No abstract

The results of foot lymphography in 295 patients with endometrial carcinoma observed from 1968 to 1978 at two institutions are reported. One hundred and eighty-two were new cases, 61 were recurrences, and 52 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The incidence of lymphatic spread was correlated with the clinical stage, the pathologic stage, and the extent of recurrent disease. In fact, in the 182 new cases, at clinical stage, the pathologic stage, lymphography was positive in 8.9% of patients at Stage I, 28.6% at Stage II, 57.1% at Stage III, and 66.6% at Stage IV disease; at pathological stage, lymphography was positive in 8% of patients at Stage I, 14.8% at Stage II, 39.3% at Stage II, and 53.3% at Stage IV disease. There was lymph node involvement in 47.5% of the 61 pretreated patients. Finally, in 52 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7.7%. In new cases, metastases were found only in the pelvic nodes in 56.2% of the patients and only in the para-aortic nodes in 9.5%; in 34.3%, both chains were simultaneously involved. The five-year survival rate for patients at Stage I, II, and III disease with positive lymphography was 35% as compared with 73% for negative cases. In patients at Stage I and II, the difference of survival was equal to 24%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-pathologic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct plan of treatment.

The effect of triethylene thiophosphoramide (Thio-TEPA), an alkylating agent structurally related to nitrogen mustard, has been described in 39 cases of very advanced ovarian carcinoma. Of the 39 cases treated, 21 had been previously treated and 18 were new cases. In the 39 cases, 42 cycles were evaluable (table 1). 8 cases showed a varying degree of improvement. Marked regression of growth and improvement of symptoms (regression exceeding 50%) was achieved in 7 cases (table 1). Regression of less than 50 % was achieved in 1 case (table 1). The clinical regression is only temporary. A high percentage of cases had side-effects. Of the 42 evaluable, 29 (69%) had one or more side-effects; particularly 28 showed leukopenia, 11 trombocytopenia, 13 anemia and 3 oral or gastrointestinal toxicity (table 2). In conclusion the therapeutic value of Thio-TEPA in ovarian cancer is small. A review of the literature has not shown that other drugs offer longer survival. The control of advanced disease can reasonably be more optimistic when randomized, prospective, clinical trials are performed. A plan for investigation in this direction is in preparation.