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The prompt availability of interstitial lymphoscintigraphy and its utilization offer significant advantages over other techniques. Computed tomography represents a highly sensitive technique that suffers from lack of specificity in detecting small lesions. The expense and accessibility of machine time limit its usefulness as a routine survey procedure. Radiographic lymphangiography represents a tedious and difficult process necessitating identification of lymphatic channels for injection of the contrast material for visualization of the lymph nodes in the region being evaluated. With these demonstrated difficulties, the lymph node scanning technique has emerged as a simple, reliable, and reproducible technique for evaluation of multiple lymph node groups.

Unusual metastases occur in a significant percentage of patients with malignant disease. In large measure, they represent a preterminal event. This is not always the case, however. In patients who have metastases to the skin, the event is generally preterminal particularly when the primary is the lung. In that instance the time between appearance of the metastasis and death is between 1.5 and 2.6 mo. Metastases to the skin occurring in patients with carcinoma of the cervix also represents a preterminal event with a time from diagnosis to death of 3 mo. In patients with carcinoma of the esophagus, the time from diagnosis to death is 4.3 mo, on the average. On the other hand, metastases to the skin from primary malignant tumors involving the colon, bladder, kidney, and ovary do not represent preterminal events. The time form diagnosis to death varies from 7.3 mo in carcinoma of the ovary to 12.7 mo in carcinomas of the kidney. Therefore, it is important when a patient presents with metastases to the skin to establish the primary source, the extent of the metastatic lesions and devise treatment programs that are appropriate to the pattern of the metastasis and the primary diagnosis...

Since its foundation in 1971, the RTOG has conducted a successful clinical research program in head and neck mucosal squamous cell carcinoma with 22 treatment protocols and one registry study which combined have accumulated data on over 5,500 patients. The RTOG was the first multicenter group to evaluate neoadjuvant chemotherapy before definitive radiation with its methotrexate study. Although the study was negative, RTOG has since conducted five pilot or phase II studies of neoinduction or concurrent chemotherapy with radiation therapy in patients with inoperable tumors. The last study showed that radiation concurrent with cisplatinum was tolerable with a suggestion of increased antitumor effect. In patients with potentially resectable tumors, RTOG has completed a pilot study of combination chemotherapy administered either before or after the surgery with radiotherapy. Based upon its findings, the treatment sequence, surgery-chemotherapy-radiotherapy, was chosen as the experimental arm for a new phase III study. This study was subsequently adopted by the head and neck intergroup mechanism as its study (INT 0034/RTOG 8503). RTOG has investigated the optimal timing of radiotherapy with surgery. The 7303 study established that postoperative radiotherapy achieved significantly better locoregional control but not improved absolute survival. Approximately 30% of the patients on each arm failed to complete both modalities. Even when comparison is restricted to patients who completed both modalities, postoperative radiotherapy still produced the better locoregional control. Efforts to overcome the limitations imposed by tumor hypoxia through use of carbogen (95% O2 and 5% CO2) breathing or the radiosensitizer misonidazole during radiotherapy have been unsuccessful. In a phase I study, RTOG showed that 15 to 18 sessions of sensitized radiation can be safely delivered with the new radiosensitizer SR 2508 in contrast to only six such sessions with misonidazole. This promising radiosensitizer is now being tested in a phase III trial. RTOG has also investigated variations in fraction size, fraction number, and total radiation dose. In the 7102 study, split-course irradiation achieved equivalent antitumor results as compared to continuous daily irradiation but with less social alteration and cost to the patient. In the hyperfraction pilot study 7703, twice a day irradiation with 120 cGys up to 6,000 cGys proved to be tolerable.(ABSTRACT TRUNCATED AT 400 WORDS)

Pleural and peritoneal effusion secondary to primary malignancy is a significant problem in the management of the cancer patient. Respiratory embarrassment and discomfort associated with the formation and collection of fluid in the chest and abdomen are among the most distressing symptoms encountered as a result of malignant disease. The guidelines for treatment should be based on respiratory symptoms, and with the understanding that the procedure is palliative. Both surgical and medical forms of treatment have been used. These include thoracostomy-tube drainage alone or with the instillation of antimicrobial agents. Pleurectomy is effective but should be reserved for situations in which conservative approaches have failed. Antitumor agents, such as nitrogen mustard, are effective but toxic. The mode of action of antineoplastic agents is related to their ability to cause pleural sclerosis and obliterate the pleural space. Systemic chemotherapy and external beam radiation are rarely effective. The intracavitary application of radioactive colloids has been used since 1945. Colloidal radioactive gold Au 198 has been replaced by the pure beta emitter, colloidal chromic phosphate P 32. Instillation of a colloidal suspension of radioactive phosphorus represents a significant and effective palliative therapeutic modality for malignant effusion.