DNA contents of individual cells from squamous cell carcinomas of the larynx and tongue.

In previous work a new method of histologic grading of malignancy in squamous cell carcinomas of the larynx was described. It was based on morphologic criteria representing the tumor cell population itself and the tumor host relationship. Nuclear polymorphism was revealed to be a very important factor for determining prognosis. This method of histologic grading of malignancy was in this work further analyzed by cytophotometric DNA determinations on individual cells obtained by scraping the surface of squamous cell carcinomas of the larynx and the tongue. Increased heterogenous cellular DNA distributions were found in cases with high histological malignancy grading. Cells in the carcinoma cases with a normal epithelial morphology had the same DNA content as that of control cells of normal buccal mucosa. Cells with higher DNA values all had malignant or suspicious morphology.

Prognosis of squamous-cell carcinoma of the gums with cytologically verified cervical lymph node metastases.

A follow-up study was made of 125 patients with carcinoma of the gums treated from 1958 to 1969. Twenty-one of these patients with cytologically verified metastases of the neck at first visit were specially studied. The primary tumour was classified as T1 in three patients, T2 in one, T3 in nine, and T4 in eight patients. Twelve patients received radiotherapy, nine radiotherapy and surgery. The five-year determinate survival rate was 7 per cent in this group compared with 41 per cent for patients without cervical metastases. The importance of the use of fine-needle biopsy and cytology is stressed in the diagnosis of metastases of the neck for proper judgement of the prognosis and for selection of method for treatment.

Histologic grading of malignancy and prognosis in glottic carcinoma of the larynx.

Two hundred and thirty patients with glottic carcinomas of the larynx treated at the Radiumhemmet from 1956 to 1966 by radiotherapy and followed for at least five years were investigated. Histologic grading of malignancy was made in each case by the registration of eight morphologic criteria, four representing the tumor cell population itself (structure, differentiation, nuclear polymorphism, and mitoses) and four representing the tumor host relationship (mode of invasion, stage of invasion, vascular invasion, and cellular response). There parameters were graded on the bases of a one to four point system according to arbitrary units. Multivariate analysis of the material revealed that the most important factors in the prediction of the five year result were found to be the nuclear polymorphism, mode of invasion, and total malignancy point value. The histologic grading of malignancy in this series was found to be better in the prediction of the five year result, recurrence or not, than the TNM classification.

Elevated plasma CEA during radiotherapy for glottic carcinoma of the larynx.

Carcinoembryonic antigen (CEA) levels in plasma were determined serially during radiotherapy in 10 patients with glottic carcinoma of the larynx. There were moderate high levels initially in three patients, all of clinical stage T1. Elevation during irradiation was noted in seven patients at a tumor dose of around 4000 rad. At this does the tumors were no longer visible and it is possible that the raised CEA represents circulating breakdown products from them. As raised levels were not seen in all patients, it is less likely that irradiation of laryngeal tissue by itself raises CEA plasma levels. After treatment, CEA normalized to the initial levels.

The detachment, attachment and growth capacity of human glioma and glia cells in culture.

The detachment, attachment and growth were studied in malignant glioma and normal glia cells in culture, using the palladium-agarose cloning method. The number of cells in each individual clone was repeatedly counted throughout 10 days. All four glioma cell-lines studied detached and attached themselves at higher rates than the normal, diploid, glia cells. This dynamic behaviour seemed to be a general property of cultured, malignant, glioma cells. All the cell-lines contained clones with different properties. Some clones were growing, others were nearly constant in cell number and yet others decreased in cell number as a function of time. The differences between these types of clones were surprisingly sharp.

Clinical evaluation of oral methadone in treatment of cancer pain.

A dose-adjustment program for oral methadone and the long-term effects of the analgesic therapy have been evaluated in 15 patients with incurable cancer. Rapid and continuous pain relief without serious side-effects was achieved by "ad libitum" dosage in the first 3-5 days. Thereafter, a dosage based on each patients's subjective need was instituted. The mean daily dose was 44 during the first day and it decreased to 22 mg daily at the end of the dose-adjustment week. Three patients did not complete the program because of insufficient effect or severe nausea. Among the 12 patients who chose to continue the methadone treatment after the initial dose-adjustment period, four continued the therapy to their death, three discontinued the therapy due to insufficient effect, and three due to adverse reactions. In one case it was possible to stop the treatment due to decreased pain. The treatment period in these 12 patients varied between 8 and 270 days. Oral methadone offers good pain relief for long periods of time in this group of patients and has obvious advantages as compared to long term parenteral therapy with narcotic analgesics.

Patient-controlled dose regimen of methadone for chronic cancer pain.

Fourteen patients with severe cancer pain participated in a trial of methadone given in a fixed dose (10 mg) but at intervals selected by the patients themselves during the loading phase. The aim was to achieve rapid pain relief while avoiding the risk of toxicity from accumulation of methadone. As expected, the dosage intervals increased gradually over the first few days of treatment, the daily dose decreasing from 30-80 mg on the first day to 10-40 mg at the end of the week. Plasma concentrations of methadone varied sevenfold after four to five days (0.24 to 1.75 mumol/1; 7.4 to 54.2 microgram/100 ml). Eleven patients reported complete or almost complete pain relief and elected to continue with methadone after the study. In no case was treatment withdrawn because of intoxication. From these findings a patient-controlled dosage regimen of oral methadone may be an effective and safe alternative to parenteral narcotic medication, adjusting both for individual variation in pain intensity and for pharmacokinetics.