Intra-arterial infusion chemotherapy versus isolated upper abdominal perfusion for advanced pancreatic cancer: a retrospective cohort study on 454 patients

Abstract

PurposeThe treatment of pancreatic carcinoma remains a challenge as prognosis is poor, even if confined to a single anatomical region. A regional treatment of pancreatic cancer with high drug concentrations at the tumor site may increase response behaviour. Intra-arterial administration of drugs generates homogenous drug distribution throughout the entire tumor volume.MethodsWe report on treatment outcome of 454 patients with advanced pancreatic carcinoma (WHO stage III: 174 patients, WHO stage IV: 280 patients). Patients have been separated to two different treatment protocols. The first group (n = 233 patients) has been treated via angiographically placed celiac axis catheters. The second group (n = 221 patients) had upper abdominal perfusion (UAP) with stopflow balloon catheters in aorta and vena cava. Both groups have been treated with a combination of cisplatin, adriamycin and mitomycin.ResultsFor stage III pancreatic cancer, median survival rates of 8 and 12 months were reached with IA and UAP treatment, respectively. For stage IV pancreatic cancer, median survival rates of 7 and 8.5 months were reached with IA and UAP treatment, respectively. Resolution of ascites has been reached in all cases by UAP treatment. Toxicity was generally mild, WHO grade I or II, toxicity grade III or IV was only noted in patients with severe systemic pretreatment. The techniques, survival data and detailed results are demonstrated.ConclusionsResponsiveness of pancreatic cancer to regional chemotherapy is drug exposure dependent. The isolated perfusion procedure is superior to intra-arterial infusion in survival times.Electronic supplementary materialThe online version of this article (10.1007/s00432-019-03019-6) contains supplementary material, which is available to authorized users.

Tumor response and the quality of life after isolated hypoxic pelvic perfusion for advanced G3 cervical cancer: A case series

“…Although we routinely perform isolated hypoxic perfusion for various cancers, we rarely see patients with gynecological tumors, primarily treated by gynecologic oncologists. The presented cases demonstrated excellent results in advanced cervical cancer, which is often the case with arterial chemotherapy and isolated hypoxic perfusion in other tumor types [ [16] , [17] , [18] , [19] ].…”

Pancreaticoduodenectomy combined with splenectomy for a patient with pancreatic cancer and pancytopenia due to liver cirrhosis: Case report

“…With regard to preoperative chemotherapy, Karl et al reported the usefulness and low toxicity of chemotherapy administered by intra-arterial infusion, including isolated abdominal perfusion [ 22 ]. However, our patient also had an abdominal aortic aneurysm with type 2 endoleak despite her previous EVAR, so catheterization was considered to be difficult.…”

Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

“…stages III and IV) SAE NS 0% mOS: IAIC 5–21 Syst chemo 2.7–14 Liu [ 30 ] 2016, R IAIC Catheter, NS 235 NS NS mOS 7 (incl. stages III and IV) Rosemurgy [ 31 ] 2017, NS IAIC Catheter, CTA 20 10 SAE in 20 pts 0% 1 yr 60% 2 yr 43% Aigner [ 32 •] 2019, R IAIC ± embolization vs. UAP Catheter, NS 174 NS AE or SAE 0% mOS: IAIC 8 UAP 12 Qiu [ 33 ] 2019, R IAIC Catheter, NS 31 1% 0% mOS 5.3 …”

“…employed for the treatment of hepatic tumors [98], but some literature has also been published on its use in pancreatic cancer [9,[30][31][32][33]. The exact tumor location and its supplying arteries determine through which vessels the chemotherapeutic infusion will be delivered.…”