Significance of Histological Response to Preoperative Chemoradiotherapy for Pancreatic Cancer

Background Neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer offers theoretical advantages over the standard approach of surgery followed by adjuvant CRT. We hypothesized that histological responses to CRT would be significant prognostic factors in patients undergoing neoadjuvant CRT followed by resection. Methods Since 1994, 193 patients with biopsy-proven pancreatic adenocarcinoma have completed neoadjuvant CRT, and 70 patients have undergone resection. Specimens were retrospectively examined by an individual pathologist for histological responses (tumor necrosis, tumor fibrosis, and residual tumor load) and immunohistochemical staining for p53 and epidermal growth factor receptor. Factors influencing overall survival were analyzed with the Kaplan-Meier (univariate) and Cox proportional hazards (multivariate) methods.Results The estimated overall survival (median±SE) in the entire group of patients undergoing resection was 23±4.2 months, with an estimated 3-year survival of 37%±6.6% and a median follow-up of 28 months. Complete histological responses occurred in 6% of patients. Overexpression of p53 was more common in patients with large residual tumor loads. Tumor necrosis was an independent negative prognostic factor, as were positive lymph nodes, a large residual tumor load, and poor tumor differentiation.Conclusions Histological response to neoadjuvant CRT—as measured by residual tumor load—may be useful as a surrogate marker for treatment efficacy. Characterization of the tumor cells that survive neoadjuvant CRT may help us to identify new or more appropriate targets for systemic therapy.     

Civil defence in the United Kingdom

What must be avoided in the nuclear age is wishful thinking. Wishful thinking occurs in an atmosphere of maximum terror (as in Mutual Assured Destruction), and where there is little opportunity for reality testing (as in the East‐West communication barrier). In the small, densely populated island of Britain, the size of today's growing nuclear threat will create responses where delusional thinking can easily dominate. A belief in effective civil defence may induce a sense of false security which may in turn direct attention from the fundamental problem of East‐West mistrust.     

A dilemma for doctors

Community physicians have recently, albeit often reluctantly, been involved in preparations for nuclear war. This paper suggests an alternative: that they should use their skills in epidemiology and in preventive and social medicine in the prevention of nuclear war.     

Global thinking,local action

This article examines the risk of proliferation of nuclear weapons to several Third World countries, exemplified by recent events in Iraq, and the possibility of rapid acquisition of a nuclear weapons capability in developed countries. It considers the role of the International Atomic Energy Agency and the United Nations in preventing proliferation and calls for wider powers for the latter. The role of the civil nuclear power industry and of reprocessing of nuclear fuel to produce plutonium is stressed, with emphasis on the part played by nuclear power in Japan and the THORP reprocessing plant at Sellafield.