Chemotherapy in bronchogenic carcinoma (author's transl)]

Therapy results in bronchogenic carcinoma remain unchanged since the establishment of thoracic surgery. Prognosis depends on the two main factors: histological type and extension of disease at the time of diagnosis. Both factors are mutually dependent. Small cell carcinoma of the bronchus represents a special entity with its early hematogenous spread and the poorest prognosis of all bronchogenic carcinomas. The tumor is highly sensitive to radioor chemotherapy. A marked prolongatoion of medium survival time can be obtained by combination chemotherapy. This is usually accompained by an obvious improvement in the patient's general condition. In certain cases results can be further improved by irradiation of the primary tumor and the mediastinum. Prophylactic cranial irradiation is often indicated because of the frequent cerebral metastases. Results of chemotherapy are much less impressive in adenoor squamous-cell carcinomas of the bronchus. Such therapy can only be recommended for the exceptional case. Pilliative radiotherapy should be used freely. Till now, adjuvant chemotherapy after surgery has only proven its value in small cell bronchogenic carcinoma.     

Chemotherapy of the ovarian carcinoma (author's transl)]

Ovarian carcinomas are highly sensitive to chemotherapy. The alkylating agents were most extensively investigated. With these drugs remissions can be obtained in about 50% of the patients. Some early results seem to show a higher response rate and a longer duration of remission after combination chemotherapy. In ovarian carcinoma it has to be the aim of the chemotherapy to obtain a complete remission. The indications for chemotherapy are not yet well defined. Treatment is definitely indicated in stage IV (FIGO) or in recurrent disease after radiotherapy. This treatment has to be given as a long-term therapy over a long period of time. In stage III and II b disease a combined treatment plan has to be developed by the radio- and chemotherapist. At the present time no data are available which prove or disprove the value of an adjuvant chemotherapy in the early stages of ovarian carcinoma. Remembering the somewhat promising results of adjuvant chemotherapy in breast cancer, it is conceivable that prophylactic chemotherapy will prove to be indicated in early stages of ovarian carcinoma.     

Diagnostic value of vaginal mouldings in uterine cancer (author's transl)]

Vaginal mouldings were originally introduced as applicators for uterovaginal radium therapy. After 13 years of experience with this method in the Gustave-Roussy Institute we have found that it is also of great value for diagnostic purposes: it enables the site of the uterine cervical and vaginal lesions to be determined in a more precise manner; areas of invasion of the vagina can be detected which would normally not have been found, either because of the difficulty of performing previous investigations, or because of the extremely superficial nature of certain vaginal lesions: the extent of invasion and the subsequent therapeutic approach can then be radically modified; objective records can be kept in the form of photographs which can be compared with any future mouldings. The vaginal moulding can, in fact, be used as a diagnostic tool during supervision of the patients, when there is the least suspicion of an abnormal finding.     

The diagnosis of occult mammarian carcinoma (author's transl)]

The proceeding of dedection of ocult mammarian carcinomas by an effective coordination of mammography and thermography is described. The frequency was 7%o of 2000 examinations and with that higher than given in the literature. The importance of post-operative controls is emphasized.     

Radiation therapy and treatment results in carcinoma of the esophagus (author's transl)]

Results from radiotherapeutic treatment of 200 patients with malignant tumors of the esophagus are reported. The principal part is represented by squamous cell carcinomas with 88%, followed by adenocarcinomas with 4.5%, by more or less differentiated solid carcinomas with 4%, and small cell carcinomas with 1.5%. Sarcoma was found in three cases, one of them a myosarcoma, another a reticulosarcoma. An ectopic carcinoma of the gastric glands was present in one case. The staging was performed according to the TNM system. A focal dose of 6000 to 6500 rd within 6 or 8 weeks was tried for, using 60Co-gamma-rays. The one-year and five-year survival rates in stage T2N0M0 amounted to 80% and to 17%; no survival was obtained in stage T3N0M0. Out of the total of stage T2-3N0M0 cases 24% obtained one-year survival, and 2% five-year survival. In stages T3N2-3M0 and T3Nx-3M1 after one year 9% and 7% of the patients were alive. The mean survival time of stage T2N0M0 cases was 30.5 months; of T3N0M0, 7.3 months; of T3N1-3M0, 5.2 months; of T3Nx-3M1, 3.8 months. The one-year and five-year survival rates, being related to the irradiation dose administered, amounted to 28% and to 2% after a minimum dose of 5000 rd to the focus. With less than 5000 rd, none of the patients survived two years. The bad results of treatment demand new therapeutic pathways. Short-term pre-irradiation followed by surgical treatment is discussed as well as a combined radiation therapy with cobalt-60 and neutrons or a combined radio-chemotherapy using cytostatics.     

