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10.1245/ASO.2003.10.021
Annals of Surgical Oncology 10:927-934 (2003)
© 2003 Society of Surgical Oncology
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ORIGINAL ARTICLES

Intra-Arterial Infusion Chemotherapy With Angiotensin-II for Locally Advanced and Nonresectable Pancreatic Adenocarcinoma: Further Evaluation and Prognostic Implications

Hiroaki Ohigashi, MD, PhD, Osamu Ishikawa, MD, PhD, Shigekazu Yokayama, MD, PhD, Yo Sasaki, MD, PhD, Terumasa Yamada, MD, PhD, Shingi Imaoka, MD, PhD, Akihiko Nakaizumi, MD, PhD and Hiroyuki Uehara, MD, PhD

From the Departments of Surgery (HO, OI, SY, YS, TY, SI) and Internal Medicine (AN, HU), Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

Correspondence: Address correspondence and reprint requests to: Hiroaki Ohigashi, MD, Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka 537-8511, Japan; Fax: 6-6981-8055; E-mail: oohigasi-hi{at}mc.pref.osaka.jp

Background: For locally advanced and nonresectable cancer of the pancreas, we performed intra-arterial infusion chemotherapy with angiotensin-II (AT-II). In our preliminary report, this treatment resulted in a median of 14 months of survival without objective adverse effects. This study was designed to clarify the prognostic factor in this chemotherapy by using a larger number of cases.

Methods: For 32 patients, intra-arterial chemotherapy was performed: 1 or 2 catheters were intraoperatively placed into the pancreas-supplying arteries. The tissue blood flow and its change by AT-II infusion were determined. For intra-arterial chemotherapy, a mixture of methotrexate (50 or 100 mg/m2) and AT-II (.4 µg/kg/hour) was repeatedly infused from the catheter, mainly at our outpatient clinic.

Results: With our intra-arterial chemotherapy, the median survival period was 13 months. The median survival period was 19 months in patients without coexisting pancreatitis but was only 9 months in those with it (P = .0003). The presence or absence of coexisting fibrosis in the neighboring uninvolved pancreas offered the only prognostic indicator. The blood flow in cancerous tissue was increased during AT-II infusion, and this was characteristic in the patients whose neighboring uninvolved pancreas had normal parenchyma (nonatrophic) or higher blood flow before AT-II infusion.

Conclusions: Because the AT-II infusion played a role in shifting the blood flow from the surrounding uninvolved pancreas to the cancer tissues, we can speculate that cancer tissues might have thereby received a higher dose of anticancer drugs if the surrounding uninvolved pancreas had been nonfibrotic and more rich in tissue blood flow.

Key Words: Locally advanced pancreatic cancer • Angiotensin-II • Hemodynamic change • Coexisting pancreatitis • Intra-arterial infusion chemotherapy






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