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Arterial Infusion of 5-Fluorouracil Combined with Concurrent Radiotherapy for Unresectable Pancreatic Cancer: Results from a Pilot Study

Toshihiro Tanaka1, Hiroshi Sakaguchi1, Hiroshi Anai1, Kiyosei Yamamoto1, Kengo Morimoto1, Tetsuro Tamamoto2 and Kimihiko Kichikawa1

1 Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Japan.
2 Department of Radiation Oncology, Nara Medical University, Kashihara, Japan.


Figure 1
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  		Fig. 1 —Schematic diagram shows desired catheter position and occluded vessels for pancreatic and hepatic infusion chemotherapy. One catheter tip is located in splenic artery (SPA), and side hole through which 5-fluorouracil is infused by way of port is positioned at celiac artery (CA). Other catheter tip is located at jejunal artery (JA), with side hole positioned at superior mesenteric artery (SMA). Left gastric artery (LGA), right gastric artery (RGA), and right gastroepiploic artery (RGEPA) are embolized with metallic coils. PHA = proper hepatic artery, GDA = gastroduodenal artery, DPA = dorsal pancreatic artery, IPDA = inferior pancreaticoduodenal artery.

 

Figure 2
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  		Fig. 2A —67-year-old woman with locally advanced pancreatic head cancer (stage III). Therapy involves using double catheters for arterial infusion chemotherapy (case 1). IV contrast-enhanced CT image obtained before treatment shows invasive hypovascular tumor (arrow) of pancreatic head.

 

Figure 3
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  		Fig. 2B —67-year-old woman with locally advanced pancreatic head cancer (stage III). Therapy involves using double catheters for arterial infusion chemotherapy (case 1). Arteriogram obtained via indwelling catheter in celiac artery shows catheter tip was inserted into splenic artery (arrow) and side hole was positioned in celiac artery (arrowhead). Right epiploic artery was embolized with metallic coils to prevent gastric mucositis due to drug distribution into stomach. Splenic artery was embolized to increase drug concentration in pancreas and liver.

 

Figure 4
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  		Fig. 2C —67-year-old woman with locally advanced pancreatic head cancer (stage III). Therapy involves using double catheters for arterial infusion chemotherapy (case 1). Arteriogram obtained via indwelling catheter in superior mesenteric artery shows catheter tip was inserted into jejunal artery (arrow) and side hole was positioned in superior mesenteric artery (arrowhead).

 

Figure 5
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  		Fig. 2D —67-year-old woman with locally advanced pancreatic head cancer (stage III). Therapy involves using double catheters for arterial infusion chemotherapy (case 1). CT image obtained during arterial injection of contrast material via indwelling catheter in celiac artery shows cranial right side of tumor is enhanced (arrow).

 

Figure 6
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  		Fig. 2E —67-year-old woman with locally advanced pancreatic head cancer (stage III). Therapy involves using double catheters for arterial infusion chemotherapy (case 1). CT image obtained during arterial injection of contrast material via indwelling catheter in superior mesenteric artery shows caudal-left side of tumor is enhanced (arrow). Whole tumor is covered by combination of supply from two catheters.

 

Figure 7
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  		Fig. 2F —67-year-old woman with locally advanced pancreatic head cancer (stage III). Therapy involves using double catheters for arterial infusion chemotherapy (case 1). IV contrast-enhanced CT image obtained after arterial infusion combined with radiation therapy shows decrease in size of pancreatic tumor (arrow).

 

Figure 8
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  		Fig. 3A —75-year-old man with locally advanced pancreatic body cancer (stage III). Therapy involves using single catheter for arterial infusion chemotherapy (case 6). IV contrast-enhanced CT image obtained before treatment shows invasive hypovascular tumor (arrow) of pancreatic body. Tumor diameter is small (3.0 cm) and tumor is limited to dorsal portion of pancreatic body, namely area perfused by dorsal pancreatic artery alone.

 

Figure 9
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  		Fig. 3B —75-year-old man with locally advanced pancreatic body cancer (stage III). Therapy involves using single catheter for arterial infusion chemotherapy (case 6). Arteriogram obtained via indwelling catheter in celiac artery shows catheter tip was inserted into splenic artery (arrow) and side hole was positioned in celiac artery (arrowhead). Left gastric, right gastric, and right epiploic arteries were embolized with metallic coils to prevent gastric mucositis due to drug distribution into stomach. Splenic artery was embolized to increase drug concentration in pancreas and liver. Replaced right hepatic artery was embolized to distribute drug to whole liver via left hepatic artery arising from common hepatic artery.

 

Figure 10
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  		Fig. 3C —75-year-old man with locally advanced pancreatic body cancer (stage III). Therapy involves using single catheter for arterial infusion chemotherapy (case 6). CT image obtained during arterial injection of contrast material via indwelling catheter in celiac artery. Whole tumor (arrow) is enhanced.

 

Figure 11
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  		Fig. 3D —75-year-old man with locally advanced pancreatic body cancer (stage III). Therapy involves using single catheter for arterial infusion chemotherapy (case 6). IV contrast-enhanced CT image obtained after arterial infusion combined with radiation therapy shows decrease in size of pancreatic tumor (arrow).

 

Figure 12
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  		Fig. 4 —Kaplan-Meier curve shows overall survival rate in this study.

 

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