腹腔干灌注化疗在晚期不可切除胰腺癌中的应用

Celiac axis infusion chemotherapy in advanced nonresectable pancreatic cancer.

作者信息

Maurer C A, Borner M M, Läuffer J, Friess H, Z'graggen K, Triller J, Büchler M W

机构信息

Institute of Visceral and Transplantation Surgery, University of Bern, Switzerland.

出版信息

Int J Pancreatol. 1998 Jun;23(3):181-6. doi: 10.1007/BF02788395.

DOI:10.1007/BF02788395

PMID:9629517

Abstract

CONCLUSION

Based on these data we suggest that regional intra-arterial chemotherapy for advanced pancreatic cancer seems not to be superior to common treatment modalities, such as combined radiochemotherapy.

BACKGROUND

The prognosis for advanced pancreatic cancer is very poor. No standard treatment is available. Recently, better survival and quality of life was reported from regional cancer treatment via celiac axis infusion. In an attempt to confirm these results we conducted a phase II study of intra-arterial chemotherapy for nonresectable pancreatic cancer.

METHODS

From May 1994 to February 1995, 12 consecutive patients with biopsy-proven advanced ductal carcinoma of the exocrine pancreas were given intra-arterial infusions consisting of Mitoxantrone, 5-FU + folinic acid, and Cisplatin via a transfemorally placed catheter in the celiac axis. Six patients were classified as UICC stage III and six as stage IV with the liver as the sole site of distant metastasis. Nine patients had primary and three had recurrent pancreatic carcinoma after a Whipple procedure. Nonresectability of primary tumors was assessed in all patients by laparotomy or laparoscopy.

RESULTS

A total of 31 cycles of chemotherapy (mean 2.6 cycles/patient) was administered. Catheter placement was technically feasible in all cycles. A groin hematoma was the only catheter complication. The follow-up by CT scans at 2-mo intervals revealed partial remission in 1 patient (8%), temporary stable disease in 4 patients (33%), and disease progression in 7 patients (58%). The same response was obtained after analyzing the CA 19-9 course. Median survival in stage III patients was 8.5 mo (3-12 mo) and in stage IV patients 5 mo (2-11 mo). Toxicity according to WHO criteria consisted of grade III (4 events), grade II (10 events), and grade I (17 events), mainly resulting from leucopenia and diarrhea/vomiting. Nine of 11 patients experienced temporary relief of pain immediately after regional treatment.

摘要

结论

基于这些数据，我们认为晚期胰腺癌的区域动脉内化疗似乎并不优于联合放化疗等常规治疗方式。

背景

晚期胰腺癌的预后非常差。尚无标准治疗方法。最近，通过腹腔动脉灌注进行区域癌症治疗报告了更好的生存率和生活质量。为了证实这些结果，我们进行了一项针对不可切除胰腺癌的动脉内化疗的II期研究。

方法

1994年5月至1995年2月，12例经活检证实为晚期外分泌性胰腺导管癌的连续患者，通过经股动脉放置在腹腔动脉的导管接受由米托蒽醌、5-氟尿嘧啶+亚叶酸和顺铂组成的动脉内灌注。6例患者被分类为国际抗癌联盟（UICC）III期，6例为IV期，以肝脏作为远处转移的唯一部位。9例患者为原发性胰腺癌，3例在Whipple手术后复发。所有患者均通过剖腹手术或腹腔镜检查评估原发性肿瘤的不可切除性。

结果

共进行了31个化疗周期（平均每位患者2.6个周期）。导管放置在技术上在所有周期均可行。腹股沟血肿是唯一的导管并发症。每隔2个月进行CT扫描随访显示，1例患者（8%）部分缓解，4例患者（33%）疾病暂时稳定，7例患者（58%）疾病进展。分析CA 19-9病程后获得了相同的反应。III期患者的中位生存期为8.5个月（3 - 12个月），IV期患者为5个月（2 - 11个月）。根据世界卫生组织（WHO）标准的毒性包括III级（4例）、II级（10例）和I级（17例），主要由白细胞减少和腹泻/呕吐引起。11例患者中有9例在区域治疗后立即经历了疼痛的暂时缓解。