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Rofo 2003; 175(5): 695-704
DOI: 10.1055/s-2003-39212
Interventionelle Radiologie
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Transarterielle Chemoperfusion des inoperablen Pankreaskarzinoms und Lokalrezidivs

Transarterial Chemoperfusion of Inoperable Pancreas Carcinoma and Local RecurrenceT.  J.  Vogl1 , M.  Heller1 , S.  Zangos1 , W.  Schwarz1 , K.  Eichler1 , M.  G.  Mack1 , D.  Berger2 , J.  O.  Balzer1
  • 1Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität Frankfurt
  • 2Klinik für Viszeral-, Gefäß- und Kinderchirurgie, Stadtklinik Baden Baden
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Publication History

Publication Date:
13 May 2003 (online)

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Zusammenfassung

Ziel: Evaluation der Wertigkeit einer lokoregionalen intraarteriellen Chemotherapie mittels eines selektiv in den Truncus coeliacus plazierten Katheters bei primär inoperablen Pankreaskarzinomen und Lokalrezidiven. Material und Methodik: Im Zeitraum von Oktober 2001 bis August 2002 wurden bei 16 Patienten 80 ambulante transarterielle Chemoperfusionen durchgeführt, im Mittel pro Patient 5 Behandlungen in 4-wöchigen Intervallen. Für die Chemoperfusion wurde eine Kombination aus Mitomycin C (8,5 mg/m2) und Gemcitabine (500 mg/m2) verwendet, die innerhalb von 60 Minuten infundiert wurde. Zusätzlich erfolgte eine Evaluation der Lebensqualität mittels Fragebogen und bildgebende Evaluierung des Tumorresponse mittels CT und MRT. Ergebnisse: Die transarterielle Chemoperfusion konnte in allen Fällen erfolgreich durchgeführt werden. 68,75 % der Patienten (n = 11) berichteten über eine gute Lebensqualität ohne Einschränkungen im täglichen Leben. Die Nebenwirkungen waren moderat und zwischen den Behandlungszyklen reversibel. 50 % der Patienten (n = 8) zeigten eine Tumorvolumenreduktion bis zu 20 %. Bei 25 % (n = 4) der Patienten konnte ein „stable disease” erreicht werden. 25 % der Patienten (n = 4) zeigten einen Progress der Metastasierung bei „stable disease” des Primärherdes. Nach einem Jahr leben noch 25 % der Patienten. Schlussfolgerungen: Die transarterielle Chemoperfusion stellt ein minimal invasives, nebenwirkungsarmes und ambulant einsetzbares Verfahren zur Therapie von inoperablen Pankreastumoren und Lokalrezidiven im Rahmen eines potenziell neoadjuvanten Einsatzes für operative Verfahren und als palliatives Verfahren zu einer Verbesserung des klinischen Benefits und der Lebensqualität des Patienten dar.

Abstract

Background: To evaluate the side effects and tumor response of a locoregional transarterial chemoperfusion with Mitomycin C and Gemcitabine in advanced pancreatic cancer. Materials and Methods: Between October 2001 and August 2002, 16 patients were treated in 80 transarterial chemoperfusion sessions with a mean of 5 sessions per patient and a pause of 4 weeks between the sessions. The chemotherapy consisted of a combination of Mitomycin C (8.5 mg/m2) and Gemcitabine (500 mg/m2), administered within 1 hour. The tumor response was evaluated by MRT and CT and the quality of life by a patient questionnaire. Results: All patients tolerated the procedure well. The therapeutic outcomes were as follows: in 50 % (n=8) of patients, minor response with a decrease in size of the primary tumor and metastases up to 20 %; in 25 % (n = 4) of patients, stable disease; and in 25 % (n = 4) of patients, progressing metastases with stable primary tumor. Eleven patients (68.75 %) reported a good quality of life without impaired performance of their daily activities. Side effects were moderate and reversible between the treatment cycles. After one year 25 % of the patients were still alive. Conclusion: Transarterial chemoperfusion is a minimally invasive treatment for pancreatic carcinomas and local recurrences with little side-effects and can be delivered on an outpatient basis. It might be indicated as potential neoadjuvant treatment before surgery or as palliative treatment to provide clinical benefits and to improve the quality of life.

Key words

Pancreatic carcinoma - transarterial locoregional chemoperfusion - Mitomycin C - Gemcitabine

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Prof. Dr. med. Thomas J. Vogl

Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität Frankfurt

Theodor-Stern-Kai 7

60590 Frankfurt

Phone: + 49-69-6301-7277

Fax: + 49-69-6301-7258

Email: T.Vogl@em.uni-frankfurt.de