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Objectives: To assess the reliability of determining sentinel node status in staging regional lymph nodes in breast cancer., Design and Setting: Prospective validation study in a major public teaching hospital, comparing histological sentinel node status with that of remaining axillary nodes., Patients: 117 women who underwent sentinel node biopsy and axillary dissection for primary breast cancer between 1995 and 1998., Main Outcome Measures: Intraoperative success rate in sentinel node identification; false negative rate; predictive value of negative sentinel node status; overall accuracy of sentinel node status., Results: The sentinel node was identified at operation in 95 patients (81.2%). Tumour involvement of the sentinel node was demonstrated in 29 of 31 women (93.5%; 95% CI, 79%-99%). Sixty-four of the 66 women in whom the sentinel node was negative for tumour showed no further involvement of remaining axillary nodes (standard haematoxylin-eosin histological assessment), giving a predictive value of negative sentinel node status of 97% (95% CI, 89%-100%). The overall accuracy in 95 women in whom sentinel node status was compared with axillary node status was 97.9%., Conclusions: Histopathological examination of the sentinel node is an accurate method of assessing axillary lymph node status in primary breast cancer and is likely to be incorporated into future surgical management of women with primary breast cancer.

Objectives: To assess the degree to which limb-sparing surgery is implemented in patients with soft-tissue sarcoma, and its outcome., Design and Setting: A detailed review of 40 patients who were all tertiary referrals to one surgeon, and general review of all 215 patients with sarcoma treated in South Australia between 1986 and 1992., Interventions: Conservation of the limb by wide resection or marginal resection of soft tissue, combined when necessary with radiotherapy. Amputation was used when limb conservation failed or was not possible., Main Outcome Measures: Median survival time after treatment., Results: Limb-sparing treatment was successful in 37 of the group of 40 patients. Thirty-two patients received adjuvant radiotherapy, and 19 received chemotherapy. Median survival time was 35 months. Review of all 215 patients with sarcoma revealed a higher initial amputation rate and a lower use of combined treatment methods than in our series. Twenty-six patients (65%) were initially incorrectly diagnosed before referral, resulting in a median delay in treatment of 16 weeks., Conclusions: The concept of limb-sparing surgery is well established, but is not yet as widely practised for limb sarcomas as it could be. Delay in diagnosis is a significant problem.

A synchronous chemoradiotherapy schedule of modest dosage has been used in 36 patients with oesophageal cancer since July 1984 at the Royal Adelaide Hospital. The schedule, which comprises two five-day continuous infusions of 5-fluorouracil, each of which is followed by a short cisplatin infusion, together with 30-35 Gy of megavoltage irradiation over three weeks, has been used alone, or before surgical resection or further chemo-irradiation. It has been extremely well tolerated and has caused complete endoscopic resolution of disease before surgery or further chemo-irradiation in 69% of patients. At the end of the full course of treatment, complete relief of dysphagia has been achieved in 27 (84%) of the 32 patients in whom this symptom was present at the start of treatment. The median duration of relief has not yet been reached with a median follow-up of over one year. This degree of palliation is significantly better than that which was achieved in a series of patients who were treated radically either by surgery or radiation alone between the years 1978 and 1983 at the Royal Adelaide Hospital. The 12- and 18-month actuarial survival figures of 72% and 55%, respectively, for the 30 patients in this series whose disease remained apparently localized to the thorax at presentation, compare very favourably with the corresponding figures for the much more highly-selected group of patients who were treated surgically between 1978 and 1983.

Forty patients with advanced squamous cell cancer of the head and neck were treated with methotrexate, cisplatin, and bleomycin. Major regression of disease occurred in 69%; 30% of patients achieved complete remission. Fifteen patients received chemotherapy as the initial treatment, followed by either radiotherapy or surgery or both. Subsequent therapy was not prejudiced by this approach. The results demonstrate the marked sensitivity of these tumors to these three agents, and the need for further assessment of their use in optimal patient care.

Twenty-one patients with metastatic melanoma were treated synchronously with procarbazine and radiotherapy. The radiotherapy was given using a conventional fractional dose schedule of 45 Gy in 20 fractions. Twenty-three lesions were treated, of which 11 (47%) regressed completely and four (17%) regressed partially. Patients who responded to treatment had a median survival of 17 months and experienced relief of symptoms. Treatment was well tolerated. The results demonstrate that many patients with unresectable deposits of melanoma can obtain worthwhile palliation from radiation therapy without the use of large fractional dose schedules. There was no evidence that procarbazine exerted a cytotoxic effect on lesions which were not irradiated.