First experience of using combination of conformal radiation therapy with intraarterial administration of gemcitabine and nanostabilized paclitaxel in patients with locally advanced pancreatic cancer complicated by persistent chronic pain

Abstract

Introduction. Locally advanced pancreatic cancer (LAPC) is accompanied by a diverse clinical picture, one of the leading symptoms is chronic pain syndrome (CPS), which occurs in 30 % of patients in the early stages of the disease and in 80 % of patients with advanced pancreatic cancer. The basic method of treating CPS is analgesic therapy. However, the widespread use of painkillers is limited due to the short and incomplete analgesic effects, as well as side effects of painkillers. The use of chemoradiotherapy (CRT) contributes to the relief of CPS, however, it is accompanied by adverse events (AE) and a short analgesic effect. Aim. The aim of the study was to evaluate the first experience of using of intra-arterial administration of a combination of gemcitabine at a dose of 1,000 mg/m2 and nano-stabilized paclitaxel at a dose of 125 mg/m 2 in combination with conformal radiation therapy in patients with LAPC with CPS. Materials and methods . A controlled open, single-center, non-randomized, retrospective study included 17 patients who received combined treatment - a single selective intra-arterial administration of gemcitabine at a dose of 1,000 mg/m 2 and nano-stabilized paclitaxel at a dose of 125 mg/m 2 , followed by conformal radiation therapy with beam of 51 Gr in medium fractionation mode. The dynamics of CPS was assessed by the intensity, severity, localization and characteristics of the applied analgesic therapy using the BPi-SF-Russian-2001 questionnaire when the patient was admitted before treatment, on the 24th and 54th days of combination therapy. Results. Complications associated with angiography and radiation therapy have not been reported. There were no pronounced (more than Grade 1) immediate and distant AEs of intra-arterial chemotherapy in patients. An analysis of CPS and its associated indicators showed a decrease in the severity of pain, which ultimately was an important component of the quality of life of patients. Significant decrease in CPS occurred on the 24th day before treatment. The analgesic effect was reliably maintained on the 54th day. The maximum analgesic effect of the combined treatment was noted on the 24th day. Thus, the duration of anesthesia was recorded up to 54 days. The analgesic effect significantly contributed to improving mood, the ability to contact with others, and also affected the quality and duration of sleep and the ability to enjoy life in patients of the study group. Conclusion. The use of intra-arterial chemotherapy with gemcitabine and nano-stabilized paclitaxel in combination with radiation therapy can effectively affect on CPS and the quality of life in patients with LAPC.