J. S. MITCHELL 



staiitially the same in Tables III and IV as in that paper. It is to be noted 

 in groups (a), (b) apd (c) of Table III that at the date of assessment 4 patients 

 are still living in the series X + I-VS and one patient is living in the series 

 X-f-I-MS, and it is almost certain that the final mean survival time in the 

 group X+I-VS will be substantially greater than the value given of 10-2 

 months from the first X-ray treatment. As this clinical trial with random- 

 ized allocation proceeds and the number of cases included increases, the 

 difference between the results in the series X-f I-VS and X-f-I-MS increases 

 in significance. 



In addition to the statistical estimation of survival times from the first 

 X-ray treatment and from the first symptom, I think it is of the greatest 

 importance to assess the detailed progress of the course of the disease in the 

 individual patients and, in particular, to try to obtain an estimate of the 



^/o. 17. H..... Ro (esjrs) X+ iMS 



Co. left main bronchus - Inoperable 



Performance si at us 

 WO 



s 



Loss of 

 sirenqfh 



Welghl It. 182 



W 12 Tnon+hs 



Dyspnoea Tl1-6-51 D 



folloiving M. T.D. 

 Influenza 3000 r 

 In 39 days 



15t W 1U-1 



me Jio 



Esflmaled prolongation of life months (possibly -2 months) 



Figure 3. 



effect of the different types of treatment. I have seen nearly all the patients 

 referred to in Tables III and IV personally but it is essential to try to present 

 the results for the individual patients objectively. A useful method of 

 approach is by the use of the Performance Status defined by Karnofsky 

 ef al^^ (Table 3). Selected examples for two patients who appeared to be 

 reasonably txpical are given in Figures 3 and 4. The former is for a case 

 treated with X-ray therapy combined with intramuscular Compound I and 

 the latter for a case treated with X-ray therapy combined with intravenous 

 Compound I. By extrapolation of the curve of deteriorating Performance 

 Status before treatment, an attempt is made to estimate the duration of life 

 in the absence of the treatment given and from this to estimate the prolonga- 

 tion of life, and also prolongation of useful life, as a result of the form of 

 treatment administered. In Figure 3 in the case treated with X-ray therapy 

 combined with intramuscular compound, it appears unlikely that the 

 treatment resulted in any prolongation of life but that there was possibly a 

 slight palliation of symptoms, although even this conclusion is by no means 



187 



