Selective transarterial infusion chemotherapy for advanced pancreatic cancer

本研究对22例不能切除的晚期胰腺癌患者行选择性经动脉输注化疗。经动脉输注化疗技术方面，11例患者采用胰周动脉亚选择性注射（亚选择性注射组），其余患者采用选择性注射（选择性注射组）。术后立即用CT评估抗癌药物潴留。在术后1个月和3个月通过CT评估治疗效果。9例患者在超过30%的肿瘤区域观察到抗癌药物的密集滞留。随访1个月CT示低密度区，13例为坏死灶。这些坏死区域在亚选择性注射组多见，与抗癌药物密集滞留区显著相关。总中位生存期为7个月，1年生存率为21.9%。9例术后立即观察到致密造影剂潴留的患者预后较好：中位生存期为9.9个月，1年生存率为42%。经动脉输注化疗前CT显示腹膜播散也显著影响预后。其他因素，包括肝转移或淋巴结转移与生存期无统计学相关性。虽然需要更多患者的进一步研究，但亚选择性经动脉输注化疗治疗晚期胰腺癌可导致部分患者肿瘤坏死，延长生存期。

Twenty-two patients with unresectable advanced pancreatic cancer were treated by selective transarterial infusion chemotherapy during this research period. Regarding the technique of the transarterial infusion chemotherapy, 11 patients were treated by subselective injection from peripancreatic arteries (subselective injection group) and others were treated by selective injection (selective injection group). Retention of anti-cancer drug was assessed by CT immediately after the procedure. Effect of this treatment was evaluated by CT at 1 month and 3 months after the procedure. Dense retention of the anti-cancer drug in areas over 30 % of the tumor was observed in 9 patients. CT obtained at one month follow-up showed low density area corresponding to necrosis in 13 patients. These necrotic areas, which were frequently observed in subselective injection group, were significantly correlated with the areas with dense retention of anti-cancer drugs. Overall median survival period was 7 months and 1-year survival rate was 21.9 %. Nine patients in whom dense contrast retention was observed immediately after the procedure, showed better prognosis : 9.9 months for median survival period and 42 % for 1-year survival rate. The presence of peritoneal dissemination on CT before the treatment of transarterial infusion chemotherapy also affected the prognosis significantly. No other factors, including liver metastasis or lymph nodes metastasis were statistically correlated with the survival period. Although further study including larger number of patients is needed, subselective transarterial infusion chemotherapy for advanced pancreatic cancer can lead the tumor necrosis and prolonged survival in selected patients.