Giovanni Dragoni

Classification and Treatment of Hodgkin's Disease

A new clinical classification for Hodgkins disease is proposed by the Committee for the Study of Malignant Lymphomas of the National Cancer Institute of Milan in cooperation with the Institute of Radiology of the University of Milan. The method of treatment of Hodgkins disease adopted in these Institutes is also outlined. The histologic classification includes paragranuloma, nodular sclerosis, granuloma and sarcoma. Stage I: disease limited to a single peripheric lymphatic region. Within this stage two groups can be recognized: a) involvement of one single lymph node or few nodes limited to a small area of the region (unifocal lesions); b) involvement of many nodes spread throughout the region (uniregional lesions). Stage II: disease limited to two contiguous lymphatic regions, or to few deep nodes (mediastinal, retroperitoneal). Stage III: disease limited to two non contiguous peripheric lymphatic regions, or to many peripheric and/or deep (mediastinal, retroperitoneal) regions, provided the involvement is either above or below the diaphragm. Stage IV: generalized disease with involvement of lymph nodes above and below the diaphragm, or involvement of one or more lymphatic regions with concomitant involvement of visceral organs, bones, marrow, nervous system and skin. Systemic symptoms and signs, fatigue, fever, night sweats, loss of weight, itching, anemia, lymphocytopenia, high erythrosedimentation rate) must be recorded in each case to evaluate prognosis and proper treatment, bu are not considered in this classification for lymph node staging. Primary visceral, bone, nervous and cutaneous involvement is exceptional; therefore staging for such lesions is not considered in this classification. In all stages endolymphatic radiotherapy with Lipiodol F 131I is indicated (10 ml in each foot with 2.5 mc/ml, corresponding to a tumor-dose of 15 - 20,000 rads). This is considered as a radical as well as a prophylactic treatment for those lymph nodes adequally filled with the contrast material; in case of non filling or incomplete filling of part of the lymph node chain, treatment will be completed with external radiation therapy. Stage I and II are treated with radical and prophylactic radiotherapy. If systemic symptoms and signs are still present after radiotheraphy, a course with anticancer drugs will be administered. Radiation therapy is given with high voltage or Co60 units. In radical treatments tumor doses of at least 3,000 r within 3–4 weeks are administered to all involved lymphatic regions. Prophylactic radiotherapy is indicated for regions clinically free of disease but contiguous to the involved areas, with tumor doses not less than 3,000 r in 3–4 weeks. In stage II radical radiotherapy follows a course with chemotherapy. In stage IV chemotherapy is the treatment of choice; palliative radiotherapy is given to any bulk of tumors, wherever the location, when specific symptoms can be attributed to the masses. The anticancer drug of choice is methyl-bis-(β-chloro-ethyl)-amine HCl(HN2) 0.4 mg/kg i.v., for those patients who did not receive any previous course of chemotherapy. Otherwise, as well as during the course of the disease, other polyfunctional alkylating agents, vinblastine (alone or in combination with chlorambucil), methylhydrazine, and corticosteroids will be administered according to each clinical situation. Radical surgery followed by radical radiotherapy is reserved for primary lymphatic involvement only in specially selected patients in stage I with unifocal lesions. Primary involvement of the stomach, small bowel or colon is treated by surgical extirpation and radiotherapy. Splenectomy is indicated when this viscus is the only site of involvement. During pregnancy radiation therapy is not administered below the diaphragm. Chemotherapy is not given during the first 4 months of pregnancy. The need for one internationally accepted clinical classification of Hodgkins disease is stressed.

Radioimmunoassay of plasma carcinoembryonic antigen (CEA): Consideration of the results of two methods

SummaryThe two methods used to analyze 384 plasma samples were the carcinoembryonic antigen test (CRT) performed at the Roche laboratories and the direct radioimmunoassay plasma carcinoembryonic antigen (DRPC) technique. The first test, which is quantitative, gave many false positives below the 5 ng/ml level (also when used in a larger series of 4,628 subjects), thus invalidating its use for detection of gastrointestinal neoplasms. The DRPC technique was positive in 62.3 % of 101 cases of gastrointestinal adenocarcinoma and gave very few false positives.

Telecobalt therapy as an unique treatment of laryngeal neoplasia

194 laryngeal tumors were treated with cobalt teletherapy. They were classified according to the T.N.M. system and 168 have been evaluated statistically (T1 -T2 = 42; T 8 -T. = 124). The results are shown in a series of survival curves; the five-year survival rate is 21.6 %. This experience confirms the value of radiotherapy as a useful conservative treatment, although in many extensive cases (T3 -T.) radiotherapy ensures longer survival if combined with surgery.

