Transcatheter Arterial Chemoembolization for Hepatic Recurrence after Curative Resection of Pancreatic Adenocarcinoma

Abstract

Background/Aims: Despite curative resection, hepatic recurrences cause a significant reduction in survival in patients with primary pancreatic adenocarcinoma. Transcatheter arterial chemoembolization (TACE) has recently been used successfully to treat primary and secondary hepatic malignancy. Methods: Between 2003 and 2008, 15 patients underwent TACE because of hepatic recurrence after curative resection of a pancreatic adenocarcinoma. The tumor response was evaluated based on computed tomography scans after TACE. The overall duration of patient survival was measured. Results: After TACE, a radiographically evident response occurred in six patients whose tumors demonstrated a tumor blush on angiography. Four patients demonstrated stabilization of a hypovascular mass. The remaining five patients demonstrated continued progression of hypovascular hepatic lesions. The median survival periods from the time of diagnosis and from the time of initial TACE were 9.6 and 7.5 months, respectively. Conclusions: TACE may represent a viable therapeutic modality in patients with hepatic recurrence after curative resection of pancreatic adenocarcinoma. (Gut Liver 2010;4: 384-388)

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

“…Eight articles were identified that utilized SIRT, also known as TARE, for hepatic metastases in mPDAC ( Table 6 ) [ 44 , 45 , 46 , 47 , 71 , 72 , 73 , 74 ]. A total of 302 patients with mPDAC (136 with liver only disease, 166 with liver + extrahepatic disease (EHD)) were included, of whom 59 were treated with pancreatic resection or SBRT and SIRT of the liver, 93 received SIRT of the liver only, 120 were used as matched controls receiving chemotherapy only, and 30 others (unknown primary treatment or different local metastatic treatment).…”

Palliative TACE for hepatic metastases of chromophobe renal cell carcinoma

“…Chemoembolisation has been shown to offer palliative and locally effective treatment of liver metastases in patients with unresectable hepatocellular carcinoma (HCC), primary breast cancer, non-small cell lung cancer, pancreatic cancer, soft-tissue sarcoma, melanoma, colorectal cancer (CRC), gastric cancer and neuroendocrine tumours (table 1). 12–23 While TACE has been used to palliate various malignancies with liver metastases, it has specifically been reported as a down-staging measure ahead of surgical resection in a Japanese patient with metastatic chRCC, although impact on survival or quality of life remains unknown 24. TARE, performed through transarterial infusion of yttrium-90 microspheres to the tumour vascular bed to selectively deliver the therapeutic radiation dose over 2 weeks, can be indicated for unresectable metastatic liver tumours.…”

Making the Case: Intra-arterial Therapy for Less Common Metastases

“…Kim et al applied lipiodol chemoembolization with cisplatin 2 mg/kg and gelatin sponge particle (Gelfoam) embolization in 15 patients with hepatic recurrence after pancreatic surgery for resection of pancreatic adenocarcinoma (Whipple, pancreaticoduodenectomy, pancreatectomy, distal pancreatectomy). 45 Liver tumors were treatment naive in 13 of 15 patients with two patients having received gemcitabine. Nine patients (60%) had early nausea and vomiting that resolved.…”