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The authors have used imidazole carboxamide (DTIC) in vascular isolation and hyperthermic perfusion for melanoma. The regional and systemic toxicity and complications of this procedure were studied in 40 cases with Stage III (15) and Stage I (25) melanoma. Technetium 99m-labelled serum albumin crossover and pharmacokinetic studies were done simultaneously to see if these correlate with toxicity. Local toxicity on muscles, nerves, skin, and arteries was conspicuously absent despite using dosages of 2 g/m2 (40-45 mg/kg) for the lower extremity and 1.2 g/m2 (24-28 mg/kg) for the upper extremity. Skin and core temperature were raised to 39 degrees C to 40 degrees C. Deep vein thrombosis was noted in three patients. No death or gangrene of the extremities occurred. Local infection was noted in only one patient. Fourteen patients (35%) manifested bone marrow toxicity (leukocyte count of 4000/mm3 or platelets of 100,000/mm3) in the second or third week after perfusion. Severe hematologic toxicity was seen in two instances. Dosages of DTIC greater than 40 mg/kg were associated with toxicity in 65% of the patients. No bleeding complications occurred in seven patients with thrombocytopenia. Measurement of crossover and recovery of radionuclide were not reliable indicators of subsequent systemic toxicity. Perfusion fluid balance data also were of no predictive value. Forty-seven percent of the administered DTIC was recovered in washout fluid. Of this, less than 2% was converted to its metabolites, that is aminoimidazole carboxamide and 2-azahypoxanthine. Thirty-five of 40 patients experienced mild nausea and vomiting. Transient and mild hepatotoxicity was noted in seven patients. It appears that DTIC hyperthermic isolation perfusion is a safe procedure, however, the total dosage should be below 40 mg/kg to avoid hematologic toxicity.

The radionuclide, gallium-67, accumulates in a wide variety of neoplastic and inflammatory lesions. Diffuse bilateral lung localization of67Ga occurred in two cases of interstitial pneumonitis associated with bleomycin therapy. Clinical symptoms and laboratory evaluation of pulmonary status correlated with scintigraphic studies in these two patients, while discrepancies between scinti-graphic and roentgenographic findings were observed.Cancer 36:1966–1972,1975.

This study analyzes the value of the liver scan as a preoperative screening procedure for occult liver metastases in patients with melanoma, sarcoma, head and neck carcinoma, and pelvic carcinoma. The records of 566 consecutive patients admitted to the Surgery Branch of the National Cancer Institute between 1969 and 1974 were reviewed and 323 patients were found acceptable for inclusion in the study. In these patients, although the liver scan had an overall accuracy of 95%, the scan identified only 50% of the patients with occult metastases to the liver and did not siginificantly add to the yield of the other screening procedures. It was useful as an adjuvant to an abnormal routine workup to confirm and localize metastases to the liver. Scans with only non specific abnormalities were of little help. Liver metastases were not identified in any patients with sarcoma, head and neck cancer, or clinically localized carcinoma of the cervix. Therefore, the liver scan was determimed to be an unnecessary part of their screening workup. Patients with recurrent or advanced carcinoma of the cervix and advanced melanoma were found to have an increased incidence of liver metastases. There was a 10% incidence of occult metastases to liver in patients with melanoma and the incidence increased with advancing clinical stage of disease. Even in this high-risk group of patients the screening liver scan did not significantly add information to that gained by history, physical examination, and blood work.

The liver-spleen scans were reviewed from 108 patients with Hodgkin's disease, including 71 not previously treated. The results were correlated with clinical and pathologic findings in 122 liver biopsies and 50 spleens. Splenomegaly on scan was associated with advancing stage and tumor involvement of the spleen and liver. All 13 spleens measuring over 15 cm on scan and all 7 with filling defects were positive for tumor. In combination with the physical examination and lymphangiogram, the scan enabled accurate prediction of splenic tumor in 43% of the cases. Mean size of the right and left hepatic lobes was greatest in patients with tumor in the liver, but this finding was attributable to the advanced stage of these cases. Filling defects were not a reliable sign of liver involvement. The combination of the lymphangiogram, physical examination, and liver scan proved useful in selecting groups with very high and very low probability of liver involvement.

The syndrome of opsoclonus and myoclonus may be the first presenting symptom of neuroblastoma. The disorder is often controlled by treatment with adrenocorticotropic hormone (ACTH). A child with this disorder and treated with ACTH gel had abnormal uptake of 67Ga in both adrenal glands during studies to attempt to detect an occult neuroblastoma. Repeat 67Ga scans proved to be normal once the ACTH was discontinued and the patient was treated with prednisone. It is concluded that ACTH stimulation of normal adrenal tissue was responsible for these abnormal findings.