Chemotherapy-induced alopecia observed in cancer patients can now be prevented by a simple, effective, inexpensive and well tolerated procedure: scalp hypothermia. Refrigeration is obtained by placing on the scalp two bags filled with crushed ice 15 minutes before, and removing them 15 minutes after intravenous injection of antineoplastic drugs. Only patients treated with drug combinations that are rapidly administered (into the giving-set tube or by i.v. infusion lasting less than 60 minutes) seem to benefit from scalp hypothermia. The fact that good results were obtained with those drugs (adriamycin, cyclophosphamide, 5-fluorouracil, methotrexate, vincristine) and modes of administration that are most commonly used in women with breast cancer or ovarian cancer makes this procedure extremely interesting.

Repopulation of the bone marrow after heavy chemotherapy and autologous transplantation was monitored by means of biopsies and bone marrow cultures on agar carried out simultaneously from the 2nd to the 33rd days after transplantation. A parallelism was observed between the reappearance of cell clusters on biopsy material and the growth of colonies in cultures, both being the centres from which the corresponding series proliferated. The clusters were almost invariably formed of one series. Repopulation began 3 to 5 days after transplantation and was complete between the 10th and 20th days. Oedematous dissociation persisted long after the clusters reappeared. Bone marrow repair was virtually always accompanied by plasmocytosis.

Septicaemias are frequent and severe in patients with acute leukaemia under aplastic treatment. The present study concerns 69 such patients: 29 with acute lymphoblastic leukaemia (ALL), and 40 with acute non-lymphoblastic leukaemia (ANLL). All were treated in single rooms in the same hospital and in similar conditions. The overall incidence of septicaemia was 62%; it was 60% in patients with recently diagnosed ALL and 68% during relapses. More than 34% of ALL patients and 82.5% of ANLL patients had one or several episodes of septicaemia. Among the 74 pathogens isolated 50% were Gram-positive organisms, 45% Gram-negative organisms and 5% Candida spp.. The first episodes of septicaemias were predominantly caused by Gram-positive spp. (61%) and the subsequent ones by Gram-negative spp. (60%). The primary infection could only be diagnosed in 19% of the cases and was most frequently located in the digestive tract or perineal region. The most common focal complications were lung infections (18 cases), skin infections (12 cases) and septic shock (15 cases). Seventy-four p. cent of the patients survived with prompt and potent antibiotic therapy. Death occurred in 26% and was clearly related to the following factors: chemotherapy of relapsed leukaemia and/or blastic aplasia and/or successive episodes of septicaemia. The incidence and severity of septicaemias in leukaemic patients will only be reduced by improved prophylactic measures against infection and by less pronounced and shorter chemotherapy-induced granulocytopenia.

Aclacinomycine-A (ACM), a new anthracycline derivative, was administered intravenously to 50 patients in doses of 10-30 mg/m2/day for periods of 6 to 30 days. Among the 45 patients who could be assessed, 17 were suffering from acute myeloid leukaemia, 19 from acute lymphoid leukaemia and 9 from non-hodgkin lymphoma. The results confirmed those first published by the authors in 1978 and led them to propose new measures aimed at reducing the toxicity of ACM. Depending on the dosage, complete or partial (more than 50%) remissions were obtained in patients with acute myeloid leukaemia. In the 19 patients with acute lymphoid leukaemia, complete remission was observed in 2 and partial remission in 2. Among the 9 patients with non-hodgkin lymphoma, there was 3 complete and 1 partial remissions. ACM did not produce alopecia and, as predicted by the authors' experimental study on hamsters, did not have major cardiac toxicity. The gastrointestinal toxicity, which had forced a reduction of the total dose in the first trial, proved moderate, even with normal dosage.

Twenty-five cases of invasive carcinoma of the bladder treated by surgery, radiotherapy and chemotherapy are discussed. Cis-diammine dichloroplatinum (CDDP) was used in 8 cases, bleomycin in perfusion in 6 cases and a combination of CDDP and adriamycin in 11 cases. Of 8 cases with lymph node invasion, 4 are alive 5 to 21 months after the start of treatment. Of 12 who were followed up and has no nodal involvement, 9 are alive 5 to 52 months from the start of treatment. The tolerance to treatment is poor, but the results are encouraging. Therefore, we suggest a program of treatment consisting of intense preoperative radiotherapy, partial or radical cystectomy, followed by an combination of 100 mg of CDDP and 60 mg of adriamycin monthly for 9 months.

From november 1981 to january 1982, 80 consecutive patients received high dose metoclopramide, adjoined to different cancer chemotherapy regimens containing cisplatine, dacarbazine, actinomycin D or mithramycin. Nineteen of them (23,75%) had no chemotherapy induced nausea or vomiting, 30 (37,5%) had nausea alone or vomited only once, and 17 (21,3%) had 3 to 5 episodes of vomiting. The overall efficacy of high-dose metoclopramide was 83,7 per cent. It has been seen whatever the chemotherapeutic agents used, and was inchanged for the following courses in 33 of 37 patients who received 2 to 4 courses. In 25 out of 33 patients who had already received the same chemotherapy without high dose metoclopramide, the digestive tolerance have been improved by the antiemetic treatment. Toxicity of high dose metoclopramide had been encountered in 17 (21,5%) of the patients and necessited this treatment to be stopped in 10. There were mainly extrapyramidal syndroms, diarrhea and drownsiness. The toxicity of high dose metoclopramide was of concern mainly in patients younger than 30, and/or when dosage escalation have been attempted.

We have studied the children born of leukemic parents who treatment had stopped. In total, 8 women (3 acute myeloblastic leukemias and 5 acute lymphoblastic leukemias) who gave birth to 11 children, and 6 men (all with acute lymphoblastic leukemias) who fathered 12 children were studied. Of these 23 children, two have a severe congenital malformation, one congenital hypopituitarism associated with mid-line defect, and one laparoschisis, and also two benign abnormalities were observed. The children with abnormalities had a leukemic mother, whilst no leukemic father had an abnormal child. It is well known that the toxic effect of chemotherapy is different in the male and the female gonad. These results are compared to those in the literature, and at present it appears difficult to form a clear opinion on the delayed teratogenic effect of chemotherapy. Fecundity and the risk for future generations are unknown. The opening of an international registry would be useful.

Seventy-one patients with advanced ovarian carcinoma (stage III and IV) were included in this study between october 1977 to june 1981. Surgical resection was initially judged impossible in 17 cases, partial in 38 and complete in 16 cases. Forty-seven patients (group A) were given a monthly course of a three drug combination including adriamycin (ADM: 40 mg/m2 day 1), cyclophosphamide (CPM: 400 mg/m2 on days 2, 3, 4), 5 fluoro-uracile (5 F.U.: 600 mg/m2 on days 2, 3, 4). Twenty four patients (group B) were given the same drug combination plus cis-DDP (80 mg/m2 on day 4). After failure of the treatment in group A, 20 patients received the same combination chemotherapy as in group B (group C). The overall response rate of treatment was comparable in both groups A and B: 62 per cent (29/47) in group A including 32 per cent of complete clinical responses (15/47), 66 per cent in group B (16/24) including 33 per cent of complete clinical responses (8/24). The median of survival was 24 months in group A and 21 in group B. Twenty per cent (4/20) of the patients in group C had an objective response to cis-DDP after failure of the combination of adriamycin-cyclophosphamide-5 fluoro-uracile. The quality of initial surgical resection, the size of non resectable tumors and the clinical response to treatment appear as parameters of significant prognostic value.

Following surgery for epithelial carcinoma of the ovary, FIGO stages IIc, III and IV, 110 patients received chemotherapy in one of four treatment regimens (Melphalan; Cyclophosphamide-Methotrexate-Fluoro uracil; Cyclophosphamide-Cisplatinum; Cyclophosphamide-Cisplatinum-Fluoro-uracil). Melphalan alone was as effective as combination chemotherapy and less toxic. The study confirms that the survival duration is inversely correlated to the stage of the disease and to the amount of residual disease following surgery. It also confirms the role of the "second look" surgery in the evaluation of the response to chemotherapy, and in the overall management of the disease.

Tumoral stem cells capable of multiplying can be selected from human tumours by in vitro culture techniques. These are the cells which renew the tumour and form metastases. Placed in a suitable agar medium, they give birth to cellular clones. The selection of clone-forming cells from human tumours makes it possible to devise chemograms, as has successfully been done in the U.S.A. by the Salmon and von Hoff teams. Working on a fairly large number of different cancers and using in vitro tests in the presence of drugs, these scientists were able to predict chemosensitivity and chemoresistance in 62 to 96% of tumours. The new techniques and results are presented and discussed.