Regional chemotherapy in the treatment of advanced pancreatic cancer - is it relevant?

The treatment of pancreatic cancer is still problematic for physicians. Onl y 15% of patients present with resectable tumours, and systemic chemotherap y is of limited effectiveness. In order to achieve higher local drug concen trations in the tumour without causing the side-effects of a comparable lev el of systemic treatment, regional chemotherapy has been introduced as an a lternative treatment. Several techniques have been developed over recent ye ars, these include: celiac axis infusion (CAI), CAI with microspheres or ha emofiltration, aortic stop flow (ASF) and isolated hypoxic perfusion (IHP). Whilst several authors have reported improved response rates and a prolong ation of median survival time, these results have not been confirmed by oth ers. In addition, the incidence of side-effects and the rate of technical c omplications have been reported to be high during regional chemotherapy. Ex cept for a single trial containing 14 patients, no randomised trial compari ng systemic and regional chemotherapy has been conducted. For these reasons , none of the reported treatment regimens can be considered to be standard treatment and in order to evaluate, if regional chemotherapy is indeed supe rior to systemic chemotherapy, randomised trials must be conducted. (C) 200 0 Elsevier Science Ltd. All rights reserved.