Prognosis of metastatic renal adenocarcinoma.

The prognosis for metastatic renal adenocarcinoma is evaluated on the basis of a consecutive series of 99 initially metastatic patients and 79 patients who developed distant metastases after radical nephrectomy. Patients with only osseous metastases survived longer, but the differences in survival between these and patients with metastases at other sites were not statistically significant. The survival for patients who developed metastases after a disease-free interval of less than 6 months was significantly lower than for others. A solitary distant metastasis was removed from 7 patients and in 4 of these cases no recurrence has been observed during 1 to 9 years' follow-up. In 54% of patients with distant metastases cytostatic agents or hormones or both in combination were administered. Only two partial responses were demonstrated, both concerning pulmonary metastases. Radiation therapy had an appreciable effect in relieving pain resulting from osseous metastases.

Recurrence of breast cancer. A retrospective study of 569 cases in clinical stages I-III.

Material comprising 569 cancer patients in clinical stages I-III is presented; recurrence, factors influencing recurrence and survival after recurrence have been studied. The 10-year recurrence rate for the whole material was 52%. Frequency of recurrence correlated with the clinical stage, the axillary biopsy finding and with the malignancy grade of infiltrating ductogenic carcinoma. The incidence ratio of local recurrence and distant metastases was 1:2; the most common site of the former being the chest wall and of the latter the viscera. After diagnosis of the first local recurrence, subsequent 5- and 10-year survival rates were 42% and 24% and after diagnosis of the first distant metastasis correspondingly 15% and 13%. Survival after the detection of axillary and supraclavicular metastases was better than after the detection of chest wall recurrences. Prognosis for distant metastases was best for soft tissue metastases and poorest for visceral and multiple metastases.

Osteonecrosis of the femoral head in lymphoma patients treated with combined chemotherapy including corticosteroids.

Osteonecrosis of the femoral head developed in two patients with malignant lymphoma treated with combined chemotherapy. Pain was the main symptom. It was not possible to radiographically distinguish the necrotic lesions from metastatic tumour growth, and in both cases only histological examination revealed the true nature of bone destruction. The large doses of corticosteroids included in the treatment regimens were most likely of more importance in the etiology of the necrosis than the cytostatic drugs proper.

Swelling of the upper extremity, function and muscle strength of shoulder joint following mastectomy combined with radiotherapy.

Swelling of the arm, mobility of the shoulder joint and muscle strength were examined in 76 patients with breast cancer 4.5 to 14 years (mean 8 years) after primary therapy. Marked arm swelling was found on the operated side in 31% of the patients operated by radical mastectomy and in 18% of those having undergone total mastectomy. The swelling was more marked in the upper arm than in the forearm. Patients irradiated postoperatively with a megavoltage technique showed more often and more oedema than those treated with a kilovoltage technique. Obese patients had more swelling than patients of normal weight. Of the various movements of the shoulder joint, abduction, adduction, flexion, extension, horizontal extension and internal rotation were significantly reduced on the operated side in comparison with the non-operated side, but the differences were not great. Neither swelling of the arm nor the patient's weight had any effect on the function of the shoulder joint, as expressed in terms of abduction. Of the muscle groups in the shoulder joint adductors, flexors and extensors were significantly weaker on the operated than on the non-operated side. The muscle strength of the operated side averaged 25% weaker than that of the control side. Swelling of the arm did not reduce the muscle strength of the shoulder joint.

Electromyography in the estimation of nerve lesions after surgical and radiation therapy for breast cancer.

EMG was performed on the upper extremity of the affected side in 55 breast cancer patients who had undergone mastectomy and postoperative radiotherapy. Radical mastectomy caused six latissimus pareses out of 26 patients and seven deltoideus pareses out of 49 patients. Simple mastectomy caused no pareses. As an early complication of radiotherapy five out of 16 patients developed slight EMG changes, most often in the biceps brachii muscle, but no clinical pareses were observed. In the follow-up group (at least 5 years after primary treatment) 18 out of 25 patients had varying EMG alterations. The relative frequency of EMG findings indicates an increasing number of neural changes caused by radiotherapy in the follow-up group. Severe pareses were infrequent as complications of radiotherapy. In neurography of the cutaneous branch of n. radialis a diminution of the amplitude of the sensory response was found one or two months after radiotherapy in the affected side. EMG proved to be useful in estimating both the early and late neural complications of primary treatment of breast cancer and in evaluating patients' capacity for work.