Multicenter phase II trial of adjuvant therapy for resected pancreatic cancer using cisplatin, 5-fluorouracil, and interferon-alfa-2b-based chemoradiation: ACOSOG Trial Z05031.

BACKGROUND: The American College of Surgeons Oncology Group sought to confirm the efficacy of a novel interferon-based chemoradiation regimen in a multicenter phase II trial. PATIENTS AND METHODS: Patients with resected (R0/R1) adenocarcinoma of the pancreatic head were treated with adjuvant interferon-alfa-2b (3 million units s.c. on days 1, 3, and 5 of each week for 5.5 weeks), cisplatin (30 mg/m(2) i.v. weekly for 6 weeks), and continuous infusion 5-fluorouracil (5-FU; 175 mg·m(2)/day for 38 days) concurrently with external-beam radiation (50.4 Gy). Chemoradiation was followed by two 6-week courses of continuous infusion 5-FU (200 mg·m(2)/day). The primary study end point was 18-month overall survival from protocol enrollment (OS18); an OS18 ≥65% was considered a positive study outcome. RESULTS: Eighty-nine patients were enrolled. Eighty-four patients were assessable for toxicity. The all-cause grade ≥3 toxicity rate was 95% (80 patients) during therapy. No long-term toxicity or toxicity-related deaths were noted. At 36-month median follow-up, the OS18 was 69% [95% confidence interval (CI) 60% to 80%]; the median disease-free survival and overall survival were 14.1 months (95% CI 11.0-20.1 months) and 25.4 months (95% CI 23.4-34.1 months), respectively. CONCLUSIONS: Notwithstanding promising multi-institutional efficacy results, further development of this regimen will require additional modifications to mitigate toxic effects.

Johann Georg Wirsüng (1589-1643) and the pancreatic duct: the prosector of Padua, Italy.

Although his primacy was subsequently challenged by a student, it is now known that Johann Georg Wirsüng, the prosector of Padua, Italy, discovered the human pancreatic duct in 1642 during the dissection of an executed murderer. Instead of publishing his discovery, he engraved a drawing of the duct on a copper plate, from which he made seven or more imprints. The copies were sent to leading anatomists of Europe with the question, "Should I call it an artery or a vein? I never found blood in it ...." Three and a half centuries later, the copper plate remains well preserved and the authors, to the surprise of European surgeons and librarians, but with their aid, have traced six copies of the "ductus Wirsüngianus" imprints still in existence. This is the story of Wirsüng the man, his subsequent assassination, and finally the recognition that his finding had opened a new field of science.