Gamma camera imaging of platinum in tumours and tissues of patients after administration of 191Pt-cisplatin.

The aim of this study was to visualize non-invasively the uptake of platinum in tumours and tissues after treatment with cisplatin. 191Pt-cisplatin was synthesized from 191PtCl4 with rigorous pharmaceutical quality control. The uptake of platinum by both tumorous and healthy tissues was studied by gamma camera imaging in 14 patients, 5 of whom showed a clear uptake of platinum in regions corresponding to known tumour sites. Maximum concentrations of platinum in the tumours were on average 4.9+/-1.0 microg/g, when normalized to an administered amount of 180 mg cisplatin. In all the patients, the liver was the organ that showed the highest uptake. Platinum uptake was also seen in the spleen, gall bladder, gastrointestinal tract, bladder, kidneys, ureter, neck and mediastinum and urogenital region. By using in-house production of 191Pt-cisplatin, it was possible to monitor the uptake of platinum in tumorous tissues and healthy organs.

Intra-arterial mitomycin C and intravenous bleomycin as induction chemotherapy in advanced head and neck cancer--a phase II study.

Fifty-six patients with previously untreated, unresectable squamous cell carcinomas of the head and neck region were treated with repeated intra-arterial chemotherapy with mitomycin C using a selective or super-selective angiographic technique, and bleomycin given i.v., followed by radical radiotherapy. In addition, restricted tumour-reductive surgery was done in 18 of these patients. The response rate (CR + PR) after completion of the integrated treatment was 89%, with 63% of the patients showing CR. The toxicity of this regimen was, however, far from negligible. The median survival for this series of patients with advanced head and neck cancers is 19 months, and 17 are still alive after 16 + -66 + months.

Male breast cancer.

The disease male breast cancer has been evaluated on the basis of data concerning 265 cases registered in Denmark over the period from 1 January 1943 to 1 July 1972. The data were obtained by review of hospital records, survey of microscopic preparations and examinations of surviving patients. The results are compared to results reported in the literature. The recent material is the second largest series hitherto published. Male breast cancer comprises 0.8 per cent of all cases of breast cancer in Denmark. The average age at establishment of diagnosis was 65.2 years in 257 cases of breast carcinoma, which is considerably higher than that found in women. The duration of symptoms in breast cancer is considerably longer in males than in females, 16 per cent having a duration of symptoms of 2 years or more. In only 13 per cent was a palpable tumour the only symptom on admission. Twenty-seven percent had ulceration. Ulceration and fixation to the underlying tissue are not, as commonly presumed, early symptoms in male breast cancer. According to the TNM classification, 35 per cent of 253 cases were in clinical stage I, 11 per cent in stage II, 42 per cent in stage III, and 12 per cent in stage IV. Duration of symptoms and histological grade of malignancy were of significant importance or the stage on admission. Assessed on the basis of the distribution into stages, the clinical appearance of the disease showed a significant improvement from the period 1943-1957 to the period 1958-1972. Attempts should be made to differentiate the disease from gynecomastia which is much more frequent. Only during the early stages of breast cancer, however, will there be differential diagnostic problems as the majority of patients do not present themselves until unequivocal clinical signs of malignancy are present. The series has been reviewed with regard to the presence of gynecomastia. Certain facts appear to support the theory that gynecomastia may be a premalignant state. A series of 30 patients with breast cancer were screened for the Klinefelter syndrome. One positive case was found. By pooling series of male breast cancer, in which such screening has been made, it was found that the incidence of the Klinefelter syndrome is higher among men with breast cancer than in the normal male population. Calculated on the basis of the general public were better informed about the existence of this disease and the value of its early diagnosis and treatment, the prognosis should undoubtedly by improved.

Male breast cancer. 6. Factors influencing prognosis.

A series of 257 cases of carcinoma of the male breast in Denmark has been examined with a view to establishing the factors which might influence the prognosis. Observed and corrected 5-year survival rates of 36% and 46% respectively correspond well with the results in other series. Expressed by corrected survival rate, the prognosis appears to be somewhat more favourable during the period 1958-71 than during the period 1943-57. This improvement of prognosis can be related to a significantly better clinical stage of advancement during the latter period. Comparison of the 5-year corrected survival rates in series of male and female breast cancer shows that the prognosis in male breast cancer is not much worse than the prognosis in females. It has been proved that the duration of disease, the clinical stage and the histological degree of malignancy influence the prognosis considerably. The therapeutic results in our series correspond well with the results found in other series. We did not find any evidence to indicate that it would be better to carry out radical mastectomy than to do simple mastectomy since radical mastectomy has not given consistently better results. It is recommended that treatment of this rather uncommon disease be centralized as far as possible.

Male breast cancer. 5. Clinical manifestations in 257 cases in Denmark.

A series of 257 cases of carcinoma of the male breast in Denmark during the period from 1 January 1943 to 1 July 1972 has been reviewed, and a number of clinical symptoms have been recorded and assessed.Male breast carcinoma comprised 0·8% of all breast carcinomata in Denmark. The average age was 65·2 years, which is considerably higher than in women. The median duration of symptoms was 6 months. In only 13% was a palpable tumour the single symptom present on referral. In 27% ulceration was found on admission. However, ulceration was not, as commonly supposed, a particularly early manifestation of male breast cancer. It has been proved that ulceration is significantly related to duration of symptoms and size of tumour. According to the TNM classification, 35% of 253 cases were in stage I, 11% in stage II, 42% in stage III and 12% in stage IV. There was a significant correlation between the duration of symptoms and the clinical stage, and the histological degree of malignancy and the clinical stage. Expressed by the classification into stages, the clinical picture was definitely more favourable on referral during the period 1958-72 than during the period 1943-57.