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

Abstract

Purpose: The 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.

Methods: We 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.

Results: For 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.

Conclusions: Responsiveness of pancreatic cancer to regional chemotherapy is drug exposure dependent. The isolated perfusion procedure is superior to intra-arterial infusion in survival times.

Keywords: Intra-arterial infusion; Isolated perfusion; Pancreatic cancer; Quality of life; Regional chemotherapy.

Fig. 1

a Scheme of UAP-F technique. b Stop-flow balloon catheter

Fig. 2

Cisplatin concentrations during intra-arterial infusion

Fig. 3

a Kaplan–Meier estimate of survival comparing intra-arterial infusion with UAP-F in stage III pancreatic cancer. b Kaplan–Meier estimate of survival comparing intra-arterial infusion versus UAP-F in stage IV pancreatic cancer. c Metastatic carcinoma of the pancreas treated with upper abdominal hypoxic perfusion (UAP-F)