Although it is generally accepted that anti-cancer chemotherapy should be administered at the maximum tolerable dose, it is not clearly established that the therapeutic results at dosage levels involving maximum tolerable toxicity are really superior to those with lower, better tolerated doses. 392 patients with advanced primary lung cancer were treated with 5 chemotherapy regimens including cyclophosphamide, methotrexate, vincristine, procarbazine, hydroxyurea, adriamycin and CCNU, in combinations of 3 to 7 agents. Response rates of 50% and over were registered after 8 weeks of treatment. During the same time the intensity of leukopenia, thrombocytopenia, vomiting, other digestive toxicity, neurologic disorders and alopecia was graded according to the worst observation from 0 to 4. The results show that there is no correlation between the grade of toxicity and the rate of response either for the whole group or for subgroups of patients as defined by cell type, degree of dissemination, age, or performance status. They demonstrate that the search for maximum tolerable toxicity is not a sine qua non for the best possible response to chemotherapy in primary lung cancer.

The prognostic value of infectious complications occurring during the induction treatment of acute myelogenous leukaemia is analysed and discussed. Eighty-eight patients were treated with the same chemotherapy. The early major infections (septicemia, pneumonia, ano-rectal abscesses) and on the other hand, the late infections (following the maximum agranulocytosis) are of a bad prognosis. During the second phase of chemotherapy-induced aplasia, the improvement of infection means usually a forthcoming complete remission while its persistence or its aggravation means usually a failure of the chemotherapy. At last, when the complete remission has been achieved, no peculiar feature of the infection is significantly correlated with the survival.

In order to prevent vomiting induced by anti-cancer chemotherapy, the efficiency of domperidone has been compared to metoclopramide in a randomised trial. No difference has been observed between both emetic treatments.

Seventy-nine patients with clinical stages IA, or II2A of Hodgkin's disease were treated from January 1977 to April 1980 by a multiple therapy schedule, H 7701. Three courses of MOPP chemotherapy were first given to all patients. They were then randomly allocated to two groups: group 7701 S (38 patients) was treated by mantle irradiation, excluding the mediastinum when this was not initially involved, or inverted Y radiotherapy; group 7701 F (41 patients) was treated by focal irradiation only. After follow-up for 9-48 months (median: 26 months), overall survival was 98,6 p. cent and relapse-free duration 94,9 p cent. No statistical difference exists between the two randomized groups. Four patients relapsed; three are now free of disease after further treatment, while one patient has since died. With this chemotherapy-radiotherapy selective of focal sequence, staging laparotomy is not indicated. Results and side effects of this treatment schedule are compared with those of other treatment strategies.

Malignant vulvovaginal tumors in 24 children were treated at the Institut Gustave-Roussy between 1970 and 1979 (16 embryonal rhabdomyosarcomas and 8 yolk sac tumors), with conservative treatment: chemotherapy, curietherapy and partial surgery according to each case. After a mean follow-up period of three years, 20 patients had been cured, while only 4 patients had moderate sequelae.

A retrospective study of 65 patients with Hodgkin's disease (clinical stage I: 11 cases; stage II: 54 cases) included an analysis of the causes of therapy failure. Twenty-five of the 65 patients had been treated by regional irradiation (thoracic mantle or inverted Y field) restricted to only one side of the diaphragm; 27 patients had received the same irradiation followed by chemotherapy (MOPP). The subjects were irradiated on both sides of the diaphragm; 3 of these had received the same radiotherapy followed by chemotherapy (MOPP). Relapses in the irradiated fields were rare. Relapses in the areas bordering the irradiated fields were definitely the result of faulty delivery. Better evaluation of the precise extent of the disease, particularly by laparotomy, would lead to improved initial treatment (radio- or chemotherapy). The availability of improved irradiation techniques and a better choice of indications, particularly concerning the timing for chemotherapy, should result in maximal reduction of therapeutic failures in the early stages of Hodgkin's disease.

From January 1976 to December 1979, 23 adults with advanced soft tissue sarcomas were treated with palliative chemotherapy associating cyclophosphamide, vincristine, adriamycin and dacarbazine (CYVADIC) according to two different schema administered successively. A higher than 50 per cent rate of tumoral response was observed in 52 per cent of cases with 13 per cent complete remissions. Median survival was 14 months in patients who responded to treatment, and 4 months in non-responders (p less than 0,01). Side effects were severe however, and it was necessary to discontinue treatment in 5 patients, and modify dosage in 9 other patients. The CYVADIC protocol is effective but requires some modifications to improve tolerance.

The interactions between three drugs and X-rays were examined in rat hepatoma cells in vitro. Incubation with Daunomycine or 9-hydroxy ellipticine decreases the survival of both exponential and plateau phase cells, whereas cis-Pt (II) decreases the survival of plateau cells, especially irradiated in anoxia. The decrease in the Do was greater when the cells were incubated with the drugs prior to X-irradiation, and was greater in the case of plateau cells than in the case of exponential cells. The repair of potentially lethal damages was inhibited by these three compounds. However, the repair of sublethal damages was inhibited by cis-Pt II, but was modified neither by Daunomycine nor 9-hydroxy ellipticine.

74 patients who had adenocarcinoma of the breast that was inoperable at the beginning because of local extension but without inflammation and without diagnosable metastases (T3b, T4, N1, 2 or 3, Mo) were submitted to a therapeutic regime which consisted consecutively of: 1) preliminary chemotherapy, 2) radiotherapy and/or extended radical surgery when there was any residual tumour, and 3) follow-up adjuvant chemotherapy. Two types of combinations of cytostatic drugs were used: adriamycin, vincristin and methotrexate (AVM) for 5-day cycles every 3 weeks, and cyclophosphamide, methotrexate and fluoro-uracil (CMF) in 14-day cycles every 4 weeks. Three to 5 cycles of AVM were used initially, then at first either AVM to a total of 550 mg/m2 adriamycin, or a series of CMF carried on for a year. Complete remission was obtained in 70% of the patients (52 out of 74) at the end of the local-regional treatment. The mean time of remission was 33 months and the mean time of overall survival was 43 months. The best results were obtained in younger women (under 65 years of age) with tumours that were less developed (T3b), and who could take all the adjuvant chemotherapy after they had complete remission. There was no relapse in 37 of the 48 patients in this group (77% of the cases). Overall the treatment was tolerated fairly well and there was no major complication at the time of radiotherapy or surgery. These results are comparable to those from other studies of a similar nature and show a real progress as compared with those that used to be obtained when only local and regional treatments were undertaken. A more thorough follow-up is however necessary since we can hope for improvements to increase the efficacy and tolerance of the treatments, but this form of treatment can here and now be considered as an important factor for improving the survival rate of these very high risk patients.