Nephrocalcinosis due to hyperphosphataemia with hypocalcaemia is a rare cause of ARF during chemotherapy of ALL. Three cases are reported, one with renal anatomopathological studies and microanalysis of the intratubular calculi. All possible preventive measures should be taken against this complication which is related to acute tumoral lysis, especially in the hyperleukocytic and/or tumoral forms of ALL.

Infection is the leading cause of illness and death in children with leukemia. The risk of infection may change over time as regimens of therapy are modified. A review of the hospital charts of 166 infants in whom leukemia had been diagnosed between 1976 and 1980 revealed an increased number of deep fungal infections (20 v. 3) during this period in comparison with the number between 1969 and 1976 in 164 patients treated at the same hospital whose leukemia was diagnosed between 1969 and 1975. The 20 severe fungal infections between 1976 and 1980 were characterized by difficulty of diagnosis (a definite diagnosis having been made three times out of four only at autopsy), an important role of Candida but also of Aspergillus (the latter having been isolated almost as often as the former) and a grave prognosis (the mortality being very high [75%] and much above that for gram-positive septicemia [6%] and that for gram-negative septicemia [31%]). This increase in frequency of fungal infections was concurrent with the introduction of phase-1 chemotherapy, which was often responsible for prolonged neutropenia. To reduce the risk of infection in children with leukemia it appears to be essential to improve diagnostic methods and approaches to therapy.

Some aspects of the relationships between malignancy and rheumatic diseases are presented. The incidence of leukaemia and lymphomas is increased in rheumatic patients previously treated by alkylating agents or x-rays; hypertrophic treated by alkylating agents or x-rays; hypertrophic osteoarthropathy is frequently associated with bronchogenic carcinoma; very exceptionally, rheumatoidlike arthritis or polymyalgia rheumatica may be paraneoplastic syndromes. As a rule there is an interval of as long as several months between the beginning of joint or bone pains and radiological appearance of metastases. Early detection is possible if there is an elevated level of alkaline phosphatase, increased excretion of hydroxyproline and a positive bone scan.

Fourteen adult patients with inoperable soft tissue sarcoma (with metastases in 4 cases) received chemotherapy as primary treatment. Nine cases were treated by CYVADIC (cyclophosphamide, vincristin, doxorubicin, DTIC) and five cases by DECAV (DTIC, cyclophosphamide, cis-platinum, doxorubicin, vindesine). An objective response was obtained in 7 cases (1 complete remission and 6 regressions greater than 50%) and stabilization in 4 cases. Seven patients became operable after 2 to 6 courses of chemotherapy and a complete resection could be performed in 6 cases. The duration of the response was 2 to 39 months. Toxicity with both combinations was acceptable. We conclude that chemotherapy can provide initial tumor reduction and permit subsequently less radical surgery.

The results of a combination chemotherapy trial (melphalan, CCNU, vincristine, cyclophosphamide) involving 28 patients with stage III (n = 21) or stage II (n = 7) multiple myeloma suggest a high response rate, with a mean 71% malignant cell destruction in 78.5% of the patients. A longer survival in responsive stage III patients as compared with patients treated with alkylating agents seems likely, but this can only be established by a randomized trial. Despite haematological side-effects, this combination therapy may be used in high risk patients, especially those resistant to a single alkylating agent and in whom the frequency, intensity and duration of responses appears to be the same as in previously untreated patients. In contrast, only one of the 7 patients treated for relapse after previous response to a single alkylating agent responded to the combination chemotherapy.

Chemotherapy is essential for the treatment of malignant diseases in childhood. Monitoring a child on chemotherapy includes: 1) looking for evidences of relapse or metastases; 2) if necessary, adjusting doses according to blood counts; 3) preventing and treating intercurrent infections, which are mostly viral, once the initial regimen is completed; 4) diagnosing and, if possible, treating, harmful side-effects, which cannot always be precluded; 5) helping both patient and family to live a normal life; in this respect, normal school attendance is of particular significance.

Following three courses of induction chemotherapy, 23 patients with small cell carcinoma of the lung were treated with a late intensive regimen including autologous bone marrow infusion. Thirteen patients received high doses (2 or 3 times the induction chemotherapy dosage) of cisplatin, adriamycin and etoposide. One patient was probably cured, but renal and mucosal toxicity was observed. Three patients treated with adriamycin, etoposide and cyclophosphamide also developed severe mucositis. The seven remaining patients received high doses of cyclophosphamide (100 to 200 mg/kg) and etoposide (750 to 1000 mg/m2); responses were obtained with moderate toxicity. The long-term survival is not yet known. The usefulness of bone marrow infusion cannot be determined without further studies.

