Of 731 patients with papillary thyroid cancer, 91 had metastases outside regional lymph nodes. The most common site was intrathoracic, occurring in 73 of the 91 patients. Miliary, micronodular pulmonary metastases, with iodine 131 (1-131) uptake and "curable'* by 1-131 treatment were encountered in seven patients. It has not been established whether this was a transient stage in additional patients. In 38 patients rounded, macronodular pulmonary metastases were found. Another 21 patients had unilateral pulmonary infiltration and mediastinal enlargement. Pulmonary infiltrations may be hematogenic, or may possibly occur via regional, mediastinal lymph nodes. Mortality within 1 year of the diagnosis of distant metastases exceeded 50%. Occurrence of distant metastases showed a slight but highly significant association with male sex, advanced age, and advanced local tumor stage. Better prognostic determinants are, however, required if adequate treatment of the individual patient with papillary thyroid cancer is to be achieved.Cancer 61:1-6, 1988.APILLARY THYROID CANCER runs an indolent clin-P ical course. A very common finding is metastases to regional lymph nodes, which also include lymph nodes in the upper mediastinum. These lymph node metastases are not indicative of distant metastases, as in most other malignant diseases. ' Metastases remote from the neck region are a rather uncommon event. The rate of distant metastases varies in different reports.* Also the implications of such events seem to differ.3 This report concerns 9 1 patients with distant metastases from papillary thyroid cancer treated between 1956 and 1978. The 9 1 patients were sampled from a defined population and have been followed up until 1986. Patients and MethodsFrom 1956 through 1978, 2345 patients with the diagnosis of thyroid cancer were registered in the Cancer Registry of Norway. Nearly 50%, more than 1150 of these patients, were eventually treated in The Norwegian Radium Hospital and their patient records were From the Departments of *Surgical Oncology, tPathology, SDiagnostic Radiology, and $Nuclear Medicine, Norwegian Radium Hospital, Montebello, Oslo, Norway.

In this study, 347 patients with epithelial ovarian cancer without residual tumor after primary laparotomy, were assigned randomly to receive either intraperitoneal instillation of radioactive phosphorus (32P) or six courses of cisplatin (50 mg/m2. Patients randomized to receive 32P with extensive intraperitoneal adhesions were treated with whole‐abdomen irradiation instead of 32P (n = 28). The median follow‐up was 62 months. Crude and disease‐free survival were similar in all groups. Late bowel complications occurred more often in patients treated with 32P compared with the cisplatin group. The estimated 5‐year crude survival rate was as high as 95% in patients with borderline or well‐differentiated tumors in Stage I. It is suggested that these patients can be treated adequately by operation alone. Patients with moderately or poorly differentiated cancers in Stage I disease had a 5‐year crude survival rate of 75%. In these patients, the relapse risk was high enough to warrant postoperative treatment. The efficacy of adjuvant treatment in this subgroup of patients can only be established in a prospective randomized study comparing postoperative adjuvant treatment with a no‐treatment arm. Because of the high number of late bowel complications after 32P treatment, it was recommended that cisplatin be used as standard adjuvant treatment for subsequent controlled studies.

The biodistributions of different Tc-MDP complexes, separated from different MDP preparations by anionic exchange chromatography, were investigated. We included MDP preparations from one producer with both ascorbic and gentisic acid as stabilizing agent and one preparation with ascorbic acid from a second producer. Bone to soft tissue ratios in rats were compared for the different Tc-MDP complexes separated. It seems that the elution profile of the radiochromatogram may indicate the biodistribution of the preparation. Ascorbic acid and gentisic acid caused different elution profiles and the different complexes isolated were demonstrated to have different bone to muscle ratios.

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In 58 patients with progressive hormone-resistant metastatic cancer of the prostate, prostate-specific antigen (PSA) greater than 100 micrograms/l, haemoglobin less than 12.0 g/dl and pronounced fatigue were found to be independent adverse prognostic factors. These risk factors distinguished a subgroup of patients with a median survival of 9 months (none or only 1 risk factor present) from a subgroup with a median survival of 4 months (greater than or equal to 2 risk factors present). The clinician should be reluctant to enter patients from the second group into complicated and resource-demanding clinical studies, particularly if such trials require frequent and inconvenient follow-up examinations.