Tumori Journal

An in vitro chemosensitivity test is described for the quantitative determination of the interference of antitumoral drugs on nucleic acid metabolism in short-term cultures of non-Hodgkin's malignant lymphomas. Preliminary biochemical studies have defined the optimal culture conditions and have guaranteed the reliability and the reproducibility of the test. Our results for adriamycin and prednisone are in agreement with those obtained on experimental systems with other techniques.

Preoperative differential diagnosis of a swelling in the neck is mandatory for a good therapeutic planning. Indiscriminate biopsy as first approach is to be disregarded, since it can compromise the result of a radical neck dissection in cases where a metastasis of epidermoid cancer is histologically recognized. A cervical biopsy is not to be performed until a complete HNT examination (including the thyroid and major salivary glands) has excluded the presence of a primary tumor in these regions. Since every localization of the head and neck malignancies shows rather fixed patterns in its lymphatic spreading, a correlation between site of T and particular localizations of N within the neck can be found. The knowledge of the probabilities that an adenopathy in a given region of the neck correlates with a primary tumor located in a given site of the body could strongly aid the physician in detecting the latter, following a rational statistically based approach. This study was performed applying Bayes theorem for probability calculus to the maps of distribution of metastases of tumors of different site in 3,700 patients who were taken into National Cancer Institute of Milan during 7 consecutive years. The results are gathered in tables and text-figures showing the great significance of some correlations, who become more evident when the adenopathies are multiple, but who usefully direct the physician also when the adenopathy is only one.

A group of 79 patients with soft tissue sarcomas and 46 with primary malignant bone tumors underwent lymphangiography as part of the initial diagnostic workup. In the group of soft tissue sarcomas, the overall incidence of metastases was 22 of 79 (28%). According to the site of origin, the highest incidence was found in tumors originating from the buttocks (57%), followed by those from the inferior limbs (31%). Considering the histology, the incidence ranges from 50 % in anaplastic sarcoma, to 43 % in rhabdomyosarcoma, to 23 % for liposarcoma and fibrosarcoma. The incidence of lymphographycally proven metastases in bone tumors was 8 of 46 (17 %), with 1 out of 4 in reticulum cell sarcoma, 1/1 in chordoma, and 22 % in Ewing's sarcoma. A radiographic/histologic correlation on the lymph nodes was obtained in 19/79 (24 %) soft tissue sarcomas and in 4/46 (9 %) bone tumors. In the 12 radiographically negative and 11 radiographically positive cases, this correlation was always correct. The results of this study suggest a larger use of lymphography in these tumors.

Ten hyperthermic isolation-perfusions with melphalan were performed for invasive malignant melanoma of the limbs. Four cases at stage II and with in transit metastases (up to 15 cm in diameter) had a complete regression. However, no improvement of survival was noticed: 4 out of 5 stage II patients who died, within 1 year after perfusion, developed a generalized disease. Systemic chemotherapy was administered in 3 patients after perfusion, but they died from distant metastases. The need for an adequate adjuvant treatment added to isolation perfusion is discussed.

Six intracarotid artery infusions of DTIC were performed in 4 patients with invasive malignant melanoma of the maxillo-facial region. A total dose of 3.5 to 7 g was well tolerated. Only 1 patient who received 9.5 g in 25 days developed a reversible bone marrow depletion. Two out of the 4 patients presented a transient 50 % tumor surface regression, but no response was seen after the second infusion. Of the 2 remaining patients, 1 had no measurable effect and 1 experienced tumor progression.

Three years experience with post operative BCG adjuvant immunotherapy in stage II malignant melanoma is reported. Compared to a historical control group (35 cases), 23 melanoma patients showed a significantly improved remission duration and survival rate. It appears that patients with weak initial BCG reactions, which become gradually positive after several immunizations, get more benefit from the adjuvant immunotherapy than do patients with strongly positive initial BCG reactions.