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Aims and background A retrospective analysis was conducted to evaluate the tolerability as well as the impact of concurrent adjuvant CMF chemotherapy and radiation therapy on total CMF dose and dose intensity.Methods The medical records of 59 patients who had received conservative or radical surgery for breast cancer were analyzed. All patients had been assigned to 6 cycles of “1,8 CMF” adjuvant chemotherapy and concomitant radiation therapy. Total drug dose and dose intensity were calculated. Toxicity was recorded scored according to WHO criteria.Results A total of 355 cycles was administered. Fifty of 59 patients received at least 85% of the programmed chemotherapy total dose, the median value being 100% (range, 42-100). The median relative dose intensity was 0.97 (range, 0.42-1.01). Forty-four of 59 (75%) patients experienced grade 3-4 neutropenia (20 febrile neutropenia) and 29 (49%) required G-CSF support.Conclusions This retrospective analysis showed that it is possible to give concurrent CMF and breast radiation while ensuring adequate chemotherapy total doses and dose intensities to most patients. However, G-CSF support is required in a significant proportion of patients.

Aims and background In the last decades, many epidemiological studies have implicated outdoor environmental carcinogens in the onset of lung cancer. The present investigation evaluated lung cancer mortality in two areas of the Province of La Spezia (Northern Italy) exposed to environmental pollution emitted by a coal-fired power station and other industrial sources, including a waste incinerator.Methods In the two exposed areas, lung cancer mortality risk for the 1988-1996 calendar period was evaluated using the whole Province population as referent. The corresponding relative risks (RR) were estimated after controlling for age structure, urban/rural gradient and deprivation factors (occupation, education, home ownership, housing conditions and family structure) by a Poisson regression modeling. The geographic pattern of risk for the whole province was evaluated via the Besag, York and Mollié (BYM) bayesian model.Results Persons living in urban areas showed the highest rates in both sexes. No statistically significant risk excess was found in the two exposed areas among males, after excluding rural and semi-rural zones from the analyses (RR = 1.03 and RR = 0.77). In contrast, a risk excess was observed for females in both exposed areas, which remained elevated and statistically significant (P <0.05) after restriction to urban/semi-urban municipalities and after controlling for deprivation factors (RR = 1.54 and RR = 2.14, respectively). Bayesian mapping confirmed the rural/urban gradient and the risk excess observed in females near the industrial sites.Conclusions The risk observed among females is consistent with pollution measurements and with other epidemiologic findings, whereas a strong confounding from occupational exposures and smoking habit could account for the lack of an excess risk in males. However, the ecologic nature of this investigation prevented drawing a causal inference. The pollution-related risk observed in the female gender is an important clue that deserves further epidemiologic attention.

This study considers the correlations between some characteristics of the primary tumor and level of lymph node involvement in 185 primary breast cancers. The average number of lymph nodes was higher in N + women than in N— women. Primary tumors with a diameter of more than 4 cm yielded the highest mean number of lymph nodes (17.5). The risk of developing lymph node metastases was fourfold in tumors with a diameter greater than 2 cm when compared to those with a diameter less than or equal to 2 cm. The most commonly metastasized lymph node level, in both large and small tumors, was the first; however, one-fifth of the patients had simultaneous lymph node metastasis in all three axillary levels. Although the left breast was the most affected (58.9 %), there was no evidence of a different risk of metastasis between the two breasts; 34.1 % of the tumors were multifocal. Lymph node involvement was higher in women under 50 years of age with a primary tumor larger than 2 cm.

A mortality study was carried out on a cohort of workers who were exposed to silica dust in a refractory brick plant. The cohort was divided into two groups: workers with and without silicosis, and their mortality was contrasted with the death rate of Genova from 1960 to 1979. Results show an increased risk for laryngeal tumors (3 obs., 0.44 exp., SMR = 682), nonmalignant respiratory disease (16 obs., 3.2 exp., SMR = 500), and cardiovascular diseases (19 obs., 11 exp., SMR = 173) among silicotics. The mortality rate for lung cancer showed an increase for the cohort of workers as a whole (11 obs., 6 exp., SMR = 183). The almost double overall mortality observed in silicotic subjects raises some doubts about the validity of other proportional mortality studies that showed no excesses for workers in these industries.

A case-control study of 60 subjects who succumbed to pleural mesothelioma and a control group of 120 subjects, dead from other causes, was carried out to determine how many dockyard workers were present in each group, and to study the effect of cigarette smoking. Accurate data was obtained on the working and smoking habits for 68.3% of the subjects. The connection between pleural mesothelioma and dockyard work was confirmed (relative risk 13.06%) while no relation was found between smoking and incidence of pleural mesothelioma when professional exposure to asbestos was evaluated.

Blood clotting, platelet aggregation, complete blood count and lipid profile were evaluated in 12 postmenopausal patients with advanced breast cancer. Patients under treatment with high-dose MPA were considered not at risk for thomboembolic disease and were given MPA orally, 800 mg/day, for at least 3 months. Laboratory investigations were performed prior to treatment with MPA then once weekly during the first month and every 2 weeks during the following months. PTT, TEG, antithrombin III and platelet adhesiveness underwent statistically significant changes, tending towards hypercoagulability, although, on the average, they did not exceed the upper normal range. The authors conclude that a clinically relevant thrombotic activity cannot be attributed to MPA at the administered oral doses in the absence of additional risk factors.

The authors examine the problems of planning and conducting a multicentric case-control study on diet and gastric cancer in Italy. The solutions chosen for the study design, cases and controls identification, dietary interview, production of a common protocol for the field work are discussed. Results on the evaluation of the quality and comparability of collected data are presented. Further, compliance of cases and controls to the interview and to the blood and urine sampling with reasons of non-response are shown. Finally, the phases of the study and the methods for improving and controlling omogeneity among Centers are summarized.

The causes of death among the dock-yard workers of Genoa from December 31, 1959 to January 1, 1970, have been investigated. These workers, mainly assigned to ship repair, refitting and construction, are exposed to several noxious substances, such as: asbestos, silica, paint solvents, welding smoke and volatile products of petroleum. Two different control groups were selected: the male population of Genoa and the staff of the San Martino Hospital in Genoa. Causes of death showing a significant increase were: gastric cancer (only in comparison with the hospital staff), cancer of colon excluding rectum, lung cancer, cancer of kidney, urinary bladder and other urinary organs, respiratory diseases, cirrhosis of the liver, cardiovascular diseases (only in comparison with the hospital staff).