Richard J. Reitemeier

Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group.

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.

Corticosteroid therapy of preterminal gastrointestinal cancer

In a controlled double blind study involving 116 patients with far‐advanced gastrointestinal cancer, dexamethasone at dosages of 0.75 and 1.5 mg four times daily produced improved appetite and sense of well‐being in comparison to placebo treatment. This symptomatic palliation, however, was not accompanied by weight gain or improved performance status. Survival of the steroid treated patients was essentially identical to that of the placebo treated patients. Cancer 33:1607–1609, 1974.

Treatment of the patient with adenocarcinoma of unknown origin

One hundred sixty‐two patients with adenocarcinoma of undertermined origin were treated with 213 chemotherapeutic regimens, primarily 5‐FU by intensive course. Objective response was obtained with 12% of these regimens and was maintained by a median time of 3.5 months and a mean of 9 months. Regimens producing a response rate of 15% or greater included 5‐FU alone, 5‐FU in combination with BCNU, and mitomycin C. Those patients achieving objective response had a significantly longer survival period than those failing to respond. Necropsy examinations revealed the greatest proportion of patients presenting with adenocarcinoma of unknown origin to have their primary neoplasms in the pancreas.

A controlled study of combined 1,3‐bis‐(2‐chloroethyl)‐1‐nitrosourea and 5‐fluorouracil therapy for advanced gastric and pancreatic cancer

Treatment with the combination of 1, 3‐bis‐(2‐chloroethyl)‐1‐nitrosourea (BCNU) and 5‐fluorouracil (5‐FU) was compared to therapy with each drug used alone in a prospective randomized study of 167 patients with advanced adenocarcinoma of the stomach and pancreas. At dosages producing comparable degrees of hematologic toxicity, the combination was associated with the highest rate of objective response, 41.3% in carcinoma of the stomach and 33.3% in carcinoma of the pancreas. The corresponding rates of objective response with 5‐FU alone were 28.6% and 16.1%; and with BCNU alone 17.4% and 0%. In pancreatic carcinoma there was no discernible difference in survival among patients in each treatment arm. In gastric carcinoma, however, both 5‐FU and die combination produced an increase in survival when compared to BCNU alone, and the combination of 5‐FU and BCNU produced an increase in long‐term survival compared to 5‐FU alone.

Cell kinetics in the jejunum and rectum of man

E PITHELIAL-CELL turnover in the gastrointestinal tract in man was the subject of a review by Bertalanffy, t who emphasized the l imited informat ion available on the renewal of gastrointestinal epi thel ium in the human. Extensive studies --7 have been made of cell migrat ion in the gastrointestinal epi thel ium in exper imenta l animals by methods based on mitot ic count ing or on labeling of cells with radioactive thymidine combined with radioautography. The re have been a comparat ively small numbe r of such studies relative to the gastrointestinal epi thel ium in man. s-la This communica t ion reports on cellular prol iferat ion in the intestinal tract in 3 men studied by means of parenteral labeling wittl tr i t iated thymidine and jejunal and rectal biopsy combined with radioautography.

A phase II study of triazinate (NSC 139105) in advanced colorectal carcinoma.

Triazinate (Bakers Antifol, NSC 139105) was given to 28 patients as a single agent in the chemotherapy of advanced colerectal carcinoma. The dosage utilized was 250 mg/m2 intravenously, administered daily in three consecutive days. Patients were evaluated at three weeks, six weeks, and then monthly until progression was evident. Various immunologic determinants (i.e., DNCB sensitization, immunoglobulins, recall skin tests, lymphocyte blastogenesis, and circulating lymphocytes, T‐cells and B‐cells) were obtained prior to treatment and at each re‐evaluation. The principal side effects were dermatitis, stomatitis, diarrhea, nausea, somnolence, and leukopenia. There was no discernable effect of Triazinate on the immunologic determinants tested. There was one complete response, and four partial responses, for an objective regression rate of 18%. This study suggests that Triazinate has a definite, though limited, effect on advanced colorectal carcinoma. Cancer 40:9–13, 1977.

Therapy of advanced gastrointestinal cancer with 1‐3‐bis‐(2‐chlorethyl)‐l‐nitrosourea (BCNU)

1‐3‐Bis‐(2‐chlorethyl)‐1‐nitrosourea (BCNU) was administered intravenously to 72 patients with advanced gastrointestinal cancer. Total doses for each course of therapy ranged between 250 and 375 mg. per square meter, given in divided doses over periods of from 3 to 6 days. Initial toxic effects were transient nausea and vomiting. Bone‐marrow depression occurred late and involved all formed elements of the blood. Four patients had evidence of clinically significant hepatotoxicity. Courses of therapy could be repeated at 8 week intervals without significant cumulative toxicity. Objective tumor regressions were observed in 12.5 per cent of patients treated, and 19.5 per cent claimed symptomatic improvement. The mean duration of the tumor regressions was 4 months. Because of the low rate of tumor regressions and the short duration of these regressions, BCNU, as administered by the method employed in this study, does rwt seem to have a practical role in the management of advanced gastrointestinal cancer.

A Phase 2 Study of Intermittent High Dose Isophosphamide Therapy of Advanced Colorectal Cancer

33 patients with advanced adenocarcinoma of the colon or rectum were treated with isophosphamide given intravenously at a dose of 4 g/m2 every 3 weeks. Patients receiving the full dose in a

An unusual extracolonic manifestation of chronic ulcerative colitis

CHRONIC ULCERATIVE COLITIS may be accompanied by any number of a wide variety of extracolonic manifestations. Cu taneous lesions, such as e r y t h e m a nodosum and pyoderma gangrenosum, are occasionally present. Thrombophlebit is , another significant complication, has been linked to a tendency toward hypercoagulation in patients with ulcerative colitis. We present herein the case of a patient with severe active ulcerative colitis in whom numerous necrotic cutaneous lesions and recurrent thrombophlebit is developed. From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota