Carcinoma of the pancreas--the Jefferson experience 1975-1988.

A retrospective review of 410 patients with carcinoma of the pancreas seen at Thomas Jefferson University from 1975-1988 was undertaken to provide a global view of the effectiveness of different modalities of treatment in the management of this disease. There were seven patients with Stage I disease, 141 patients with Stage II disease, 91 with Stage III, and 171 with Stage IV disease. The overall median survival was 7 months and a 1-year survival of 30% was observed. Median survival was 15 months for Stage I, 10 months for Stage II, 9 months for Stage III and 4 months for Stage IV patients. Several treatment approaches were utilized in these patients. Twenty-three patients underwent surgical resection. Five of these had Stage I tumor, and 18 patients had Stage II or III disease. Median survival in this group was 12 months with an operative mortality of 13%. No resected patients survived greater than 3 years. Eleven patients with Stage II and III disease received chemotherapy alone, 28 patients received external radiation alone, and 30 patients received Iodine-125 implantation plus external radiation. Median survival in all three groups was 7 months. Forty-five patients received combined chemotherapy plus external radiation for Stage II and III cancer with a median survival of 10 months and a 2-year survival of 14%. Eighty-one patients received combined Iodine-125 implantation+external radiation+chemotherapy and had a median survival of 13 months and a 2-year survival of 22%. Local control of disease was achieved in 74% of these patients. This combined modality approach appears to have the best potential for control of primary cancer and long-term survival of selected patients.