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Forty-five lung cancer patients who had recurrence and/or endobronchial obstruction were treated with intrabronchial radiotherapy (IBRT). The majority had been heavily treated previously, mainly by external radiotherapy; six patients were treated surgically. IBRT was given with high-dose-rate equipment, either 18 Gy in three fractions or 15 Gy as a single dose was originally planned. For different reasons several patients received other regimens. Palliation of dyspnoea was obtained in 64% of the patients. Palliation of hemoptysis (12/14) and cough (11/17) was registered, as well as improvement in atelectasis in 11/26 patients. Palliation of dyspnoea was enhanced with an IBRT dose > 15 Gy. The median survival after IBRT was 13 weeks. Fatal hemoptysis (FH) occurred in 12 patients; 10 of these within 6 months after treatment. The risk of FH significantly increased with an IBRT dose > 15 Gy.

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Eight patients with colon perforations after combined treatment with radiotherapy and steroid medication are studied retrospectively. Sigmoid diverticuli perforated after a minimum of 5 days treatment. The main symptom was a varying degree of abdominal pain. Clinical parameters were of limited value. The most important single examination was plain abdominal x-ray, though this was not positive in all cases. Seven patients were operated on, one with simple suture, the rest with Hartmann's procedure. None developed postoperative peritonitis. One died from cerebral infarction. Four died within 38 days postoperatively after discharge from hospital. Abdominal symptoms during high dose steroid treatment may indicate perforation of the colon. Immediate operative intervention may have an uncomplicated postoperative course.

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This study was performed to evaluate local tumour control and toxicity of chemoradiotherapy given to patients with primary or recurrent carcinoma of the anal canal. A total of 117 patients were admitted to the Norwegian Radium Hospital during the period of 1983-1989, of which 106 received a combination of radiotherapy (50 Gy to the pelvis) and chemotherapy (mitomycin C + 5-fluorouracil). Sixty-five percent of the patients with primary carcinomas presented with advanced tumours (T3 or T4). Good local tumor control was obtained as only 25% of the patients with advanced tumours (T3 and T4) and 7% of those with smaller tumours (T1 and T2) had a local relapse after treatment. Recurrent tumours following primary surgery did not respond as well; 50% of these patients still had carcinoma 1 month following therapy. All patients experienced acute toxicity (dermatitis/mucositis, diarrhoea and general fatigue), and 50% needed as split course. There was, however, no therapy-related mortality. Survival data seem promising, but further follow-up is necessary to make conclusions. Eight percent of the patients had serious anal insufficiency after treatment. We conclude that the present regimen provides good local tumour control and well-preserved anal function, but has considerable acute toxicity.

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This study was performed to evaluate the survival and late morbidity rates of a widely used combined chemotherapy and radiation therapy regimen given to patients with carcinoma of the anal canal. One hundred six patients received radiation therapy (5000 cGy given by two anteroposterior-posteroanterior [AP-PA] opposed fields) and chemotherapy (mitomycin C plus 5-fluorouracil [5-FU]) from 1983 to 1989. Patients with primary tumors (n = 86) had a complete response rate of 84% and a 5-year survival rate of 72%. There was no significant difference in survival rate according to tumor stage. Patients with local recurrence (n = 20) after primary surgery had a complete response rate of 50% and a 5-year survival rate of 40%. Fifteen percent of the patients experienced late treatment-related symptoms including anal incontinence, intestinal obstruction, and chronic pelvic pain. The current treatment regimen is effective but carries a considerable risk of complications. As survival rate was independent of tumor stage, the locoregional treatment should probably be less extensive for small tumors than for advanced tumors. This strategy may reduce the late side effects for patients with small tumors without reducing the survival rate.

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Symptoms, delay in diagnosis, tumour stage and the clinical value of a follow-up programme were studied in 107 patients admitted to the Norwegian Radium Hospital for anal canal carcinoma. Sixty percent of the patients had advanced tumours (T3 or T4) at the time of diagnosis, while 1/4 presented with metastases to the pelvic lymph nodes and 5% with distant metastases. The most frequent initial symptoms were anal bleeding and pain (38 and 23%, respectively). About 3/4 of the patients experienced more than 1 month's delay of diagnosis, either because of the patient himself (1/2 of the cases), doctor (1/5 of the cases) or hospital (1/10 of the cases). About 1/3 of the patients had more than 6 months' total delay. The follow-up after treatment (chemoradiotherapy) shows that frequent digital rectal examination is the most important procedure. Some patients may benefit from serum carcino-embryonic antigen measurement, liver ultrasonography or chest X-ray.

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Impairment of vocal cord function is a threat to patients with thyroid carcinoma; either due to the tumor having infiltrated the larynx or the recurrent nerve, or to accidental damage to the laryngeal nerves during thyroid surgery. We have reviewed 1,245 patients' records which were filed under the diagnosis of thyroid carcinoma at Det Norske Radiumhospital from 1956 to 1978. Pareses of vocal cords were noted in 465 patients (37.3%) during the course of their illness. In 135 patients (10.8%) the pareses were due to infiltration by the tumor, most commonly seen in anaplastic carcinoma. In 267 patients (21.4%) the pareses followed surgery; planned resections of the recurrent nerves were performed in 48 patients (3.9%). Transient pareses with normal vocal cord movements within months were experienced in 137 cases (11%). Permanent paralysis caused accidentally during surgery was seen in 82 patients, representing 6.6% of all patients and 4.7% of the surgically exposed nerves. We stress the need for pre- and postoperative evaluation of vocal cord movement as an aid to future diagnosis and optimal surgical planning.

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Twenty-four patients with carcinoma of the anus were treated with a combined regimen of external irradiation (50 Gy) and mitomycin C and 5-fluorouracil. A relatively large number of patients with locally advanced disease were included. A local complete response rate of 87.5% was obtained. The major acute toxicity was dermatitis/mucositis, necessitating a split course in 14 cases. After treatment four patients had persistent anal incontinence. After an observation period of 40-70 months 14 of the patients were alive without disease. We conclude that the conservative combined radiotherapy/chemotherapy regimen is an effective treatment also of advanced anal carcinoma, with tolerable toxicity and with promising survival results.

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The expression of NSE and hormone immunoreactivity were examined in lymph node metastases from 15 primary breast carcinomas (6 NSE-positive and 9 NSE-negative). NSE immunoreactivity was expressed in metastases in 7 cases. Both the primary tumour and lymph node metastasis(es) were NSE-positive in 3 cases. In 4 cases NSE-negative primary tumours were associated with NSE-positive lymph node metastases. In 2 of the 7 cases with NSE-positive metastases, the metastatic lesions did not express uniform NSE immunoreactivity. Immunoreactivity for hormones (gastrin (1 case), prealbumin (2 cases), ACTH and beta-endorphin (1 case) and somatostatin (1 case] was present in 5 of the 7 NSE-positive lymph node metastatic lesions. In one case only the same hormone (gastrin) was expressed in both the primary tumour and its lymph node metastasis. The present study shows that no relationship exists between primary tumours and the corresponding lymph node metastases with regard to NSE and hormone immunoreactivity.

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