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Carcinoembryonic antigen (CEA), alpha-foetoprotein (AFP), and enzymes were determined in the blood of 59 patients with primary oesophagus carcinoma. Raised CEA values were encountered in 59 of the patients, and AFP above that of an age-matched control group in 33 of the patients. Values of CEA during progression were significantly higher than in regression of disease. Two patients had exceptionally high serum AFP, but in most cases AFP levels were not related to disease progress. CEA and AFP could appear in a discordant fashion. The combined assay did not improve diagnostic sensitivity.

A series of 602 patients with verified urinary bladder cancer have been treated with full irradiation in the period 1957–1970. As expected, the survival rate decreased with increasing stage of the tumour. Another group was randomized and treated according to either of two fractionation schemes. This trial started in 1971 and shows that there is increased survival and tumour clearance rate with superfractionation.

We have followed a large population of patients receiving radiation treatment for bladder carcinoma with respect to survival and recurrence-free survival. Bivariate and multivariate life table analyses have been performed using a set of independent variables. The most important were T class, grade (G), urinary carcinoembryonic antigen (U-CEA) taken before treatment and cytological analysis 4 months after treatment. We compared the usual way of classifying a patient (T+G) with the combination of U-CEA and cytology since the latter two variables seemed to have great prognostic importance. The analyses show that T+G gives the best significance for survival (P=0.0003) while U-CEA and cytology is better for recurrence-free survival (?=0.0002). 0.0002).

Cytological analyses of bladder washings from 974 patients with disorders of the urinary tract are reported. The cytological findings were compared with the clinical and histological diagnoses. The histological grading of bladder tumours was based on the classification proposed by Bergkvist et al. No false positive diagnosis of malignancy was made in the 320 patients without tumour growth. The five cases with positive cytology had histologically verified carcinoma in situ. The frequency of cytological diagnosis of cancer increased with the histological grade of malignancy in the 428 patients with bladder neoplasm. Carcinoma was graded in smears according mainly to the degree of epithelial atypia. A comparison with the histological grading was attempted. Of 226 cases of bladder carcinoma treated with supervoltage irradiation, 108 had persistence or recurrence of carcinoma. The clinical diagnosis was cytologically confirmed in 92 per cent of these cases.

The plasma pharmacokinetics of adriamycin has been studied in 21 cancer patients (31–85 years old) without liver tumours after short (3.00 min) and prolonged (45 min-16h) i.v. infusions.

During the years 1957-1966 nineteen patients with advanced carcinoma of the vulva were selected for external radiotherapy using cobalt-60 irradiation. All patients belonged to clinical stage T4, according to UICC proposed TNM-classification of carcinoma of the vulva in 1967. No other treatment could be given in these advanced cases. Biopsies were taken and thin-needle aspiration biopsies were performed from suspicious inguinal nodes. The local tumour dose was in the range 5 200 rad in 37 days to 6 900 rad in 45 days. The inguinal regions were irradiated in 11 of the 19 patients. Four of the 19 patients have a symptom-free survival time of more than 5 years. Six patients had cytologically verified lymph node metastases in one or both groins; two of these patients have no signs of tumour growth in the inguinal regions after over 6 years. We recommend the use of super-voltage treatment for patients with advanced tumours in the vulvar region.

The cytologic findings in 355 patients with symptoms of genito-urinary disorders were compared with the clinical and histologic diagnoses. Neoplasm was histologically verified in 140 cases. The tumours were graded according to the degree of cellular atypia in histologic specimens as papilloma (grades 0-1) or carcinoma (grades II-IV). Papilloma was found in 23 per cent of the tumour cases.The cytologic diagnosis was based on analyses of sediment from urine and bladder washings. No false positive cytologic diagnosis of malignancy was made in the 195 patients without neoplasm. No definite cytologic report of malignancy was made in the 32 cases of papilloma. Of the 108 cases histologically classified as carcinoma, 71 per cent (58 per cent of grade II and 85 per cent of grades III-IV tumours) were cytologically recognized as malignant from the first sample of urine and bladder washings.The importance of uniform concepts of histologic grading of bladder tumours for evaluating the accuracy of exfoliative cytology is emphasized.

A series of 111 patients was followed up in order to study the effect of radiation therapy on normal ureteric orifices and on orifices constricted by bladder tumours of infiltrative growth.In cases of bladder tumour the outflow from the upper urinary tract is appropriately studied and followed up with urography. The examination should be carried out in close connexion with any surgical or radiotherapeutic procedure. Ureteric obstruction caused by a tumour may wholly or in part be relieved by radiation therapy, even in cases in which urography has failed to demonstrate any signs of function.The outflow through healthy ureteric orifices not infiltrated by tumour is not impaired by the radiation therapy.An impairment in outflow after the treatment almost always reflects progression of the tumour and calls for continued clinical investigation.

