A novel arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization
A novel arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization
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DOI：
10.1002/1097-0142(20000715)89:2
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发表时间：
2000-07-15
期刊：
影响因子：
6.2
通讯作者：
Niitsu, Y
中科院分区：
文献类型：
--
作者：
Homma, H;Doi, T;Niitsu, Y
背景资料。美国癌症联合委员会TV期晚期胰腺癌的患者已经接受了全身化疗、动脉内化疗、放射治疗和综合使用这些疗法的多学科治疗。然而，结果并不总是令人满意。本文介绍了一种新的治疗晚期胰腺癌的化疗方法和结果。方法：为了限制进入胰腺的血流(主要流向胰腺大动脉和胰尾动脉)，超选择性地用微弹簧圈栓塞胰周血管。31例晚期胰腺癌患者，在治疗原发肿瘤时，动脉化疗的导管尖端放置在胰腺大动脉分支近端的脾动脉，对于转移性肝肿瘤，导管尖端放置在肝总动脉。结果31例晚期胰腺癌患者中，23例(74%)接受了血流动力学改变和动脉化疗，有效率为73.9%(完全缓解率为8.7%，部分缓解率为65.2%)，平均生存期为18.26±10.06个月。术后1、2、3年生存率分别为90.9%、42.8%、18.3%，平均生存期19.0个月。其中肝转移组16例，有效率68.8%，平均生存期16.25±8.35个月；无肝转移组7例，有效率87.5%，平均生存期22.86±12.69个月。结论。在IV期晚期胰腺癌患者中，血流动力学改变后的动脉灌注化疗对原发肿瘤和转移性肝脏病变均有效。作者认为，即使在晚期胰腺癌患者中，只要有供血管分布的血管存在，也应该尝试本研究中提出的治疗方法。(C)2000年美国癌症协会。
BACKGROUND. Patients with American Joint Committee on Cancer Stage TV advanced pancreatic carcinoma have been treated by systemic chemotherapy, intraarterial chemotherapy, radiation therapy, and multidisciplinary treatment using a combination of these. However, the outcome has not always been satisfactory. In the current study the authors describe the method and results of a new chemotherapy for advanced pancreatic carcinoma.METHODS. To restrict the blood flow into the pancreas (mainly to the great pancreatic artery and the caudal pancreatic artery), the peripancreatic blood vessels were embolized superselectively with microcoils. In 31 patients with advanced pancreatic carcinoma, the catheter tip for the arterial infusion chemotherapy was placed in the splenic artery just proximal to the branching of the great pancreatic artery when the treatment was given for primary tumors, and in the common hepatic artery when the treatment was given for a metastatic liver lesion. The other end of the catheter was connected to an implanted injection port embedded in the femoral region, and 5-fluorouracil and cisplatin were administered by continuous arterial infusion.RESULTS. Of the 31 patients with advanced pancreatic carcinoma, 23 (74%) underwent hemodynamic change and arterial infusion chemotherapy, with a response rate of 73.9% (complete response rate of 8.7% and a partial response rate of65.2%) and a mean survival period of 18.26 +/- 10.06 months. The I-year, 2-year, and 3-year survival rates were 90.9%, 42.8%, and 18.3%, respectively, with a mean survival period of 19.0 months. Of these 23 patients, the 16 patients with liver metastases had a response rate of 68.8% and a mean survival period of 16.25 +/- 8.35 months, whereas the 7 patients without liver metastases had a response rate of 87.5% and a mean survival period of 22.86 +/- 12.69 months. CONCLUSIONS. In patients with Stage IV advanced pancreatic carcinoma, arterial infusion chemotherapy after hemodynamic change was found to be effective against both primary tumors and metastatic liver lesions. The authors believe that the treatment presented in the current study should be attempted, even in patients with advanced pancreatic carcinoma, as long as the blood vessels for vascular supply distribution exist. (C) 2000 American Cancer Society.