Pelvimetry (author's transl)]

A simple and precise technique for pelvimetry, delivering only a low dose of irradiation, is described. It includes the usual lateral view, but for the AP uses that of Fernstro?m. The technique and results are described.     

Irradiation pneumonitis after high voltage treatment of carcinoma of the breast (author's transl)]

Pulmonary changes following irradiation after post-operative high voltage therapy of the carcinoma of the breast is usually greater than following orthovoltage treatment. Among our own 635 patients, treated post-operatively with telecobalt including the chestwall, pneumonitis occurred in 35%. The data published in the literature and our own show the need for refined techniques of irradiation and individual planning.     

Recurrency in primary duodenal carcinoma (author's transl)

18 months after the operation (duodenectomy and partial pancreatectomy) a tumor recurrency is observed in a 64 years old patient with primary adenocarcinoma of the duodenum. The roentgen diagnostic shows a partial destruction of the upper jejunal loops combined with a free passage.     

Recurrences of the gastric carcinoma after surgery (author's transl)]

A series of 71 patients with recurrences of gastric carcinoma after operation is reviewed. The most frequent localization is the gastric bed (48 cases , 67.6%) while the local recurrences is less frequent (22 cases, 30.9%) and usually the esophago-cardial junction is affected. In one patient both the local recurrence and that of the gastric bed were present. The radiologic investigation was negative in about 60% of the patients because it is not useful for a correct examination of the gastric bed. In any case it must be considered essential for the study of the local recurrences and for the evaluation of the post operative anatomic patterns.     

Operative therapy for primary malignant bone tumors (author's transl)]

During the last 20 years, particularly in Europe, high dosage radiation therapy was primarily advocated and secondarily surgical amputation. Today, the earliest possible surgical elimination is considered to be the most sensible. This need not necessarily take the form of a mutilating procedure since, on the basis of American statistics, the results of resection procedures can be considered to be equally good. In each case, the diagnosis must be histologically clarified by biopsy before drastic surgery. In the context of a plan of therapy which is individually discussed among surgeons, radiation therapists and internists, additional tasks such as metastasectomy and stabilizing procedures in tumor-induced fractures fall to the surgeon. While it is still too early for a survey, we nevertheless hope that the positive aspects of combined therapy in our individual cases will increasingly benefit the total number of patients with malignant bone tumors - even if only in the form of a prolongation of life with less symptoms.     

Angiographic findings in primary miliary hepatic tuberculosis (author's transl)]

The authors describe the hepatic angiographic findings in two patients with primary miliary hepatic tuberculosis. The main angiographic features are abnormalities of the distal arterioles, with small, nodular and irregular formations. The hepatic and portal veins are normal. To our knowledge, it is the first report of angiographic abnormalities in miliary tuberculosis of the liver. The diagnostic and pronostic interest of these findings are discussed.     

Bronchial carcinoma. Problems and treatment with special reference to radiotherapy (author's transl)]

With reference to the recent literature, a representation of case-history, therapy and prognosis of bronchial carcinoma is made. Inhalation of tar products by smoking, as well as predominantly occupational dust are the important etiological factors for the increase in bronchial carcinoma. Because of the long occult progression of the disease the diagnosis based on clinical symptoms is made very late. Only a greater effort in organisation and diagnostics permits an early detection in high-risk groups. Therapeutic success has remained constant since the sixties. Up to now only the consequent pre-operative selection of patients has been significant for improvement of surgical results. Five-year cures are more frequent after lobectomy than after pneumonectomy. In radiation therapy, the use of high-voltage gamma rays in contrast to conventional deep radio-therapy, has not brought any significant improvement. An additional intensive and individual care and follow-up of patients is of vital importance. The optimal curative radiation dose is 6000 rad. Particularly pre-operative irradiation is important to prepare some inoperable patients for curative surgery. Postoperative radiation therapy is also valuable for doubtful radical surgery and after exploratory thoracotomy. Palliative radiation therapy results in rapid disappearance of symptoms; with generalized disease or in suspicion for formation of metastases, chemotherapy should be preferred. This is particularly true for anaplastic, small and large cell carcinomas, and their rapidly growing metastases. In those cases, combination of polychemotherapy may decrease the tumor size and increase the length of remission. The prognosis depends on microscopic tumor type, stage of the disease, and therapy. Abnormal excretion of steroids and immunological disturbances are prognostic at the time of diagnosis.     

Ureteral diverticulosis (author's transl)]

We report here two new cases of ureteral diverticulosis. This condition is found usually in the man of the fifties who has most frequently an urinary tract infection or a prostatic adenoma. The roentgen findings are multiple out-poutchings of the lumbar ureter. Several factors are combined (constitutionnal, urinary tract infection, disordered ureteral-motility) to explain the creation of diverticules in the areas of weakness of ureteral wall, where penetrate the vessels.