Regional Celiac Artery Infusion as Adjuvant Treatment after Pancreatic Cancer Resection

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Abstract
The dismal course of pancreatic adenocarcinoma patients after resection is determined by the biology of the disease preventing R-0 resections. In the spontaneous course after resection, patients frequently develop either local recurrences, liver metastases and/or peritoneal metastases. Postoperative radiochemotherapy may extend survival and reduce local recurrences without influence on hepatic progression. We performed adjuvant celiac artery infusion in pancreatic cancer, to find out whether this treatment prolongs survival and changes the biology of the disease after resection, especially by reducing liver metastasis. 20 patients received cyclic celiac artery infusions (CAI) after resection of their pancreatic cancer (18 ductal, 2 cystadenocarcinoma). The treatment consisted of 6 cycles intraarterial infusion using Seldinger's technique with mitoxantrone (Novantron, Wyeth-Lederle, Germany) 10 mg/m2 dl, 5-fluorouracil + folinic acid (Fluroblastin, Farmitalia, Germany + Leucovorin, Wyeth-Lederle) 600 mg/m2 + 170 mg/m2 d2-4, and cis-platinum (Cisplatin, Bristol, München, Germany) 60 mg/m2 d5. The patients were monitored for toxicity, development of disease progression and survival. The median survival time was 21 months, and only 15% of the patients developed liver metastases. The median survival time of the CAI-treated patient group compared favorably to the median survival of 9.3 months in a matched historical control group. Adjuvant celiac artery infusion seemed to prolong median survival and the occurrence of liver metastases appeared to be delayed or reduced.

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