George Blackledge

Computed tomography of abdomen in staging and clinical management of lymphoma.

During July 1976 to Demember 1977, 150 patients with Hodgkins disease and 138 with non-Hodgkins lymphoma were examined by computed tomography (CT). In 45 cases 50 repeat examinations were conducted. Concurrent laparotomy and lymphography were performed on 68 and 56 patients respectively. The overall incidence of false-positive CT examinations as confirmed by laparotomy was 7.4%. In 18 patients with non-Hodgkins lymphoma in the abdomen there was good correlation between the two techniques. Of the 50 patients with Hodgkins disease who underwent laparotomy, 17 had splenic disease and 14 minimally enlarged lymph nodes in 20 areas; CT, however, detected only four diseased spleens and five minimally enlarged lymph nodes. Nevertheless, CT often detected enlarged lymph nodes missed by lymphography and was 23% more efficient than lymphography in detecting unsuspected disease. CT also detected unsuspected disease in patients with relapse of lymphoma. CT may replace other non-invasive investigations of abdominal disease in patients with lymphoma and give a reliable guide to prognosis. It does not, however, eliminate the need for laparotomy in staging Hodgkins disease.

Advanced recurrent squamous cell carcinoma of the head and neck. Results of a chemotherapeutic regimen with adriamycin, bleomycin, 5‐fluorouracil, methotrexate, and vitamin A

Twenty‐five patients with advanced squamous cell carcinoma of the head and neck were entered into this study. All patients had previously been irradiated and the majority had also undergone surgery for recurrent tumor. A low‐dose regimen consisting of adriamycin, bleomycin, 5‐fluorouracil, methotrexate, and vitamin A was prescribed, the median number of courses was four and a total of 95 were administered. Ten patients (40%) achieved objective responses (7 partial, 3 complete). The median duration of response was 14 weeks (range, nine to 60 weeks) with a median survival time of 38.5 weeks (range, eight to 72 weeks). The nonresponding patient groups survival time was significantly reduced (P = 0.002; median, 12 weeks; range, three to 40 weeks). The treatment was given on an outpatient basis and no serious hematologic toxic reactions were encountered. Mucositis was uncommon. This regimen produced an acceptable response rate without serious side‐effects. The use of Vitamin A may have helped to prevent further impairment of the patients nutritional status by ameliorating drug‐induced mucositis.

Computed tomography (CT) in the staging of patients with Hodgkin's disease: A report on 136 patients

One hundred and thirty-six patients with biopsy proven Hodgkins disease (HD) had conventional staging investigations and CT carried out at presentation. CT did not detect 20 out of 24 positive spleens and did not detect disease at 16 involved lymph node sites proven at laparotomy. In 60 cases in whom lymphography was performed, CT detected all disease shown by lymphography and showed additional disease in 13 other cases (three within the lymphogram area). In 43 patients CT was the only investigation of the abdomen that could be performed and identified 31 unexpected areas of disease in this group. CT altered the stage of the patients in 16% of cases compared with 8% (lymphography) and 34% (laparotomy). The importance of CT as a baseline investigation for the subsequent monitoring of the complete remission of all known disease is discussed, and the routine use of CT when available as the primary non-invasive staging investigation of the abdomen in HD is recommended.

Role of computed tomography in staging and management of gastrointestinal lymphoma.

Twenty-six computed tomography (CT) examinations in 18patients with histologically proven gastrointestinal lymphomas are reported. Fourteen CT examinations were performed at the time of initial presentation, the others being performed during the course of the disease. CT did not help in the diagnosis of the disease but it is effective in assessing the extent and thus the stage of the disease. A normal CT scan during follow up is associated with good prognosis. CT may be of help in planning treatment, especially radiotherapy. It is an investigation easily tolerated by patients and can be used in circumstances where other investigations would be impossible.

Chemoimmunotherapy for metastatic malignant melanoma using vincristine (NSC-67574), DTIC (NSC-45388) and bacillus Calmette-Guerin

Abstract Forty-seven patients with stage IV malignant melanoma were treated with pulses of Vincristine and DTIC. Intercalated, monthly BCG was administered by multiple puncture gun. No patient exclusions were made. The response rate was 38% ; all complete responders (8.5%) were metastatic to skin and nodes only. The median survival of the responder patient group was 6.7 months (1–21) and 2 months ( for non-responders. No significant differences were found for response nor survival length between patients grouped according to sex, severity of haematological toxicity, intervals from initial diagnosis to appearance of metastases or to start of therapy. Patients with the higher Karnofsky scores survived longer. No side effects attributable to BCG were noted and no serious haematological toxicity was encountered. Despite a high response rate, survival was disappointing, and represented the presence of metastases in more than one organ system with only a minority (13%) of patients having metastases in ‘favourable’ (skin, node) sites. A full description of metastatic sites and other prognostic features is necessary for future treatment evaluation.

Computerised acquisition and analysis of flow cytometric data

An interface between a commercial flow cytometer (Ortho Cytofluorograf 4800) and a Desk Top Computer (H.P. 9845S) is described. Programs for data acquisition and analysis have been developed. These include cell DNA content analysis, 2-parameter (3D) histograms and sophisticated sub-population selection. Although cell sorting is not possible using the facility, the data acquired per cell is optimised and detailed analysis can be carried out. The system represents a flexible, easily controlled and economical method for storing and analysing flow cytometric data.