title: Unresectable pancreatic cancer: arterial embolization to achieve a single blood supply for intraarterial infusion of 5-fluorouracil and full-dose IV gemcitabine.
abstract: OBJECTIVE
  Response rates to systemic chemotherapy for unresectable pancreatic cancer are low. The purposes of this phases 1 and 2 study of intraarterial therapy were to ascertain the recommended dose of intraarterial chemoinfusion and to evaluate the efficacy and safety of this therapy.
  
  
  METHODS
  Pancreatic arteries originating from the superior mesenteric artery (the anterior and posterior inferior pancreaticoduodenal and the dorsal pancreatic) were embolized to achieve a single blood supply from the celiac artery to manage pancreatic cancer, and a catheter-port system was placed. Intraarterial 5-fluorouracil (5-FU) and IV gemcitabine (fixed dose of 1000 mg/m(2)) were administered. In phase 1, doses of 5-FU were increased from 750 to 1000 mg/m(2). In phase 2, tumor response, toxicity, and survival time were assessed.
  
  
  RESULTS
  A total of 20 patients were enrolled. In 19 patients (95%), the technique to unify the pancreatic blood supply was successful. No severe toxicity was observed with escalation of the 5-FU dose. The tumor response rate was 68.8%. The median overall survival time was 9.8 months and the progression-free survival time, 6.0 months. The grade 3 toxicities neutropenia (15.8%) and thrombocytopenia (5.3%) occurred.
  
  
  CONCLUSIONS
  In intraarterial administration of 5-FU at a dose of 1000 mg/m(2) combined with full-dose systemic gemcitabine for unresectable pancreatic cancer, the toxicity rate was acceptable, and response rate and survival time improved over those for treatment with gemcitabine alone.
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara, Japan. toshihir@bf6.so-net.ne.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nishiofuku
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Inaba
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D003287:Contrast Media; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015641:Radiography, Interventional; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003287:Contrast Media; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine