulder girdle.

Morbidity and cosmesis were assessed in relation to the volume of breast tissue removed as measured in the pathology specimen, together with the size of the primary tumour, the type of axillary surgery, (sample/clearance) and the type of radiation boost given to the breast (electrons/implant). Overall cosmesis was assessed from the clinical photographs by a panel of judges blinded to the identity of the patients and the type and date of treatment.

A Review of Male Breast Cancer in Edinburgh

K. Andrews, Western General Infirmary, Edinburgh, UK

A retrospective review was carried out of 55 male patients treated for breast carcinoma in Edinburgh between 1974 and 1993. The median age at diagnosis was 70 years. The mean duration of symptoms was 14 months. Presentation was of a breast mass in 65%, skin infiltration in 18%, breast pain or nipple discharge in 3% and bony metastases in 3%. The breast mass was an incidental finding in 11%. The tumour was in the left breast in 28 patients (51%). Diagnosis was by a surgical biopsy in 83% of patients; in 17% it was by fine needle aspiration cytology. Infiltrating ductal carcinoma was the predominant histological pattern. Mean patho- logical turnout size was 2.09 era. Twenty-four patients (52%) were stage T4 at presentation and 26 patients (56%) were clinically node negative. Seven patients presented with metastatic disease. Three patients had Paget's disease, four had gynaecomastia and nine a second primary malignancy. A positive family history of breast carcinoma was noted in three patients. One patient had prior exposure to oestrogen. The initial management was surgical in 38 patients: nine patients underwent local excision, 27 simple mastectomy and two radical mastectomy. Twenty patients had axillary nodal surgery. Thirty-four received radical radiotherapy, 76% postoperatively. Nineteen patients received adjuvant systemic therapy, 90 with tamoxifen, which significantly reduced the risk of relapse. The median follow-up was 42 months. Com- plete remission was achieved in 42 patients. The actuarial risk of relapse at 5 years was 71.9% and at 10 years 76.9%. Twenty patients developed metastatic disease. Overall 5- and 10-year survival was 44% and 36% respectively. The relationship between survival and stage at presentation was statistically significant at all

stages. In patients presenting with metastatic disease, the median survival was 24 months and in those developing metastatic disease, 11 months.

Acute Changes in Peak Expiratory Flow Rate Following Palliative Radiotherapy for Bronchial Carcinoma

M. Q. F. Hatton, D. L. Nixon, F. R. Macbeth and R. P. Symonds, Beatson Oncology Centre, Western Infirmary, Glasgow, UK

The changes in respiratory function that occur in the months and years following radiotherapy are well documented. Any changes occurring in the hours following a fraction of radiotherapy treat- ment have been less well studied. We report a study performed to record changes in peak expiratory flow rate (PEFR) in the first 72 hours following radiotherapy treatment to the mediastinum and large airways.

Forty-nine patients with bronchial carcinoma were recruited and baseline spirometry and PEFR measurements taken using a Vitalograph dry spirometer and a Wright mini peak flow meter. Patients were instructed on home peak flow recording and asked to take readings in the 72 hours after radiotherapy.

Thirty-four patients were male, and the median age was 67 years (range 44-92); 42 had histologically proven bronchial carcinoma, one had bronchial metastasis, one had lymphoma and three had no histological diagnosis. The median baseline PEFR was 285 1/s (range 120-600); 43 patients were treated with a parallel opposed technique, five isocentrically with three of four fields. Radio- therapy doses ranged from an 8 Gy single fraction to 60 Gy in 30 fractions.

The lowest PEFR recorded in the 24 hours after radiotherapy was a median of 20% lower than the baseline value (range 0-60%). By 48 hours, the mean PEFR had returned to baseline values. Insufficient numbers of patients were taking corticosteroids or bronchodilators to be able to assess their influence on any fall in PEFR that occurred. The influence of fraction size (less or greater than 4.5 Gy) was analysed using the Mann-Whitney U-test; no statistically significant difference was found.

Twenty-five patients (51%) experienced a fall of greater than 20% of their baseline PEFR, suggesting that, in patients whose large airways may be already compromised, radiotherapy to the mediastinum can exacerbate airways obstruction.

Case Report: Bilateral Scapular Osteoehondromas in a Child with Spinal Primitive Neuroectodermal Tumour (PNET) Treated with Chemotherapy and Radiotherapy, and with Megatherapy and TBI for Relapse

M. Daley and A. Barrett, Beatson Oncology Centre, Glasgow, UK

Radiation-induced osteochondroma (RIO) is a late sequela of radiotherapy (RT) in childhood. First described in 1957, it occurs most often following radiotherapy for Wilms' tumour (WT) and neuroblastoma (NBL), but has been described in other malignan- cies and also following radiotherapy for non-malignant conditions, especially for 'thymic enlargement' (TE).

A spinal PNET, T2-T7, was diagnosed in a male child aged 8 years 11 months. Four cycles of OPEC chemotherapy were given, with subsequent RT (43.58 Gy in 24 fractions over 36 days) to the thoracic spine. A further two cycles of OPEC were given and a complete response was attained. He relapsed 18 months later, locally and in the lung, and was treated with VAC chemotherapy, high dose melphalan and TBI (14.4 Gy in eight fractions over 4 days). Three and a half years later, he developed a prominent swelling on the medial border of the right scapula, which, clinically and radiologically, was an osteochondroma. Three months later, an osteochondroma developed on the medial border of the left scapula. Both were 7.5 cm from the midline. The total dose to the scapulae was approximately 35.68 Gy.

This is the first reported occurrence of FIO following treatment of PNET and the first after TBI. Since 1957, 86 cases of RIO have been described following external beam RT: for WT in 34% of cases, NBL in 10.5%, rhabdomyosarcoma in 6%, and less com- monly for lymphoma and dysgerrninoma. Twenty-nine per cent of RIOs followed RT for 'TE'. The incidence in long term survivors following RT varies from 0.3% to 18% (mean reported incidence 7.1%), but many of these lesions may never be diagnosed, as they are rarely symptomatic. The mean age at RT was 2.2 years (range 2