Hofmann Helene, von Haken Rebecca, Werner Jens, Kortes Nikolas, Bergmann Frank, Schemmer Peter, Jäger Dirk, Radeleff Boris, Schulze-Bergkamen Henning
National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
Department of Anesthesiology, University Clinic of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Pancreatology. 2014 Nov-Dec;14(6):546-9. doi: 10.1016/j.pan.2014.08.006. Epub 2014 Sep 16.
BACKGROUND/OBJECTIVES: Solid pseudopapillary neoplasms of the pancreas (SPN) are rare tumors. For patients with unresectable liver metastases of SPN, no standard treatment has been defined so far. Here we report a case of a 40-year-old woman with SPN and metastases confirmed to the liver, and disease progression in the liver after primary tumor resection and chemotherapy with gemcitabine and cisplatin.
Chemosaturation with percutaneous hepatic perfusions is a minimally invasive, repeatable regional therapy which delivers chemotherapy directly to the liver while limiting systemic toxicity. As an individual treatment approach, the patient was treated with chemosaturation with percutaneous hepatic perfusions of melphalan.
The procedure was performed twice within 8 weeks after which the liver metastases showed a marked reduction in size and vascularization (partial response). Grade 3 leukopenia after the second procedure was managed effectively with granulocyte colony-stimulating factor. No other toxicities were observed. Ten months after initiating treatment, the patient had a good performance status and remained stable.
For SPN with unresectable liver metastases and progression despite systemic treatment, repeat chemosaturation with high-dose melphalan may also offer an effective regional treatment option.
背景/目的：胰腺实性假乳头状瘤（SPN）是罕见肿瘤。对于SPN发生不可切除肝转移的患者，目前尚未确定标准治疗方案。在此，我们报告一例40岁女性，患有SPN且已证实发生肝转移，在原发肿瘤切除及接受吉西他滨和顺铂化疗后肝脏疾病仍进展。
经皮肝灌注化疗饱和是一种微创、可重复的区域治疗方法，可将化疗药物直接输送至肝脏，同时限制全身毒性。作为一种个体化治疗方法，该患者接受了美法仑经皮肝灌注化疗饱和治疗。
在8周内进行了两次该操作，之后肝转移灶大小及血管化程度显著降低（部分缓解）。第二次操作后出现3级白细胞减少，使用粒细胞集落刺激因子有效处理。未观察到其他毒性反应。开始治疗10个月后，患者身体状况良好且病情保持稳定。
对于SPN伴不可切除肝转移且尽管进行了全身治疗仍进展的患者，高剂量美法仑重复化疗饱和也可能提供一种有效的区域治疗选择。
