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In a prospective randomized study, 31 patients with inoperable esophageal cancer were treated with a combination of bleomycin and adriamycin, and with a combination of these cytostatics and radiation. Evaluation of treatment results showed 3 partial remissions and 2 stable-disease cases in the group of 16 patients treated by cytostatic drugs alone; in all other cases, the disease progressed. The response rate achieved in this group was 19%. In the group including 15 patients who were irradiated with a dose of 3600--4000 rad and received simultaneously the same cytostatics with a somewhat lower dose of adriamycin, there were 3 complete remissions, 6 partial remissions, and 4 stable-disease cases, while in 2 cases the disease progressed. The response rate was 60%, which was statistically significant (P less than 0.025) when compared with the results achieved by the group receiving the bleomycin adriamycin combination. The average duration of remissions in the complete-response cases was 11 months, and in the partial-response cases, 5.2 months with combined treatment, and 4.2 months with combination chemotherapy. The toxic side-effects were tolerable for the patients, albeit more intensive with the combined-treatment modality. Four esophagobronchial fistulas (four disease progressions) and one rupture of the aorta were noted during treatment. This study has shown the advantages of chemoradiotherapeutic treatment of inoperable esophageal cancer.

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Levels of iron, copper, and zinc in liver tissue and of copper in serum were studied in 53 cases of untreated malignant lymphoma (14 cases of Hodgkin's disease and 17 of lymphocytic and 22 of histiocytic lymphoma). The values were compared with the levels of these metals in the liver tissue of 23 healthy persons. Liver tissue was obtained by means of percutaneous biopsy examination with a Menghini needle. Part of the samples was used for histologic examination, and the remainder for metal level determination. Atomic absorption spectrophotometry was used in determining metal levels in dry liver tissue and in sera. In all malignant lymphoma patients, a significantly higher serum copper level was established (P < 0.05). A lower iron level in liver tissue was only found in those patients with lymphocytic lymphomas without a lymphomatous process in the liver (P < 0.05), while lymphomatous hepatic infiltration was associated with a higher iron level and lower copper level (P < 9.05). Significant changes in liver zinc levels were only proved by higher levels of this metal in patients with histiocytic lymphoma and lymphomatous hepatic infiltration (P < 0.05). The only redistribution of copper between the serum and liver tissue was found in those patients with lymphocytic lymphomas and lymphomatous hepatic infiltration.

Thirty-three patients with inoperable esophageal cancer were treated in a randomized study. There were 24 squamous cell, 2 anaplastic, 4 unclassified, and 3 adenocarcinomas. Eighteen patients were treated with 6 cycles of adriamycin with a 3 week rest period between cycles. Adriamycin was administered in doses of 40 mg/m2 body surface daily for 2 days during each cycle. The other group of 15 patients were treated with both adriamycin and radiation. The tumor was irradiated with speed electrons (4500–5200 rads total dose), and during irradiation, 3 cycles of adriamycin were given. All patients previously had had no treatment. In the group of patients treated with adriamycin, the response rate (> 50 % tumor regression) was 33 % (6/18) with 1 complete and 5 partial remissions. In the combined treatment group, there were 4 complete and 5 partial remissions (9/15) with a response rate of 60 %. In both groups of patients, remissions were obtained in the squamous cell carcinomas, except 1 patient with anaplastic carcinoma in the adriamycin-treated group, and 1 adenocarcinoma in the combined treated group. Remissions lasted 2–12 months (M = 3.2 months) in the adriamycin-treated group and 3–15 months (M = 8.6 months) in the combined treatment group. There were no significant differences in the toxic side effects, except a slightly increased myelodepression in the combined treatment modality. One patient of the combined treatment group showed a potentiation of radiation dermititis. The results obtained show that adriamycin does have an antitumor effect on esophageal (squamous cell) carcinoma, which so far has not been proven. Significantly better results with longer remission duration can be obtained when both adriamycin and radiation are combined.