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• W2018177638 abstract "The first results of adjuvant chemotherapy’ in breast cancer with positive lymph nodes, are like those obtained formerly by castration. The comparison is even more striking since the lirst surgical or radiotherapeutic castrations were performed, not merely as a palliative, but in the hopes of obtaining a definite cure. The initial results of comparative trials of hormone manipulation have demonstrated clearly that the appearance of metastasis either was retarded in the castrated group ” or that the number of recurrences’ was reduced until the time of the menopause;‘o in the same way, survival rate was improved by castration.” However, in all groups, the differences diminished, and then disappeared after 5 years; the maximum benefit was experienced for 4 years.’ Furthermore, significant differences occurred during the early years in some serie?’ particularly in the presence of axillary metastases. Kennedy et al.’ demonstrated that survival in the two series was the same, since castration realized for recurrence lengthened the survival period appreciably. Nissen Meyer’ showed that around menopause, or a few years later, castration had an indisputable therapeutic effect for as long a time as the ovarian and hormonal functions continued. The action of corticosteroids’ prescribed over a long period improved the effect of castration well beyond 5 years, probably by suprarenal depression. Identical observations had been made with thiophosphoramide (THIOTEPA);. the favorable results decreased after 5 years. One should consider the possibility that the chemical agents have an indirect action. This is important because, in 80% of the patients, chemotherapy causes amenorrhea;‘,6.9 measures of hormone levels after chemotherapy6’ have shown that the levels of estrogen, progesterone and prolactin become considerably lowered. At the present time, it cannot be concluded from studies already published that systematic chemotherapy does extend the survival of patients with breast cancer beyond several years, for it probably acts on the non-apparent metastases as much by temporary indirect hormonal effects as by direct chemical cytotoxic effect. Does not the hypothesis of predominant hormonal action become more likely when one seeks to explain why chemical agents have no effect on the micro-metastases of breast cancer after menopause, but act so effectively on younger patients? If the direct action of chemotherapy on the cancer cell plays a more important role than a strictly hormonal one, it should be maintained, at least partially, after menopause. Long-term chemotherapy is not without danger. Some of the incidents or toxic accidents that have been reported were very serious. Chemotherapy would be useless for many patients; they would pay a high price for what really is a rediscovery of breast cancer hormone dependence. For others, no lasting cure can be anticipated as was the case formerly with castrated patients. Melphalan (ALKERAN) monochemotherapy has been proved a failure;” those who prescribe it should be informed of its dangers. At present time there is no reason for a fundamental change of attitude in the locoregional treatment of breast cancer; therapeutic trials should be continued on a national scale, for in this complex field of research, individual studies can make no really significant advance nor bring any valuable contribution to it." @default.
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• W2018177638 date "1978-09-01" @default.
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• W2018177638 title "Adjuvant chemotherapy of breast cancer: Is it a direct cytotoxic or has it an indirect hormone effect?" @default.
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• W2018177638 doi "https://doi.org/10.1016/0360-3016(78)90058-5" @default.
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