Split course radiation therapy for adenocarcinoma of the pancreas.

Ninety-five patients with biopsy proven adenocarcinoma of the pancreas were treated with split course radiation therapy. Fifty-five patients had disease confined to the peripancreatic tissues and lymph nodes. Forty patients had metastatic disease. The intended radiation therapy scheduled consisted of two courses of 25 Gy in 10 fractions each followed by a 3 to 4 week rest period. Depending on the response and the patient's clinical status, another 10 Gy in 5 fractions was administered as a final boost. The median survival in patients with metastatic disease was 3 months and the median survival in patients with localized disease was 8 months. Twenty-seven of the fifty-five patients with localized disease received chemotherapy (5 FU or FAM) combined with radiotherapy. There was no significant difference in median survival between the patients treated with radiation alone and those with combined radiation and chemotherapy. The median survival for patients with localized disease receiving 25, 50, and 60 Gy were 3, 7, and 12 months respectively. After a dose of 50 Gy in 20 fractions, CT scan showed no evidence of tumor in 6%, smaller tumor size in 31%, stable tumor size in 41%, and tumor growth in 22% of patients. The split course radiation therapy was well tolerated and no late complications were detected. The medical and economic advantages of using split course radiation therapy and in using CT scan response to plan boost therapy are discussed.

Leiomyosarcoma of the Cervix Uteri.

We have described a 38-year-old woman with a lesion of the cervix found on routine physical examination. The lesion proved to be a primary leiomyosarcoma of the cervix. Despite radiation therapy, surgery, and chemotherapy, the tumor recurred and grew relentlessly. She is alive with disease at two years seven months after initiation of therapy. The biologic behavior of leiomyosarcoma appears to be quite different from that of squamous cell carcinoma of the cervix.

Primary malignant melanoma of the esophagus: report of two cases.

Two cases of primary esophageal malignant melanoma diagnosed at the Columbia-Presbyterian Medical Center are reported. One patient who received 3800 rads and had subsequent surgery lived for 18 months. The other had surgery and subsequent chemotherapy and is still alive three years later. Forty other cases reported in the literature are briefly analyzed.

The effect of ketamine on nerve conduction in isolated sciatic nerves of the toad.

The actions of 100-2500 mug ketamine hydrochloride per ml Ringer solution were examined on the various components of the compound nerve volley of isolated sciatic-tibial nerves of toads. The smaller diameter fibres were blocked first and fibres of progressively larger diameter were blocked with increasing ketamine concentration. A progressive reducton in conduction velocities and amplitude, as well as increasing thresholds, accompanied increased drug contact and concentration. A preliminary trial on human volunteers revealed an apparent loss of pain and thermal sensations following subcutaneous injection.