A new method of intra-arterial regional chemotherapy with more selective drug delivery for locally advanced pancreatic cancer.

ABSTRACT

BACKGROUND/AIMS: In order to deliver the anti-cancer drugs more selectively into the cancer tissues, we have developed a new method of intra-arterial regional chemotherapy for locally unresectable cancer of the exocrine pancreas. MATERIALS AND METHODS: This method involved placing the catheters selectively into the splenic artery and/or into the gastroduodenal artery during laparotomy. Postoperatively, via the catheter, we infused 50-100 mg of Methotrexate mixed with 10 micrograms of Angiotensin-II with an intent of increasing the blood flow in the tumor tissue but decreasing that to the non-tumor tissues. Simultaneously, a bolus iv-infusion of 5-fluorouracil (5-Fu, 500 mg) was performed. One day after each chemotherapy, citrovorum factor (Leucovorin, 30mg) was given per orally, For 15 patients with locally non-resectable pancreatic cancer, this treatment was repeated weekly or biweekly at our out-patient clinic. RESULTS: As a result, the toxicity was so slight that all patients could tolerate this treatment as long as the catheter was patent (11 +/- 8 postoperative months). The survival period was 16 +/- 9 months (range 5-36 months; median 14 months), and one-, two- and three- year survival rates were 60%, 23% and 11%, respectively. Patients could take care of themselves within 12 +/- 9 months, and either complete (50%) or partial (50%) pain-relief was obtained among the 12 patients with severe pain. Only one patient experienced local tumor regression during the chemotherapy, and the incidence of liver metastasis was as low as 13%. CONCLUSIONS: Comparing with the previously reported data in the traditional chemo- and/or radio-therapies, we consider that our method of intra-arterial chemotherapy is quite useful not only for the prolongation of patient's survival but also for improving the quality of life. Thus, this new treatment seems worthy of entering into the prospective randomized study.