Seventy-seven patients with inflammatory breast carcinoma were included in a randomized trial between march 1977 and september 1979. All patients were treated with the same association of chemotherapy and radiation therapy. Chemotherapy included adriamycin on day 1 (45 mg/m2), vincristine on day 2(1,2 mg/m2), cyclophosphamide on days 3, 4 and 5 (400 mg/m2/day) and 5 fluoro-uracil on days 3, 4, and 5 (500 mg/m2/day). Each course of chemotherapy was repeated every 28 days for one year. Patients were then given a maintenance course of chemotherapy for one year. Radiation therapy with CO60 was applied after 4 courses of intensive chemotherapy. The dose distributed was 70 Gy over seven weeks. During radiation therapy, chemotherapy was administered according the same scheme, but adriamycin was excluded. All the patients were randomly distributed into two groups before treatment: group I patients received chemotherapy and radiation therapy alone; group II patients received chemotherapy and radiation therapy plus living BCG vaccinations. After chemotherapy, inflammatory manifestations disappeared in 51% of cases. The mean of disease-free interval was 26 months and the overall survival mean 34 months. No difference in favor of the BCG treated group was noted. Lymph node involvement, age, hormonal status, response to tuberculin, and disappearance of inflammatory signs after 4 months of chemotherapy are of insignificant prognostic value.

Thirteen patients with inoperable squamous cell lung cancer were treated by a protocol combining multiple chemotherapy with radiotherapy. Chemotherapy with Adriamycine, Vinblastine, Cyclophamide, Methotrexate and Cis-platinum was administered every month, followed by two radiotherapy sessions with doses of mediastinum. Six cycles were programmed. In 11 non-metastatic patients, 8 responses were obtained (4 objective remissions). Three developed distant metastases. However, mean survival (27 weeks) and 1 year survival (2/10) rates were disappointing. Multiple chemotherapy could be useful in decreasing tumoral size before radiotherapy, modalities of combined treatment should be studied.

Vindesine is a semisynthetic vinca alkaloïd. The short plasma half-life suggested that continuous infusion can improve the therapeutic results by maintaining a constant plasma level. Twenty one patients (acute lymphoblastic leukemia = 5 cases; blastic crisis of chronic myelocytic leukemia = 6 cases; lymphomas 10 cases) received 5-day Vindesine infusion (0,7 mg/m2/d). All these patients had previously several treatments and were resistant to usual chemotherapies including other vinca alkaloids (76% of cases). Eighteen patients were evaluable for response: 13 (72%) had partial responses or minor regressions. Toxicity was not important. Continuous 5-day infusion of Vindesine might be used widely in patients with blood diseases.

Concomitant combined radiotherapy and chemotherapy is less well tolerated by normal tissues than sequential administration. Furthermore, as chemotherapy has to be continued for long periods in order to be effective, the benefits of concomitant administration appear to be minimal in relation to its inconveniences. For sequential treatment, a time interval of one week between the two therapies can reduce cumulative toxic effects on normal tissues. Moreover it is preferable to administer each of them as early as possible to reduce the risk of the development of resistant tumoral cells. A treatment schedule is proposed in which chemotherapy is started as soon as possible with the conventional scheduling of one cycle every month. Radiotherapy is given one week after interrupting chemotherapy, and continued until one week before beginning further cycle of chemotherapy. It is then reinstituted on week after the end of this course, and continued until all tissues have been sufficiently irradiated.

The pathological review of 300 larynx hypopharynx and pyriform sinus carcinoma was done systematically. The results expressed according to the absence or the type of chemotherapy (Bleomycine alone or O.M.B. association) are analysed. There is no difference for the epithelial proliferation but the collagenous part of stroma was enhanced by therapeutic. The foreign body granulomas are related to the tumor maturation (keratinization).

213 squamous carcinomas of the pharyngo-larynx (piriform fossa, pharyngo-laryngeal junction and larynx) received preoperative chemotherapy in the form of oncovin, methotrexate and bleomycin (OMB). All the patients then underwent total or partial laryngectomy, associated with lymph node excision of some sort, followed by radiotherapy. A symptomatic improvement after OMB was seen in 21.2% of cases. Overall tumour response regardless of the site was 32%. Tumour response was all the better when lymph nodes were histologically free of disease (38.7% tumour response in N- as against 26.7% in N+). There was no significant difference in 1 year survival rates between those patients in whom there was a tumour response and those in whom tumour size remained the same.

Systemic chemotherapy and lung irradiation have very similar effects on lung tissue. Several mechanisms are involved, mainly: --cytotoxic effects on lung cells (type II pneumocytes, capillary endothelial cells, and connective tissue); --enhancement of infection; --hypersensitivity and auto-immune phenomena. Acute pneumonitis or chronic lung sclerosis develops which may or may not be compatible with life, depending on the lung volume involved and the clinical course. These effects are dose dependent for radiotherapy, and for most of the chemotherapeutic drugs. In some cases however, the dose-effect relationship is not clear, especially with some drugs such as methotrexate, and sometimes with radiotherapy even when it can be assumed that there is no mistake in dose calculation. It must be stressed that we will lack basic knowledge on the pharmacokinetics and actual concentration of drugs in lung tissue. Additive or supra-additive effects are likely when chemotherapy is combined with lung irradiation, but current relevant data does not allow any firm conclusions to be drawn on the quantitative changes resulting from the association. Prevention of lung complications is however possible if the tolerance doses and the optimal distribution of each agent with time are respected. Combined lung irradiation and bleomycin administration must be avoided.

A man with a carcinoma presented an unusual cytology P. falciparum transfusion malaria. The authors suspect cytotoxic chemotherapy for having induced these cytological changes.

On a two years period, 21 patients with advanced Hodgkin's disease who failed usual therapeutic proceedings were treated by a sequential combination chemotherapy with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD, first described by Bonadonna). Initially 16 patients among 21 had a disseminated disease with stage III B (9 obs.) or IV B (7 obs.). Previously all had been submitted, during a four years mean period, to multiple therapeutic trials always involving MOPP plus lymphoid irradiation and/or other combination chemotherapy. In 19 patients among 21, ABVD was decided because of persistent abdominal lymphoid and/or visceral localizations (liver: 6 obs.; lung: 4 9bs; épidural space: 1 obs.). In 12 patients, abdominal localizations were proved after delayed staging laparotomy. Immediate results with ABVD were: CR: 9 obs. (43%); PR: 5 obs. (24%); failure: 7 obs. (33%). With vinblastine interrupted by intermittent ABVD, 4 CR are persisting with a 8 to 23 months' follow up; among 5 patients who relapsed (3 to 24 months), 4 are still alive. After irradiation of résidual lesions, 4 PR among 5 are persisting with a 6 to 12 months' follow up. For the 21 patients, median survival has not been reached at 30 months.