A novel arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization

BACKGROUND. Patients with American Joint Committee on Cancer Stage TV advan ced pancreatic carcinoma have been treated by systemic chemotherapy, intraa rterial chemotherapy, radiation therapy, and multidisciplinary treatment us ing a combination of these. However, the outcome has not always been satisf actory. In the current study the authors describe the method and results of a new chemotherapy for advanced pancreatic carcinoma. METHODS. To restrict the blood flow into the pancreas (mainly to the great pancreatic artery and the caudal pancreatic artery), the peripancreatic blo od vessels were embolized superselectively with microcoils. In 31 patients with advanced pancreatic carcinoma, the catheter tip for the arterial infus ion chemotherapy was placed in the splenic artery just proximal to the bran ching of the great pancreatic artery when the treatment was given for prima ry tumors, and in the common hepatic artery when the treatment was given fo r a metastatic liver lesion. The other end of the catheter was connected to an implanted injection port embedded in the femoral region, and 5-fluorour acil and cisplatin were administered by continuous arterial infusion. RESULTS. Of the 31 patients with advanced pancreatic carcinoma, 23 (74%) un derwent hemodynamic change and arterial infusion chemotherapy, with a respo nse rate of 73.9% (complete response rate of 8.7% and a partial response ra te of65.2%) and a mean survival period of 18.26 +/- 10.06 months. The I-yea r, 2-year, and 3-year survival rates were 90.9%, 42.8%, and 18.3%, respecti vely, with a mean survival period of 19.0 months. Of these 23 patients, the 16 patients with liver metastases had a response rate of 68.8% and a mean survival period of 16.25 +/- 8.35 months, whereas the 7 patients without li ver metastases had a response rate of 87.5% and a mean survival period of 2 2.86 +/- 12.69 months. CONCLUSIONS. In patients with Stage IV advanced panc reatic carcinoma, arterial infusion chemotherapy after hemodynamic change w as found to be effective against both primary tumors and metastatic liver l esions. The authors believe that the treatment presented in the current stu dy should be attempted, even in patients with advanced pancreatic carcinoma , as long as the blood vessels for vascular supply distribution exist. (C) 2000 American Cancer Society.