58 patients given various forms of treatment for Peyronie's disease have been reinvestigated. The late results in general were poor, resembling the spontaneous course of the disease. A new therapeutic principle with a cyto-toxic drug (Natulanar®) is presented.

For 10 years we have treated carcinoma of the bladder with external Cobalt 60 irradiation. In cases where the tumour was still viable 6 months after irradiation or showed a later recurrence, further treatment by cystectomy and urinary diversion is discussed. Out of 450 irradiated patients 35 were selected for complementary cystectomy and urinary diversion after irradiation. Six patients died of postoperative complications. Seven patients recovered uneventfully from surgery. The remainder had various severe complications. Fifteen patients died within 1 year of the operation. At follow-up, 9 patients are still living.The pathologic anatomic specimens were graded according to malignancy of cell type and depth of growth. A significant correlation between histological grading and survival time was observed. Furthermore, a tendency towards short survival time was observed in cases where the tumour was penetrating the muscle.The result of the present study have given us the impression that late surgery after irradiation of poorly differentiated tumours with growth in the muscle will not prolong the survival time and often will cause the patient unnecessary suffering.

Patients with bladder cancer were evaluated for T-class, histo-pathological grade and U-CEA (urinary carcinoembryonic antigen) before treatment and the cytological picture 4 months after treatment. Previous work has shown that these variables are not significantly intercorrelated. Scores were computed, consisting of the sums of these (dichotomized) variables. In a statistical analysis with the life-table technique, the scored variables have been logrank tested for a prognostic trend. In 155 patients, p for symptom-free survival between subgroups with low and high scores was 0.0019 and for relative survival 0.0005. This implies that a combination of variables may have predictive value in bladder cancer.

Orgotein, the drug version of Cu-Zn superoxide dismutases is a new and safe anti-inflammatory agent. Animal experiments have shown that it does not interfere with the tumourolytic effects of radiation or chemotherapy. A double-blind, placebo-controlled study has demonstrated that orgotein injected after each daily irradiation session can be used safely and effectively to ameliorate or prevent the side effects due to high-energy radiation therapy (8,400 or 6,400 rads) of bladder tumours. Orgotein significantly reduced the signs and symptoms both in the bladder and the bowel, indicating that it provides a therapeutic regimen for control of these side effects, which to date could only be treated symptomatically.

In 160 cases of carcinoma of the urinary bladder treated with supervoltage irradiation, cytologic examination of the urine and bladder washings was included in frequent follow-up examinations. Persistence or recurrence of carcinoma was clinically diagnosed in 79 patients. In 89 per cent of them the clinical diagnosis was cytologically confirmed. The factors influencing the accuracy of the cytologic diagnosis of malignancy following irradiation are discussed.

Twenty-three patients with poorly differentiated carcinoma of the prostate, which had been diagnosed cyto-logically from transrectal aspiration biopsy, were given combined oestrogen medication and radiotherapy. the oestrogens were 5 mg stilbestrol by mouth daily and/or 80-160 mg estradurin (polyestradiol phosphate) parenterally per month. Cobalt teletherapy was given in a mean tumour dose of 5500 rad over 5 to 7 weeks. the survival rate after 1 year was 78%. of the 15 patients who could be followed up for at least 2 years, 10 were still alive after 2 years (67%). the 3-year survival rate was 5 of 11 patients (45%). Though the series was too small and the observation period too short to permit conclusions concerning this therapeutic régime, the clinical benefit conferred on a substantial proportion of the patients and the rarity of complications have encouraged us to continue use of oestrogens plus radiotherapy in poorly differentiated prostatic carcinoma.

In a series of patients with recurrent bladder carcinoma, treatemnt with various cytostatic drugs was generally unsatisfactory in cases of infiltrating carcinoma. Better results were achieved using instillation of Thiotepa for bladder papillomatosis and by instillation of Adriamycin for carcinoma in situ.

In 1969 a clinical trial was started where patients with bladder carcinoma stage T2 and grade 3 were subjected to preoperative radiotherapy followed by cystectomy. The survival rate in this series was higher than in a previous series of comparable patients who were given full irradiation without cystectomy.

Bleomycin produced regression of tumours in 10 of 15 cases of human squamous cell carcinoma. Hearing and equilibrium were not affected. No ototoxic effects were found in guinea pigs when Bleomycin was administered subcutaneously and intraperi-toneally. Cochlear damage was seen when the drug was injected into the middle ear.