Scintigraphic study of lung neoplasms with mercuric chloride

100 patients were scanned with a tumor-specific scanning agent (197HgCl2) for suspected lung cancer. 67 primitive malignant tumors and 8 metastatic localisations were detected; all but one case of secondary localisation, where no significant :fixation was demonstrated, showed a high and selective uptake of the radio active compound. Among the other patients without neoplastic disease a significant :fixation took place only in two cases of sarcoidosis. The comparison of these results with the X-ray :findings in the same patients clearly demonstrated that with the scanning method detection of the tumoral characters of the disease is easier. The results of the sputum cells examination for diagnostic purpose are still poorer, if compared, though a positive response is more decisive. TMHgCl., whose localisation in the tumors may depend on its HS-protein-binding properties, is a suitable agent for the diagnosis of lung tumors and its properties make it suitable for a routine clinical use. The only limitation appears to be a non negligeable irradiation of the kidneys.

Studies on the Effect of Association of Daunomycin and X-Rays on Oberling-Guérin-Guérin Transplantable Myeloma

The effect of daunomycin and x-rays in association on the survival time of Long Evans and Wistar rats with Oberling-Guérin-Guérin transplantable myeloma is studied. No favorable results were obtained in Wistar rats, whereas in Long Evans rats the association proved more effective than one treatment alone. In Long Evans rats histoincompatibility phenomena against the tumor may be a cause of the enhanced effect of the association under study. The experimental results are discussed in relation to the use of this association in clinical treatment.

CARCINOGENIC RISK IN RADIOTHERAPY.

The information on the appearance of skin, bone, thyroid and internal tumors following radiotherapy has been reviewed. As far as the development of leukemias, the data concerning humans are discussed, particularly in relation to the treatment for thymic hypertrophy, spondilitis and hyperthyreotoxicosis. The authors conclude that an oncogenic and leukomogenic risk connected with the therapeutic use of ionizing radiations exists although it is difficult to evaluate on a quantitative basis. The need of awareness of the risk by physicians and radiologists is stressed.

The scintigraphic study of the liver in tumoral pathology

The authors report their experience in the use of colloidal Au108 for liver scanning in the neoplastic disease. Radioisotope scintillation scanning of the liver has been performed in 156 patients, of whom 3 with primary tumors, 94 with clinical suspicion of metastatic lesions from tumors of various origin and kind, and 58 with lymphomas. According to the experience of the authors, liver scanning gives certain information about changes in size and shape of the liver; it is principally useful in demonstrating the derangements of internal pattem produced by space-occupying lesions. In fact it is a valuable test to employ in the study of malignant neoplasms. However the procedure may be not sufficient for the detection of liver lesions of Sm.all size, not inducing changes of the volume and shape of the liver. Original scintigraphs are presented and the results of some interest and of particular meaning are discussed.

Scintigraphic study of the spleen in some diseases of the lymphoreticuloendothelial system

Considerations on the value of scintillation scanning of the spleen, using Cr51 and BMHP-Hg197 labelled red cells, in neoplastic diseases and particularly in malignant lymphomas are reported. The examination was performed in 45 patients and was found useful for the demonstration of changes in spleen size and morphology and for differential diagnosis with abdominal masses. Splenomegalies were studied also through the index of splenic surface. It was also possible the demonstration of « cold areas », corresponding to intrasplenic alterations, as neoplastic infiltration.

Considerazioni Anatomo-Radiologiche Sui Tumori Pararenali

Six cases of pararenal tumors, roentgenographically diagnosed and histologically proved are presented. Mesenchymal tumors arising in the fibroadipose envelopes of the kidney were found to be prevalent; at the histological examination they show, occasionally, areas of sarcomatous degeneration. Retroperitoneal tumors are histologically classified and described, and the various radiological tecniques, which may be valuable from a diagnostical viewpoint, are critically surveyed. Besides the findings which may be noted following the roentgenographic examination of the abdomen without contrast medium, the topographic changes of the urinary ways appear to be particularly significant: in fact, the reno-ureteral displacements constitute the most frequent occurrence, in that the neoformations of the pararenal space, arising in the renal fascia and generally spreading, may cause displacements and dislocations of the kidney and ureters. The great importance of the uropyelographic examination is therefore stressed, whereas an undoubted even if sometimes complementary value is ascribed to the more modern techniques.