title: [A case of postoperative liver metastasis from pancreatic carcinoma treated with percutaneous isolated hepatic perfusion(PIHP)].
abstract: We report a case of postoperative liver metastasis arising from pancreatic carcinoma treated with a novel procedure that we developed-percutaneous isolated hepatic perfusion (PIHP). A 69-year-old man diagnosed with pancreatic body cancer(pT3, pN0, pStage III) was treated using distal pancreatectomy and adjuvant therapy with gemcitabine(GEM). Six months later, a metastasis to the medial segment of the liver was found using computer tomography(CT). The patient was treated by chemotherapy with S-1, but the liver metastasis grew, and we therefore employed PIHP as the third-line therapy, using 80 mg doxorubicin (DXR) and 62 mg mitomycin C (MMC). Six weeks after PIHP, the tumor marker carbohydrate antigen 19-9( CA19-9) had decreased from 44,469 to 4,268 U/mL, and the carcinoembryonic antigen(CEA) level decreased from 28.8 to 5.4 U/mL. Although the size of the carcinoma remained the same on CT, some cells had liquefied as a result of necrosis. However, the patient died about 1 year after PIHP due to the growth of liver metastasis, peritoneal metastasis, and local recurrence, reflected by a progressively increasing level of tumor marker. In this case, PIHP seemed to be ineffective due to local recurrence and peritoneal metastasis as well as early enlargement of liver metastasis. However, the reduction in tumor marker levels and the observed tumor necrosis, suggest that PIHP is a potentially effective and promising treatment for liver metastasis arising from pancreatic carcinoma.
authors.affiliation: Dept. of Surgery, Kobe University Graduate School of Medicine, Japan.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Toyama
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Shinzeki
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Shirakawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamashita
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Ueno
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Sawa
authors.forename: Izuru
authors.initials: I
authors.lastname: Otsubo
authors.forename: Sae
authors.initials: S
authors.lastname: Murakami
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation / Q000379:methods*; D004317:Doxorubicin / Q000008:administration & dosage; D004338:Drug Combinations; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D010094:Oxonic Acid / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D004317:Doxorubicin