Abstract Objective To compare the clinical efficacy of arterial infusion chemotherapy and systemic chemotherapy treatment of advanced pancreatic cancer, and to explore the clinical value of selective intra-arterial infusion chemotherapy. Methods 51 patients with advanced pancreatic cancer, of which 25 cases were treated with intra-arterial infusion of gemcitabine and 5 Fu program, 26 patients with peripheral vein infusion of gemcitabine and 5 Fu program. Application of evaluation standards of the World Health Organization Solid Tumors evaluate the efficacy, tumor volume measured by MRI or CT. Clinical benefit response (CBR) to change the situation to make a comprehensive evaluation of pain, physical condition and body weight. WHO anticancer drugs acute and subacute toxicity grading criteria to evaluate the adverse reactions. The results arterial infusion chemotherapy group efficiency (32.0%) than in the peripheral vein chemotherapy group (23.1%), but the difference was not statistically significant. Arterial infusion chemotherapy group clinical benefit rate (80.0%) than in the peripheral vein chemotherapy group (50.0%), there are significant differences. 6 months, 9 months, 1-year cumulative survival rate and median survival time, intra-arterial chemotherapy group than peripheral intravenous chemotherapy group, there are significant differences. Adverse reactions between the two groups of patients according to WHO classification criteria, no significant sex differences. