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. 2019 Nov;145(11):2855-2862.
doi: 10.1007/s00432-019-03019-6. Epub 2019 Sep 10.

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

Karl R Aigner  1 , Sabine Gailhofer  2 , Emir Selak  2 , Kornelia Aigner  2
Affiliations

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

Karl R Aigner et al. J Cancer Res Clin Oncol. 2019 Nov.

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.

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Conflict of interest statement

Karl Reinhard Aigner declares that he has no conflict of interest. Sabine Gailhofer declares that she has no conflict of interest. Emir Selak declares that he has no conflict of interest. Kornelia Aigner declares that she has no conflict of interest.

Figures

Fig. 1
Fig. 1
a Scheme of UAP-F technique. b Stop-flow balloon catheter
Fig. 2
Fig. 2
Cisplatin concentrations during intra-arterial infusion
Fig. 3
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)
See this image and copyright information in PMC

References

    1. Aigner KR, Gailhofer S (2005) Celiac axis infusion and microembolization for advanced stage III/IV pancreatic cancer—a phase II study on 265 cases. Anticancer Res 25:4407–4412 - PubMed
    1. Aigner KR, Gailhofer S, Kopp S (1998) Regional versus systemic chemotherapy for advanced pancreatic cancer: a randomized study. Hepatogastroenterology 45:1125–1129 - PubMed
    1. Aigner K, Gailhofer S, Ben-Ari G (2016) Systemic and regional chemotherapy for advanced and metastasized pancreatic cancer. In: Aigner K, Stephens F (eds) Induction chemotherapy. Springer, New York, pp 243–251
    1. Aigner KR, Gailhofer S, Aigner K (2018) Carotid artery infusion via implantable catheters for squamous cell carcinoma of the tonsils. World J Surg Oncol 16:104 - PMC - PubMed
    1. Aigner KR, Selak E, Aigner K (2019) Short-term intra-arterial infusion chemotherapy for head and neck cancer patients maintaining quality of life. J Cancer Res Clin Oncol 145:261–268 - PMC - PubMed

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