Influence of perioperative intraarterial selective chemotherapy on terms of recurrent ductal adenocarcinoma of the pancreatic head after pancreaticoduodenectomy

Aim. To analyze influence of perioperative intra-arterial selective chemotherapy on terms of recurrent ductal adenocarcinoma of pancreatic head after pancreaticoduodenectomy.

Material and methods. 111 patients underwent combined treatment. Surgical stage included conventional pylorussparing pancreaticoduodenectomy in all groups. The main group consisted of 52 patients who received combined treatment: neoadjuvant chemoembolization with gemcitabine (400 mg/m2) and oxaliplatin (50 mg/m2), surgical treatment and 6 courses of regional chemotherapy – infusion of gemcitabine (800 mg/m2) and oxaliplatin (45 mg/m2) into celiac trunk in adjuvant mode. The control group was presented by 59 patients who underwent perioperative regional chemotherapy (neoadjuvant chemoembolization and adjuvant infusion of gemcitabine (800 mg/m2). Progression-free survival (PFS) and terms of recurrence were analyzed in all groups. In case of progression and recurrence we applied regional chemotherapy alone. Systemic chemotherapy was not used in the study.

Results. Annual PFS in the main and the control groups was 80%. Three-year PFS in the main group was 37%, in the control group – 14% (p < 0.01). Five-year PFS was 11% in the main group and absent in the control group. Median survival was 26 months in the main group and 22.6 months in the control group. Overall annual, 2-year and 5-year survival in main group was 80%, 57% and 15%, respectively.

Conclusion. Regional intra-arterial chemotherapy decreases incidence of recurrences and improves PFS after surgical treatment of pancreatic head adenocarcinoma.Further multi-center studies are necessary to assess the effectiveness of regional chemotherapy.

1. Sostoyanie onkologicheskoj pomoshchi naseleniyu Rossii v 2014 godu [The state of oncological care for the population of Russia in 2014]. Ed. Caprin A.D., Starinsky V.V., Petrova G.V. Moscow: MNIOI named after P.A. Herzen branch of FGBU “NIIRTs” of the Ministry of Health of Russia, 2015. 236 p. (In Russian)

2. Cameron J., He J. Two thousand consecutive pancreaticoduodenectomies. J. Am. Coll. Surg. 2015; 220 (4): 530–536. DOI: 10.1016/j.jamcollsurg.2014.12.031.

3. Kim S., Itchins M., Arena J., Chris N., Nick P., Clarke S., Gill A., Samra J., Mittal A. Paterns and determinants of reccurence of pancreatic ductal adenocarcinoma after resection. Pancreas (Online). 2017; 18 (6): 458–464.

4. Groot V., Rezaee N., Wu W., Cameron J., Fishman E., Hruban R., Weiss M., Zheng L., Wolfgang C., He J. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann. Surg. 2018; 267 (5): 936–945. DOI: 10.1097/SLA.0000000000002234.

5. Patyutko Yu.I., Kotel'nikov A.G., Jastrebova E.V., Proskurjakov I.S., Ponomarenko A.A., Kudashkin N.E., Moroz E.A., Polikarpova S.B. Surgery for ductal pancreatic cancer. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2017; 22 (4): 18–30. (In Russian). DOI: 10.16931/1995-5464.2017418-30.

6. Jian-Bo X., Bin J., Ya C., Qi F., Jian-Huai Z., Hang Y. Optimal adjuvant chemotherapy for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Oncotarget. 2017; 8 (46): 81419–81429. DOI: 10.18632/oncotarget.19082.

7. Granov D.A., Polikarpov A.A., Pavlovskiy A.V., Moiseenko V.E., Popov S.A. Evaluation of the safety of intraarterial chemotherapy with gemcitabine and oxaliplatin in combined treatment of pancreatic head adenocarcinoma. Annaly khirurg icheskoy gepatologii = Annals of HPB surgery. 2017; 22 (2): 54–59. (In Russian) DOI: 10.16931/1995-5464.2017254-59.

8. Pavlovskij A.V., Polikarpov A.A., Moiseenko V.E., Popov S.A., Statsenko A.A., Granov D.A. Long-term results of combined treatment of ductal adenocarcinoma of the pancreatic head using perioperative intraarterial chemotherapy with gemcitabine and oxaliplatin. Voprosy oncologii. 2018; 64 (1): 116–120. (In Russian)

9. Wolfgang C., Herman J., Laheru D., Klein A., Erdek M., Fishman E., Hruban R. Recent progress in pancreatic cancer. CA Cancer J. Clin. 2013; 63 (5): 318–348. DOI: 10.3322/caac.21190.

10. Granov D.A., Pavlovsky A.V., Shapoval S.V., Popov S.A., Gulo A.S. Neoadjuvant arterial oil chemoembolization and celiac axis chemoinfusion following curative resection of pancreatic carcinoma. Preliminary results. Hepato-gastroenterol. 2007; 57: A62. P. 27.

11. Tanaka T., Sho M., Nishiofuku H., Sakaguchi H., Inaba Y., Nakajima Y., Kichikawa K. Unresectable pancreatic cancer: arterial embolization to achieve a single blood supply for intraarterial infusion of 5-fluorouracil and full-dose IV gemcitabine. Am. J. Roentgenol. 2012; 198 (6): 1445–1452. DOI: 10.2214/AJR.11.8008.

12. Sperti C., Pasquali C., Piccoli A., Pedrazzolli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J. Surg. 1997; 21 (2): 195–200.

13. Bakens J., van der Geest G., van Putten M., van Laarhoven W., Creemers J., Besselink G., Lemmens E., de Hingh I. The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population-based analysis. Cancer Med. 2016; 5 (10): 2825–2831. DOI: 10.1002/cam4.921.

14. Granov D.A., Pavlovskij A.V., Suvorova Ju.V., Gulo A.S., Popov S.A., Shapoval S.V., Tlostanova M.S. Neoadjuvant intraarterial oil chemoembolization and adjuvant regional chemoinfusion in combined treatment of pancreatic cancer. Voprosi oncologii. 2008; 15 (4): 501–503. (In Russian)