A new subcutaneous flap technic, derived from the chinese forearm flap has been demonstrated. It has been used to cover large cutaneous defects of the hand, especially when the extensor tendons were exposed. An excellent functional repair has been obtained in a single procedure avoiding large scar formation usually seen on the forearm after classical chinese fasciocutaneous flap.

The authors report protocols and results observed with various palliative chemotherapy, used successively against epidermoid carcinomas of head and neck area. This study was followed up during the last ten years by a group of physicians working in 8 specialized oncological centers. The poor prognosis and efficiency of antimitotic drugs in head and neck carcinomas require analyse of a great number of patients files. The cooperative work of several teams allows for more rapidly significant results. Each protocol was closed after a two year period. The protocols were dropped one after another, in order to provide a greater efficiency and a lower toxicity. It was possible to confirm the limited efficiency of "heavy" protocols and the most useful association. The members of this group now pursue a randomised study comparing the results obtained with cis-platyl used alone or in addition to three other drugs. The aim of this study is to assess which is more efficient and less toxic.

Peripheral lymphocyte chromosomes were analyzed in 55 consecutive patients with complete remission after treatment for Hodgkin's disease. In 8 patients, observed metaphases were too few in number. The other 47 patients, 29 men and 18 women, had been off all therapy for 53 months (median 41, ext. 1 to 250 months). The mean interval since the diagnosis was 78 months (median: 73 months) and the mean age at the time of chromosome analysis was 38 years (median: 34, ext. 10-78 years). No patient had either a preleukemic syndrome or leukemia. In contrast to karyotypes in normal controls and previously untreated patients, abnormal cells, hypodiploid, hyperdiploid and tetradiploid cells were more frequent. But neither monosomy 5 or 7 nor trisomy 8 were observed. Intrachromosomal rearrangements (gaps, breaks...) were significantly more frequent (12% vs 5% in untreated patients) particularly on chromosomes 1 and 2. Interchromosomal rearrangements were also numerous (1,25%) but no cells showed any specific translocation for malignant hemopathy. Chromosomal aberrations do not seem closely associated with treatments but influenced by the post-diagnosis interval and the factors present at the time of primary treatment.

In past years, health authorities have exempted anti-neoplastic agents from undergoing carcinogenesis tests. However, in view of increasing knowledge of this therapeutic family and of patients' increased life expectancy, toxicologists are having to reconsider the problem from both ethical and scientific points of view. Analysis of data has established a correlation between mutagenic activity of these molecules, carcinogenic activity in the animal and carcinogenic activity in man. For this reason, studies in laboratory animals are of interest at the present time. Assessment of the carcinogenic activity of anti-neoplastic agents in animals must take into account the chemical structure of the drug. The experiments to be carried out are: either in vitro, short term tests aimed to detect genotoxic drugs by mutagenesis tests, or limited in vivo tests, in order to determine the promoting or initiating character of these drugs. However, the obtention of negative results with the latter tests does not exclude the necessity of long term tests. Whatever the results obtained during these experiments, the decision to stop or to continue the development of an anti-neoplastic agent does not belong exclusively to the toxicologist, who can assess the risk, but not the potential benefice.

In a retrospective study of 1 094 patients treated for Hodgkin's disease between 1963 and 1976, we have observed 65 malignant complications including 28 granulosis acute leukemias and 37 solid tumors. The actuarial 10 year risk of developing acute leukemia is 4.7 per cent; and 5.4 per cent for solid tumors. These figures vary according to the medications received. They are more important in the case of polychemotherapy, particularly for acute leukemia, thus confirming the specific role of alkyl agents. While the course of solid tumors does not seem to differ from that of identical primitive tumors; on the other hand, induced leukemia seems to have a more perjorative prognosis than spontaneous leukemia and they are often announced by cytopenia. The overall risk of developing secondary cancer is multiplied by 2.4 compared to the normal population; that of developing acute leukemia is multiplied by 9.3. In order to reduce this risk, active non alkyl agents of limited duration must be advocated. Irradiation fields must also be reduced.