Safety and Optimal Management of Hepatic Arterial Infusion Chemotherapy After Pancreatectomy for Pancreatobiliary Cancer

Hashimoto, Aya; Nomura, Hideyuki; Tanaka, Toshihiro; Sho, Masayuki; Anai, Hiroshi; Nakajima, Yoshiyuki; Kichikawa, Kimihiko

doi:10.2214/ajr.11.6751

Cited by 8 publications

(7 citation statements)

References 27 publications

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“…However, timely adjuvant chemotherapy is still essential for patients with high-risk factors or who have already experienced early liver metastasis, and the relevant theoretical evidence will be further studied in our center. Although no standard adjuvant chemotherapy for PDAC has been established, several gemcitabine-based adjuvant therapies have been investigated [ 21 ], and previous studies reported that systemic intra-arterial chemotherapy appeared to be effective against liver metastasis [ 22 , 23 ]. Furthermore, hepatectomy for recurrent PDAC was applied in a German national cancer center and was proven to be safe and beneficial [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Tong

et al. 2022

Gastroenterology Research and Practice

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Background. Liver metastasis arises in many postoperative patients with PDAC, occurring in the early stage appears to lead to a very poor prognosis. Objective. We aimed to analyze the risk factors for early liver metastasis after radical resection for patients with pancreatic ductal adenocarcinoma (PDAC) and to indicate the poor prognosis of early liver metastasis. Methods. Patients who underwent pancreatectomy for PDAC at the Ningbo Medical Centre Lihuili Hospital between January 2015 and June 2021 were included. The exclusion criteria were death within 30 days after the operation, complications with other malignancies, and a positive final resection margin (R1). Liver metastasis and its occurrence time were recorded, and risk factors for early (≤6 months) liver metastasis were analyzed by logistic regression models. The prognosis of patients with early liver metastasis and different recurrence patterns was analyzed by Kaplan–Meier curves and the log-rank test. Results. From the identified cohort of 184 patients, 172 patients were included for further analysis. 55 patients developed early liver metastasis within 6 months after the operation. Univariate analysis showed that CA 125 ≥ 30 IU / ml , tumor size ≥ 4 cm , poor tumor differentiation, and portal vein/superior mesenteric vein (PV/SMV) reconstruction were risk factors, and multivariate analysis showed that poor tumor differentiation and PV/SMV reconstruction were independent risk factors for early liver metastasis. The prognosis of liver metastasis was the worst among the different recurrence patterns. Early liver metastasis indicates a poor prognosis in patients with PDAC. Conclusions. Poor differentiation and PV/SMV reconstruction are independent risk factors for early liver metastasis in patients with PDAC, and early liver metastasis indicates a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Tong

et al. 2022

Gastroenterology Research and Practice

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“…Adjuvant chemotherapy is common, and there are few reports where HAIC was used as a treatment for postoperative liver metastases. Hashimoto et al (11) performed HAIC using 5-FU combined with systemic GEM for liver metastases after pancreatectomy in nine patients. In their report, the overall response and disease control rates were 44.4% and 88.9%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Arterial Infusion Chemotherapy for Liver Metastases Following Standard Chemotherapy for Pancreatic Cancer

et al. 2021

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A 65-year-old man diagnosed with locally advanced pancreatic cancer underwent distal pancreatectomy and combined portal vein resection. One month after surgery, contrast-enhanced magnetic resonance imaging revealed multiple liver metastases. We administered two courses of gemcitabine plus nab-paclitaxel combination therapy followed by 17 modified FOLFIRINOX courses. However, the response was insufficient, and the patient thereafter developed grade 3 neutropenia, which made it difficult to continue the treatment regimen. As a result, we administered hepatic arterial infusion chemotherapy comprising gemcitabine plus 5fluorouracil because the residual tumor was limited to liver metastases. The progression-free survival period was 7 months, and no drug-related adverse effects were noted during the treatment.

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“…Hepatic artery infusion chemotherapy has been used in the adjuvant setting to prevent hepatic recurrence after resection of pancreatic primaries. [41][42][43] Hashimoto et al described use of hepatic artery infusion chemotherapy in nine patients with liver metastases from pancreatic adenocarcinoma and in 42 patients without liver metastasis for prevention of hepatic metastases. 43 Overall, patients received a median of nine courses with a median duration of 89 days.…”

Section: Hepatic Artery Infusionmentioning

confidence: 99%

“…[41][42][43] Hashimoto et al described use of hepatic artery infusion chemotherapy in nine patients with liver metastases from pancreatic adenocarcinoma and in 42 patients without liver metastasis for prevention of hepatic metastases. 43 Overall, patients received a median of nine courses with a median duration of 89 days. Toxicities were hepatic arterial occlusion (2%), hepatic artery stenosis (19.6%), liver abscess or biloma (5.9%), catheter dislocation (5.9%), and wound infection (3.9%).…”

Section: Hepatic Artery Infusionmentioning

confidence: 99%

Making the Case: Intra-arterial Therapy for Less Common Metastases

Gordon

Uddin

Riaz

et al. 2017

Semin intervent Radiol

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Intra-arterial therapies have high antitumor activity for both primary and secondary hepatic malignancies. Selective infusions allow increased delivery of cytoreductive therapy to the tumor bed while sparing the normal hepatic parenchyma. These therapies are now often applied in the outpatient setting or with short overnight hospital stays and have a growing role in the treatment of liver-dominant disease from metastatic colorectal cancer and from neuroendocrine tumors. Less commonly, intra-arterial therapies are applied to treat secondary hepatic malignancies from breast cancer, melanoma, pancreatic adenocarcinoma, and soft-tissue sarcomas. The available data are limited and generally retrospective observational cohort series of single institutions. The purpose of this article is to summarize the recent literature on outcomes for intra-arterial therapy in nonsurgical patients. Multi-institutional registries and prospective data are greatly needed, as intra-arterial therapies are increasingly applied in these patients to stop progression of chemorefractory tumors.

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Safety and Optimal Management of Hepatic Arterial Infusion Chemotherapy After Pancreatectomy for Pancreatobiliary Cancer

Abstract: Our findings suggest that HAI chemotherapy after pancreatectomy is feasible and tolerable, although caution is required particularly after pancreaticoduodenectomy or after total pancreatectomy.

Cited by 8 publications

References 27 publications

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Risk Factors of Early Liver Metastasis for Pancreatic Ductal Adenocarcinoma after Radical Resection

Hepatic Arterial Infusion Chemotherapy for Liver Metastases Following Standard Chemotherapy for Pancreatic Cancer

Making the Case: Intra-arterial Therapy for Less Common Metastases

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