Summary The usefulness of post-operatively serial serum CA15-3 determination with CEA and TPA was evaluated in a group of 285 breast cancer patients. In particular, the CAI 5-3 sensitivity to 'early' diagnosis and monitoring of the response to treatment of breast cancer relapses, was compared with those of the two other markers in order to'define the most suitable association. Moreover, in a group of 169 non relapsed patients with a prolonged follow-up (40±8 months; mean±s.d.) CA15-3 specificity was investigated.During post-operative follow-up in 27 (10%) patients, distant metastases occurred. In most of them, elevated values of one or more tumour markers were the first pathological sign and CA15-3, CEA and TPA sensitivity to 'early' diagnosis of metastases were 46%, 7% and 63% respectively. When each tumour marker was considered in combination, CA15-3-CEA-TPA association showed a higher sensitivity (87%) than both CA15-3-TPA (83%) and the CEA-TPA (70%). Serum CA15-3 increase preceded the certain sign of metastases 2.7 ± 2.6 months (mean ± s.d. In our previous study (Nicolini et al., 1989) we showed that their serial serum determinations with contemporaneous urinary hydroxyproline-creatinine ratio (OHP/Cr) measurement (the latter as a bone tissue marker) provide guidelines for a rational post-operative follow-up of breast cancer patients. In fact, in most patients, high values of these tumour markers were the first sign of relapse; furthermore, they are easily repeatable and harmless examinations. More recently, a new antigenic determinant defined by two monoclonal antibodies (115 D8 and DF3), has been found in blood of patients with breast cancer. Thus, an immunoradiometric assay (IRMA), has been developed with these two MAbs to measure the breast cancer associated antigen 115 D8/DF3 (CA15-3).So far, the collected data also suggest that this tumour marker is not useful for the diagnosis of the primary tumour (Gion et al., 1986;Schmidt-Rhode et al., 1987). Moreover, they indicate that this new marker correlates with the stage of disease and in metastatic patients with the response to treatment (Colomer et al., 1986;Hilkens et al., 1984;Omar et al., 1988).Nevertheless, there are insufficient data to define whether this marker is advisable for use with or in place of the more commonly used markers for the post-operative follow-up of breast cancer patients.In our Center since 1985, all breast cancer patients followed-up with CEA and TPA have also been followed with serial serum CA15-3 determinations.The prolonged period of observation and the large number of patients studied allowed us to evaluate the usefulness of serum CA15-3 measurement in 'early diagnosis' and in the monitoring of response to therapy of breast cancer relapses. Moreover, these findings were compared with those of CEA and TPA to define the most suitable association of these three tumour markers. Materials and methods PatientsSince June 1985 until September 1989, 285 breast cancer patients, aged 29 to 84 years, followed-up post-operatively with se...

A pilot study with adjuvant hormone therapy in FIGO stage I endometrial carcinoma with myometrial invasion was carried out. All patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy plus complementary radium therapy on the vaginal stump. After the conventional treatment, patients were randomly allocated to adjuvant hormone therapy or no further treatment. Hormone therapy consisted of gestonorone caproate (17α-hydroxy-19-norpregn-4-en 3,20 dione caproate) administered i.m. at the dose of 200 mg/week for 1 year. Of the 62 patients who entered the study, 51 were considered evaluable (24 with adjuvant hormone therapy and 27 with no further treatment). Five patients had a relapse: four of these were in the group with no further treatment. Actuarial relapse-free survival analysis at 5 years was 95.7% in the group of adjuvant-treated patients and 82.8% in the control group. Although there is no statistical significance, adjuvant therapy appears to result in an increase in relapse-free survival in the group of patients with deep myometrial invasion and undifferentiated carcinoma. Further studies are necessary to assess the effectiveness of hormone adjuvant treatment in FIGO stage I endometrial carcinoma with myometrial invasion.

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From January, 1973, to June, 1976, 226 patients with palpable ovarian masses were evaluated preoperatively by lymphography. Histology showed 166 cases of malignant epithelial tumors, 26 benign tumors, and 34 malignant special tumors (not included in this report). Furthermore, the group of patients included 99 recurrences of ovarian epithelial cancer and 24 patients who underwent restaging diagnostic procedures without clinical evidence of disease. Lymphography was negative in all patients with benign tumors. In the 289 cases of epithelial cancer, lymphangiography gave evidence of nodal metastases in 88 (30%). When the histological subtype was considered, the highest incidence of metastases was in undifferentiated carcinoma (50%) and the lowest, in mesonephroid carcinoma (14%). According to the stage before lymphography, nodal metastases were found in 8% of Stage I, 0% of Stage II, 29% of Stage III, and 53% of Stage IV cases. The incidence of metastases was 46% in patients studied for recurrent disease and 17% in patients studied for restaging. Fifty-four percent of patients had metastases only in the pelvic nodes and 18% only in the para-aortic chains; in 28% both chains were involved simultaneously. Bilateral involvement was found in 63% of the positive cases. Retroperitoneal node biopsies were performed in 68 patients (36%). The radiologic/histologic correlation was 100% in the lymphangiographically positive cases; 81% in the negative cases, with nine false-negative reports; and 87% in all cases.

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