Celiac axis infusion and microembolization for advanced stage III/IV pancreatic cancer--a phase II study on 265 cases.

Abstract

BACKGROUND: Despite various chemotherapeutic drugs and combinations given systemically, the impact of these agents on survival has not been convincing, and drug-related toxicity continues to be the limiting factor. PATIENTS AND METHODS: Two hundred and sixty-five patients with locally advanced or metastasizing (UICC III/IV) pancreatic cancer underwent celiac axis infusion with Mitomycin, Mitoxantrone and Cisplatin combined with degradable starch microspheres in 5 courses and 1 course of isolated hypoxic abdominal perfusion and chemofiltration. RESULTS: The study end-points were survival and quality of life. Seventy-five percent survival was 6 months, 50% (median) 9 months and 25% was 18 months. Eighty patients survived for one year and more. The longest actual survival time was ten years in a former unresectable stage IV patient. The quality of life improved in responders. No therapy-related hospitalization or increased morbidity was noted. The resectability rate after therapy in long-term survivors (>12 months) was 39%. Peritoneal carcinosis or progression of liver metastases occurred in 18%. The major cause of death in 48% was recurrence at the primary site. CONCLUSION: In good responders to arterial infusion and microembolization chemotherapy, the resectability rate increased remarkably. Relapses predominantly occurred at the primary site, and progression of distant metastases and peritoneal lesions may be reduced due to isolated abdominal perfusion.