title: Improvement of survival by efficacy orientated sequential polychemotherapy of exocrine pancreatic cancer.
abstract: Results of palliative chemotherapy in 104 patients suffering from exocrine pancreatic carcinomas are presented. First-line therapy included intraarterial approaches with gemcitabine + mitomycin-C and intravenous systemic treatments with gemcitabine, gemcitabine + mitomycin-C and oxaliplatin, respectively. In addition, it was the aim to improve survival by adding second- and third-line chemotherapies, mainly including high dose 5-FU/FA and irinotecan resp. alone or in combinations. Follow-up included clinical investigations, imaging methods and determination of tumor markers. Evaluation of efficacy followed the WHO guidelines. The results indicated the intraarterial locoregional treatment of exocrine pancreatic cancer with a combination of mitomycin-C + gemcitabine as a highly effective treatment modality with PR + CR of 40% measured by imaging methods and 81% analysed by tumor marker determinations. The survival analyses suggested relevant prolongation of survival in relation to the number of effective second- and/or third-line therapies (0/1/> 1) with median survival--based on the imaging data--of 7, 11 and 20 months for Mo tumors and 3, 8 and 14 months for tumor diseases with liver metastases at time of admission, respectively. Relevant preconditions for second- and/or third-line therapies of pancreatic carcinomas are given by more or less effective first-line treatment modalities of this cancer disease on the one hand and by the actual diagnostic aids allowing the beginning of first-line therapy as well as the detection of recurrence early enough to try a second- or third-line therapy before clinical/ethical aspects prevent further antitumoral treatment trials in the individual patient.
authors.affiliation: Internal Medicine, Jerusalem Krankenhaus, Mootkamp 2-8, D-20095 Hamburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Klapdor
authors.forename: C
authors.initials: C
authors.lastname: Müller
authors.forename: R
authors.initials: R
authors.lastname: Seutter
authors.forename: M
authors.initials: M
authors.lastname: Bahlo
authors.forename: W
authors.initials: W
authors.lastname: Peters
authors.forename: C
authors.initials: C
authors.lastname: Fenner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate