One-hundred-ninety-four eligible and evaluable patients with histologically confirmed locally unresectable adenocarcinoma of the pancreas were randomly assigned to therapy with high-dose (6000 rads) radiation therapy alone, to moderate-dose (4000 rads) radiation + 5-fluorouracil (5-FU), and to high-dose radiation plus 5-FU. Median survival with radiation alone was only 51/2 months from date of diagnosis. Both 5-FU-containing treatment regimens produced a highly significant survival improvement when compared with radiation alone. Forty percent of patients treated with the combined regimens were still living at one year compared with 10% of patients treated with radiation only. Survival differences between 4000 rads plus 5-FU and 6000 rads plus 5-FU were not significant with an overall median survival of ten months. Significant prognostic variables, in addition to treatment, were pretreatment performance status and pretreatment CEA level.

We have reviewed the natural history, reliability of diagnosis, and survivorship of 100 patients with adenocarcinoma of the pancreas, in the context of a thorough review of the literature on survival after therapy for adenocarcinoma of the pancreas. There is 40-62.5% error in the histologic confirmation of the diagnosis of pancreatic cancer. The error by inspection and palpation alone at the time of surgery may be as great as 25%. The absolute 5 year survival rate calculated from 61 clinical studies representing approximately 15,000 patients is 0.4%. The best series in the current literature has only 3% 5 year rate based upon the total population of pancreatic cancer patients. 12.3% of 5 year survivors from the world literature did not have curative surgery. This study shows the necessity for standardization of reporting methods. The same patients and survivors should not be used repeatedly in different reports. Some authors who claim the most effective palliation by pancreatic resection have the highest mortality rates.Cancer 42:2494-2506, 1978.ANCER OF THE PANCREAS, a malignancy C difficult to recognize or treat, has apparently so increased in frequency as to account for 2 1,800 deaths in the United States in 1977' and is now the fourth leading cause of death from cancer among men. The age adjusted mortality rate from pancreatic cancer in the United States has risen from 2.9 per 100,000 in 1920 to 9 per 100,000 in 1970,57,58 an increase of over 300%. In our own state, the Connecticut Tumor Registry has shown an incidence of pancreatic cancer of 6.9 per 100,000 in men in 1935 to 1939,19 9.9 in 1968,20 and 12 Accepted for publication February 3, 1978. dence and any increased survival after therapy. In order to have a base for our clinical impressions, we reviewed the natural history, diagnosis and survivorship of patients with pancreatic cancer in the state of Connecticut. MATERIALS A N D METHODST o establish a convenient data base, we investigated the fate of 100 patients with histologically proven adenocarcinoma of the pancreas, and we selected the years 1960-1971 for our review. The criteria for selection were: 1) histologic proof of the lesion, and 2) operative or autopsy localization of the primary tumor in the pancreas. In some patients with a pancreatic mass, in whom the diagnosis depended upon lymph node or liver biopsy, the site of pancreatic cancer was substantiated at laparotomy or confirmed by autopsy. In order to find 100 records which fulfilled the foregoing criteria, 197 records of patients with a discharge diagnosis of pancreatic cancer had to be scrutinized. The implication of this will be discussed later. Follow-up, ranging from one month to eight years and eleven months, was possible in 97 of the 100 histologically proven cases. The findings in this series were then compared to published results in a thorough literature review.

No abstract

No abstract

Increases in serum growth hormone which characterize acute starvation in non-obese individuals were usually absent in anorexia nervosa. Serum LH was decreased with serum FSH apparently normal in the majority. Increased adrenocortical activity as indicated by high basal 11 (OH)-corticosteroids and their incomplete suppression by dexamethasone and hyperresponsiveness to exogenous ACTH was recorded in about one-half of the patients tested. Urinary steroid responses to intravenous metyrapone were normal in all but one patient who had hypothalamic-pituitary hypofunction. Thyroid function was normal but TSH shortage has been reported. Resistance to insulin and a waning of insulin responses to hyperglycemia were noted in these individuals with anorexia nervosa.