Abstract
Objective. To study effectiveness of intra-arterial chemotherapy in patients with locally advanced and metastatic pancreatic cancer.Material and methods. There were 329 patients who underwent regional chemotherapy in 2000 – 2015 (infusion through celiac trunk – 167, chemoembolization of gastroduodenal artery – 52, combination of these methods – 72, combined chemo-radiotherapy – 38). Locally advanced unresectable pancreatic cancer with arterial invasion (T4 grade) was observed in 198 (60.2%) patients, liver metastases (stage IV) – in 131 (39.8%) patients. Chemoembolization or chemoradiation therapy was performed for patients without distant metastases.Results. The best results for unresectable pancreatic cancer were obtained in 160 patients after chemoembolization combined with infusion. Partial response was obtained in 24.1% of cases compared with 8.9% and 13.4% of cases after infusion or chemoembolization alone. Mean life expectancy was 15.5 months compared with 14.6 and 10.6 months, respectively. Median of life expectancy was 15.6 months compared with 11.7 and 10.8 months, respectively. At the same time, progression of disease was observed in the majority of 131 patients with metastatic cancer. Partial response was noted only in 2.3% of patients only after chemoinfusion. Survival and median survival after chemoinfusion and combination of chemoembolization with chemoinfusion were similar (10.1 (8.3) and 10.9 (7.5) months). Chemoradiotherapy in 4 patients with initially unresectable pancreatic cancer resulted reduction of tumor dimension by 28% (24–32%). Therefore, radical operations were performed later. One-year survival was achieved in 20 (58.8%) out of 34 patients with unresectable pancreatic cancer. Mean life expectancy was 15.4 months (median 13.8 months).Conclusion. Intra-arterial chemotherapy is effective treatment in patients with pancreatic cancer stage III and IV. Combination of celiac axis infusion with arterial embolization, as well as infusion with radiotherapy resulted the best survival. Certain advantage of chemoinfusion was found for liver metastases. The use of new chemotherapy modes for intra-arterial infusion requires further study.
Highlights
Granov Russian Scientific Center of Radiology and Surgical Technologies of Ministry of Health of the Russian Federation; 70, Leningradskaya str., p
Chemoembolization or chemoradiation therapy was performed for patients without distant metastases
The best results for unresectable pancreatic cancer were obtained in 160 patients after chemoembolization combined with infusion
Summary
There were 329 patients who underwent regional chemotherapy in 2000 – 2015 (infusion through celiac trunk – 167, chemoembolization of gastroduodenal artery – 52, combination of these methods – 72, combined chemo-radiotherapy – 38). Advanced unresectable pancreatic cancer with arterial invasion (T4 grade) was observed in 198 (60.2%) patients, liver metastases (stage IV) – in 131 (39.8%) patients. The best results for unresectable pancreatic cancer were obtained in 160 patients after chemoembolization combined with infusion. Intra-arterial chemotherapy is effective treatment in patients with pancreatic cancer stage III and IV. Операбельными являются лишь 10– 20% больных РПЖ, при этом медиана выживаемости в зависимости от стадии заболевания составляет 8–18 мес, а пятилетняя выживаемость не превышает 20% [1,2,3]. Химиоинфузию (ХИ) при РПЖ изучали на небольших группах больных в отдельных медицинских учреждениях, и ее клиническое значение до сих пор не определено. Что лучевая терапия (ЛТ) недостаточно эффективна при РПЖ, в том числе ввиду низкого общего статуса больных и выраженных побочных эффектов, в первую очередь повреждающего воздействия на соседние органы. Цель исследования – увеличение эффективности лечения больных нерезектабельным и метастатическим РПЖ применением рентгенэндоваскулярных методов
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