173. Does the correlation between chemotherapy-induced leukopenia with response in locally advanced breast cancer exist?

PurposeThe correlation between chemotherapy-induced toxicity and treatment outcome in cancer patients has not been thoroughly studied. Our aim was to evaluate whether leukopenia following primary chemotherapy may be predictive for response in patients with locally advanced breast cancer.Patients and MethodsThe records of 164 breast cancer patients administered primary chemotherapy between 1985 and 1995 were analysed. Most of the patients presented with locally advanced disease, however included were also patients with large operable tumours. Chemotherapy included one of the three combinations: CMF; modified Cooper regimen (CMFVP); 31 patients (19%), anthracycline-based regimens (FAC and FEC); 16 patients (10%) and 118 patients (71%).ResultsThe objective response rate in the entire group was 58%; 75% in patients who developed grade 2–3 leukopenia during induction chemotherapy, and 52% in those who had no or grade 1 leukopenia (p < 0.01, multivariate analysis). No other patient- or treatment-related factor including age, performance status, T stage, N stage, supraclavicular Iymph node involvement, inflammatory carcinoma or chemotherapy regimen correlated with response to chemotherapy. There was no correlation between treatment-induced leukopenia and overall survival.ConclusionsThese findings suggest a relationship between chemotherapy induced leukopenia and tumour response in patients with locally advanced breast cancer. The prognostic impact of leukopenia is negliglble

Surgery followed by irradiation in glioblastoma multiforme. A report of 28 cases

Treatment results in glioblastoma multiforme, irrespective of the management, are poor. Median survival in patients managed with surgery alone is 4 months and in those treated with surgery and adjuvant radiotherpy -9 months.Twenty eight patients with glioblastoma multiforme were treated at the Department of Oncology and Radiotherapy, Medical University of Gdańsk between 1991 to 1995. There were females and 20 males and the median age was 58 years (range 18 to 75 years). In 22 cases (78%) diagnosis was confirmed by histology, and in the remaining six cases biopsy was not taken due to the deep localization of the tumour; in all these patients diagnosis was based on CT imaging. All patients were irradiated with cobalt unit and received conventional radiotherapy, 5 days a week, 1.8 Gy per fraction. The first part of treatment included whole brain irradiation (40 Gy) delivered through lateral parallel opposed fields. Thereafter in all instances a brain CT was done and in case of regression or stabilisation (23 pts), a boost dose of 15–22 Gy with reduced portals was delivered. Total dose delivered to the tumor bed was 55–62 Gy. Radiotherapy tolerance was satisfactory and there were no serious complications and interruptions of treatment.Median local recurrence-free survival was 5.3 months, and a median survival – 9.9 months (range, 1.6 to 31.2 months). There was no correlation between survival and radiotherapy dose, sex, pretreatment WHO performance status and tumor localization.Our results confirm poor prognosis in glioblastoma multitorme. New more effective therapeutic approaches are sorely needed in this tumour

On Optimal Stopping and Impulse Control with Constraint

The optimal stopping and impulse control problems for a Markov-Feller process are considered when the controls are allowed only when a signal arrives. This is referred to as control problems with constraint. In [28, 29, 30], the HJB equation was solved and an optimal control (for the optimal stopping problem, the discounted impulse control problem and the ergodic impulse control problem, respectively) was obtained, under suitable conditions, including a setting on a compact metric state space. In this work, we extend most of the results to the situation where the state space of the Markov process is locally compact

Expansion of Nature Conservation Areas: Problems with Natura 2000 Implementation in Poland?

In spite of widespread support from most member countries’ societies for European Union policy, including support for the sustainable development idea, in many EU countries the levels of acceptance of new environmental protection programmes have been and, in particular in new member states, still are considerably low. The experience of the countries which were the first to implement union directives show that they cannot be effectively applied without widespread public participation. The goal of this study was, using the example of Poland, to assess public acceptance of the expansion of nature conservation in the context of sustainable development principles and to discover whether existing nature governance should be modified when establishing new protected areas. The increase in protected areas in Poland has become a hotbed of numerous conflicts. In spite of the generally favourable attitudes to nature which Polish people generally have, Natura 2000 is perceived as an unnecessary additional conservation tool. Both local authorities and communities residing in the Natura areas think that the programme is a hindrance, rather than a help in the economic development of municipalities or regions, as was initially supposed. This lack of acceptance results from many factors, mainly social, historic and economic. The implications of these findings for current approach to the nature governance in Poland are discussed