Endolymphatic radiotherapy in malignant lymphomas. A clinical evaluation of 285 patients

Intralymphatic infusion of interferon in patients with lymph nodal metastases from melanoma of the lower limbs

In five patients with regional lymph nodal metastases from malignant melanoma of the lower limbs, intralymphatic infusion of interferon caused a complete remission in one patient and a partial remission in two others. The remaining two patients, in whom the massive neoplastic infiltration had obstructed the inflow of the drug in the tumoural seat, were unresponsive. Since the efficacy of interferon seems to be dose-dependent, intralymphatic infusion causes the accumulation of massive quantities of the drug in the tumoural seat, thus favouring its antiproliferative action.

Lymphoscintigraphy in gynecologic malignancies

Lymphoscintigraphy is an easily performed noninvasive procedure that offers the potential to detect small numbers of ascitic tumor cells and early diaphragmatic tumor involvement. Moreover, it can be used to delineate and define abnormalities in lymph nodes that are not routinely visualized by bipedal contrast lymphangiography, ultrasound or computed tomography. Lymphoscintigraphy is recommended as an important investigative and adjunctive procedure in diagnosing gynecologic malignancies; there does not appear to be sufficient sensitivity and specificity to justify its routine clinical use.

Regional intralymphatic infusion (ILI) of irradiated tumor cells with evidence of distant effects

A case of canine lymphoma with radiographically-documented involvement of the para-aortic nodes is reported. Intralymphatic infusions (ILI) of cultured irradiated autochthonous tumor cells to remote lymph node bearing areas were associated with a dramatic initial shrinkage of the para-aortic lymphadenopathies. Three ILI timing schedules were used consecutively during a course of 10 treatments, allowing a comparison of responses in the same animal. The reported case suggests that a normal lymph node can be effectively "stimulated" by the same agent approximately every 3 weeks. A possible schedule for intralymphatic infusion is proposed for further investigation.

Endolymphatic Radiotherapy in Cancer of the Cervix

From 1962 to 1968, 93 patients with cancer of the cervix were given endolymphatic radiotherapy at the National Cancer Institute of Milan. Lipiodol Fluide 131I was injected at doses ranging from 2.3–2.5 mCi/cm3 (8–10 cm3 each foot) with a total activity of 46 to 50 mCi. The 93 patients were treated with endolymphatic radiotherapy and conventional radiotherapy or surgery (table 1). Lymph node metastases were detected in 29 of 93 patients. In 41 cases the histopathologic findings of lymph nodes removed during surgery were correlated with the lymphographic findings; a correct correlation was found in 90,2% of cases (table 4). No side-effects or complications of endolymphatic treatment were observed. The long-term results were evaluated in two groups of patients and compared with the series treated at our Institute with conventional therapy. A first group of 49 cases was treated with radium and endolymphatic radiotherapy. In the 19 who had metastatic retroperitoneal nodes on lymphography the 5-year survival was 26%; in the 30 without radiological evidence of nodal metastases the 5-year survival was 84% (text-fig. 1). Considering all cases for every stage, with and without metastases, the 5-year survival was 69% for stage I and 60% for stage II. In comparison with the series treated at our Institute with radiumtherapy only, the percent increase in 5-year survival is 9% for stage I and 13.2% for stage II (table 6). This difference is not statistically significant. A second group of 36 cases was treated with a combination of endolymphatic radiotherapy, surgery and radiumtherapy. Considering all cases for every stage, with and without metastases, the 5-year survival was 91% for stage I and 77% for stage II. In comparison with the series treated at our Institute with surgery and radiumtherapy the percent increase in 5-year survival is 16.5% for stage I and 7% for stage II (table 6). Again, statistical evaluation failed to detect a significant difference. No definite conclusions can be drawn from these results. However, there is the possibility that endolymphatic radiotherapy destroys early microscopic metastases located in the retroperitoneal nodes and so contributes substantially to the cure rate. To prove this hypothesis, a prospective randomized clinical trial is indicated.

Diagnosis and Therapy of Malignant Lymphoma during Pregnancy

Eighteen cases of malignant lymphoma associated with pregnancy observed at the National Cancer Institute of Milan from 1953 to 1968, are reported. Four patients without retroperitoneal adenopathies were treated prophilactically with endolymphatic radiotherapy (Lipiodol Fluide 181I) and became pregnant afterwards. Their pregnancy had a normal outcome. Two patients treated respectively during the first 4 months and from the 6th to the 7th month of pregnancy with antiproliferative agents (chlorambucil, vinblastine) delivered a normal infant while a third patient treated during the third month of pregnancy had a miscarriage. Two patients were treated with radiotherapy on adenopathies above the diaphragm and had normal pregnancy and delivery, with normal foetuses. The importance of diagnostic lymphography during pregnancy to define the stage of the disease and to plan the appropriate treatment is stressed. A therapeutic abortion is indicated only in presence of adenopathies below the diaphragm or in case of visceral involvement, discovered during the first three months of pregnancy. It was performed in one case after a lymphographic diagnosis of pelvic involvement.