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SRS for unresectable pancreatic carcinoma can be delivered in three fractions with minimal morbidity and a local tumor control rate of 91.7%. The survival is comparable or better than the reported results for advanced pancreatic cancer, specifically for the group of previously untreated patients with unresectable tumors. Development of distant metastases remains a significant factor.

To study the biologic behavior and natural history of this rare but challenging tumor faced by oncologists, a clinicopathologic study of 42 patients with histologically proven adrenal cortical carcinoma from Roswell Park Memorial Institute (1929--1977) was done. These constituted .04% of all cancer cases and 0.2% of all autopsy cases. Age range was 3--74 years with median of 53 years; female to male ratio was 1.5 to 1. Clinical manifestations were: abdominal mass (36%), metastatic disease (30%), hormonal excess (17%) and weakness with lethargy (17%). Nine of ten functioning tumors were seen in female patients. Tumors arose in left adrenal in 26 patients, right adrenal in 12, and in four the site could not be determined because of bilateral presence of cancer. Median duration of symptoms was six months. At diagnosis, 52% had distant metastases, 41% had locally advanced tumor and 7% had tumor confined to adrenal. Sixteen patients underwent "curative" resection. Tumor diameter ranged from 1--30 cm with median of 10 cm. Of 28 patients who received different chemotherapeutic regimens, three (11%) had objective response; four of ten patients had objective response to radiation therapy. Overall median and five-year survival rates were 14 months and 24%. Prolonged survival (P less than .05) was noted in women, patients who had "curative" resection, a disease-free interval of more than 12 months, and tumor size greater than 10 cm diameter. Patients with functional tumors had longer median survival than those with non-functional ones (28 vs. 12), but P value was greater than .05. A second primary cancer was noted in 22.4% of cases, breast and lymphoma being the most common. At autopsy in 31 patients, the most common metastatic sites were retroperitoneal lymph nodes 68%, lung 71%, liver 42%, and bone 26%. To improve survival, an aggressive surgical approach is recommended to extirpate the tumor with involved organs and retroperitoneal lymph nodes. Adrenal carcinoma should be suspected in patients with metastatic cancer with an occult primary.

From 1950 to 1973, 254 patients with metastatic cancers from occult primary tumors, comprising 0.5% of all the referred cancer patients were seen. The average age was 59 years. Clinical presentation was commonly in the form of metastatic lesions in lung, cervical lymph node, bone or liver. Radiological and radioisotopic investigations proved helpful in determining the extent of disease rather than the origin of primary tumor. Adenocarcinoma was the commonest type, followed by undifferentiated and squamous cell carcinomas. The origin of the primary tumor was established in 77 (30%) patients, mostly at autopsy. It was in the lung in 40% of the cases, followed by stomach, pancreas, kidney, ovary and colon. Some correlation was found between clinical presentation and the origin of the primary tumor. Histologically different second cancers were detected in 28 (11%) patients. Overall median and five-year survival rates were nine months and nine per cent respectively. Longer survival was seen in patients with squamous cell carcinoma metastases, middle and upper neck lymph node lesions, and those who had "curative" surgery. In localized metastatic lesions, surgical extirpation should be done. Depending on the histological type of the metastatic lesions, chemotherapy and/or radiation therapy have definite roles in the management of these patients. Periodic follow-up examinations also prove valuable.

Angiosarcoma is a rare and aggressive tumor of the thyroid gland, mainly seen in the Alpine regions. We present such a case with literature review. We present the case of a 60-year-old man with cough, dyspnea, and hemoptysis along with slow increase in the size of his long-standing goiter. Computed tomography of the neck showed a large thyroid mass and chest imaging revealed multiple pulmonary nodules. Fine needle aspiration cytology and tru-cut biopsy of the thyroid were notable for poorly differentiated malignant cells. Diagnosis of angiosarcoma of the thyroid was made after total thyroidectomy. Patient died of continued hemoptysis and respiratory failure 3 weeks after admission. We searched the literature for previous case reports using Pubmed and Ovid. Forty-seven reported cases were identified and our case was added to make a database of 48 cases. Demographic and tumor characteristics were analyzed. Angiosarcoma was found to be more common in females and at age of 60 or above. Results were consistent with previously reported series of 14 and 17 cases from Austria. This review provides information on various characteristics angiosarcoma of the thyroid which can be used as baseline data for future reference and research studies for this cancer.

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Eightyeight cancer patients with the presence of one or more adverse factors for healing (carcinomatosis, adhesions, prior chemotherapy and radiation therapy, bowel obstruction, anemia, and low leukocyte count or albumin value) were prospectively randomized to undergo conventional twelayer hand suhuing (45 patients) or mechanical stapling with a GIA/TA instrument (U. S. Surgical Corp., Norwalk, CT) (43 patients) of the large or small bowel anastomosis. Age, sex, complete blood count findings, and all biochemical plasma values were comparable in both groups. The anastomosis took an average of 19 minutes for the sutured and 9 minutes for the stapled technique (P = O.OOOl), but the average length of operation, postoperative return of bowel function, and hospital stay were comparable in both groups. Bowel fistula was seen in one case of stapled anastomosis (P = not significant). The pulmonary and wound complication rates were the same in both groups. Of the four deaths (4.5%) due to causes unrelated to bowel anastomosis, three occurred in the stapled and one in the sutured group. It was concluded that a stapled anastomosis is as safe as a sutured one in patients with advanced-stage cancer. It saves time in anastomosis, but does not save time in postoperative return of the bowel function and hospital stay.

Since 1963, eight patients with extraosseous osteogenic sarcoma were treated at Roswell Park Memorial Institute; these constituted 4.6% of all the osteogenic sarcoma patients during the period. The mean age of the patients was 58.7 years and a ratio of male to female was equal. Local swelling of insidious onset was the commonest symptom. All the tumors originated in extremities; the lower extremity was the more frequent site. At the time of diagnosis, seven patients had localized tumor and one had pulmonary metastases. Radiologically, a soft tissue mass with spotty calcification without any adjacent bone involvement, was the classical sign. Elevated alkaline phosphatase without liver metastases was observed in five of six patients when disease progressed. Ultrastructurally, the prominent cell type was a fibroblast-like cell intermingled with varying numbers of osteoblasts and undifferentiated mesenchymal cells. Extreme morphologic variability probably accounts for the difference in composition of this tumor. Radical soft part excision or amputation should be the treatment of choice. Local recurrence was not seen in four patients after radical surgery, but it was observed in three of the four patients who had simple excision. The lung was the commonest site of metastases. No objective responses were observed after chemo-or immunotherapy. The overall median survival was 20 months and 5-year survival rate was 25%.