CELIAC AXIS INFUSION CHEMOTHERAPY IN ADVANCED NONRESECTABLE PANCREATIC-CANCER

Conclusion. Based on these data we suggest that regional intra-arteria l chemotherapy for advanced pancreatic cancer seems not to be superior to common treatment modalities, such as combined radiochemotherapy. B ackground. The prognosis for advanced pancreatic cancer is very poor. No standard treatment is available. Recently, better survival and qual ity of life was reported from regional cancer treatment via celiac axi s infusion. In an attempt to confirm these results we conducted a phas e II study of intra-arterial chemotherapy for nonresectable pancreatic cancer. Methods. From May 1994 to February 1995, 12 consecutive patie nts with biopsy-proven advanced ductal carcinoma of the exocrine pancr eas were given intra-arterial infusions consisting of Mitoxantrone, 5- FU + folinic acid, and Cisplatin via a transfemorally placed catheter in the celiac axis. Six patients were classified as UICC stage III and six as stage IV with the liver as the sole site of distant metastasis . Nine patients had primary and three had recurrent pancreatic carcino ma after a Whipple procedure. Nonresectability of primary tumors was a ssessed in all patients by laparotomy or laparoscopy. Results. A total of 31 cycles of chemotherapy (mean 2.6 cycles/patient) was administer ed. Catheter placement was technically feasible in all cycles. A groin hematoma was the only catheter complication. The follow-up by CT scan s at 2-mo intervals revealed partial remission in 1 patient (8%), temp orary stable disease in 4 patients (33%), and disease progression in 7 patients (58%). The same response was obtained after analyzing the CA 19-9 course. Median survival in stage III patients was 8.5 mo (3-12 m o) and in stage IV patients 5 mo (2-11 mo). Toxicity according to WHO criteria consisted of grade III (4 events), grade II (10 events), and grade I (17 events), mainly resulting from leucopenia and diarrhea/vom iting. Nine of 11 patients experienced temporary relief of pain immedi ately after regional treatment.