Melvin Deutsch, MD

Lannin and Haffty provide aninteresting and informative reviewon the management andclinical course of an ipsilateral breasttumor recurrence (IBTR) followinglumpectomy and breast irradiation forprimary breast cancer. They presentan engaging discussion concerningthe distinction of a true recurrencefrom a new primary tumor within theipsilateral breast. Although bothevents are included in the term IBTR,the authors point out that the morefavorable outcome follows treatmentof a new primary as opposed to a truerecurrence. Presumably, the true recurrencewould indicate tumor thathas not been eradicated by surgeryand radiotherapy (with or without systemictherapy), which would be amore aggressive malignancy. Thebetter prognosis for a new primarynotwithstanding, there is still a lackof data to indicate whether treatmentshould be different for these twoentities.

Sequelae that affect quality of lifein women following breastconservationtherapy can begrouped into three categories: (1) thosethat affect cosmesis such as skinchanges, distortion, and asymmetry ofthe breasts; (2) those that cause physicalsymptoms such as local pain, decreasedmobility of the ipsilateralshoulder, and in extreme cases, respiratoryand cardiovascular impairments;and (3) those that require furthertreatment such as breast infection andabscess, arm edema, soft-tissue andbone necrosis, rib fractures, in-breasttumor recurrence, and second malignancieswithin the treated area.

The prognosis for patients with newly diagnosed medulloblastoma has improved dramatically over the past several decades. In contrast to the dismal results of treatment during the first half of the 20th century, current 5-year survival rates of better than 50% are now being reported, and certain subsets of patients have more than a 70% chance of long-term disease-free survival.[1,2] Although neurosurgeons and radiation oncologists have proposed that this improvement is due to advances in their respective specialties, probably multiple factors are involved.