Intraoperative irradiation combined with radical resection for cancer of the head of the pancreas

Since December, 1976, intraoperative irradiation combined with resection for cancer of the head of the pancreas has been used in our clinic to prevent local recurrence. Thirty Gy of the electron beam from a linear accelerator were administered to the operative field including the celiac axis and mesenteric artery following pancreaticoduodenectomy. Results of the combined therapy in 12 patients were compared to results in 12 patients who underwent pancreaticoduodenectomy alone. The combined therapy group compared to pancreaticoduodenectomy alone showed improvement in the 1-year survival rate, but not in the 2-year survival rate. Autopsy of 3 paients who underwent the combined therapy did not reveal any involvement of the lymph nodes in the irradiation field. However, there was involvement of the lymph nodes around the aorta from the diaphragm above to the inferior mesenteric artery below (except in the irradiation field). Additionally, there were metastases to the liver in all autopsied patients and recurrence in the pancreatic remnant in 1 patient. In spite of the local effect of irradiation therapy, there was no prolongation of survival. These results suggest that treatment for carcinoma of the head of the pancreas should be intensified toward liver metastases and the lymph nodes around the aorta from the diaphragm above to the inferior mesenteric artery below.

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Resumen La irradiación intraoperatoria combinada con resección para cáncer de la cabeza del páncreas ha sido utilizada en neustra clinica desde diciembre de 1976, con el proposito de prevenir recurrencia local. Treinta Gy del haz de electrones de un acelerador linear fueron administrados al campo operatorio, incluyendo el tronco celíaco y la arteria mesentérica, a continuatión de la pancreato- duodenectomía. Los resultados de la terapia combinada en 12 pacientes fueron comparados con los resultados en 12 pacientes sometidos a pancreato-duodenectomía solamente. El grupo de tratamiento combinado demostró mejor supervivencia a un año sobre el grupo con pancreatoduodenectomía solamente, pero no en la tasa de supervivencia a dos años. La autopsia de 3 casos que recibieron la terapia combinada demostró que no había invasión tumoral de los ganglios linfáticos en el campo irradiado. Sinembargo, había invasión de los ganglios alrededor de la aorta, desde el diafragma hasta la arteria mesentérica inferior, excepto en el campo irradiado. Además, se demostraron metástasis hepáticas en todos los casos y recurrencia en el rémanente pancreático en un caso. A pesar del efecto local de la terapia de irradiación, no se observó prolongatión de la supervivencia.Estos resultados sugieren que el tratamiento del carcinoma de la cabeza del páncreas debe ser intensiflcado hacia el control de las metástasis hepáticas y de los ganglios periaórticos ubicados entre el diafragma y la arteria mesentérica inferior.

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Résumé Depuis 1976, les auteurs ont associé l'irradiation per-opératoire à la duodéno-pancréatectomie céphalique pour tenter de prévenir la récidive locale du cancer de la tête du pancréas. Trente Gy provenant d'un accélérateur linéaire furent concentrés sur le champ opératoire, l'axe coeliaque, l'artère mésentérique après l'exérèse. Les résultats de ce traitement mixte pratiqué chez 12 malades ont été comparés à ceux d'une série de 12 malades qui avaient subi une simple exérèse. Le traitement mixte s'est soldé par une amélioration du taux de survie à un an alors que le taux de survie à deux ans n'a pas été modifié. L'autopsie de 3 malades qui avaient été traités par la méthode combinée a montré l'absence d'adénopathies malignes au niveau du champ opératoire alors que les ganglions juxta-aortiques au dessus du diaphragme et au dessous de l'artère mésentérique inférieure étaient le siège de métastases associées dans les 3 cas à des métastases hépatiques et à une récidive au niveau de pancréas restant. La survie de ces malades n'avait pas été prolongée.Ces résultats selon les auteurs invitent à étendre le traitement du cancer de la tête du pancréas aux ganglions péri-aortiques situés au dessus du diaphragme et au dessous de l'artère mésentérique inférieure.

     

Nerve fiber caliber analysis in the mouse facial trunk distal to the stylomastoid foramen with the electron microscope

Nerve fiber counts and caliber analysis were performed with the electron microscope on 5 facial trunks distal to the stylomastoid foramen from 3 mice. On an average, about 89% of the total nerve fibers (3,205) were myelinated and about 11% unmyelinated. Majority (80.5%) of the myelin sheaths of the myelinated fibers in the nerves were 2.0-4.5 microns and majority (86.4%) of their axons were 1.0-3.0 micron in minor diameter. Their frequency distributions were similar in pattern to that of the large fiber zone of the motor root of the mouse facial nerve. Majority (86%) of the unmyelinated fibers in the facial trunk distal to the stylomastoid foramen were 0.1-0.5 micron in minor diameter. Its frequency distribution showed that the unmyelinated fibers of the facial trunk tend to be rather smaller than that of the other nerves examined in the previous studies. Ratios of the circumferential length of the myelinated fibers to that of the circles with the same areas ranged from 1.00 to 1.98, with 1.02-1.10 being most frequent (72%). Ratios of the axons of the myelinated fibers ranged from 1.00 to 2.54, with 1.04-1.14 being most frequent (51.8%). Ratios of the unmyelinated fibers ranged from 1.00-1.18 (84%), and those which over 1.20 were rare.     

Clinical significance of the epidermal growth factor receptor gene in squamous cell carcinomas of the nasal cavities and paranasal sinuses.

The authors retrospectively analyzed epidermal growth factor receptor (EGFR) gene amplification in 49 cases of squamous cell carcinoma (SCC) arising from the nasal cavities (NC) and paranasal sinuses (PS) by using slot-blot analysis of DNA extracted from formalin-fixed, paraffin-embedded tissues. Also, the relationship between the results of gene analysis and the clinical features of the patients was studied to investigate the clinical significance of the EGFR in SCC of the NC and PS. Amplification of the EGFR gene was detected in 5 of the 49 cases (10%). No significant difference was observed between EGFR gene amplification and the presence of lymph node metastases, local recurrence, or prognosis. This suggests that EGFR gene amplification is not related to the local progression or metastasis of the SCC in the NC and PS. In addition, it appears that amplification of the EGFR gene is not a prognostic indicator for SCC in the NC and PS.