Intravenous and intra-arterial chemotherapeutic possibilities in biliopancreatic cancer.

Chemotherapy of carcinomas of the pancreas and biliary tract has always been of limited value. Pancreatic cancer is well known for its aggressive nature, poor prognosis and resistance to antineoplastic agents which are effective in other solid tumors. 5-Fluorouracil has long been the mainstay of the treatment of pancreatic cancer, although the response rate to this agent is < 10% and the influence on survival and quality of life is negligible. Combination chemotherapy in pancreatic cancer adds to the side effects of treatment, but has had no proven effect on effectiveness. The only new anticancer drug of which an improvement in clinical benefit has been indicated on the basis of randomized clinical research, is gemcitabine, although the magnitude of improvement is limited. Due to the rarity of tumors of the biliary tract, the data on the effect of chemotherapy in this disease is sparse but does not suggest that it leads to superior results than supportive care alone. Likewise, no literature exists supporting the routine application of regional chemotherapy infusion in these type of tumors.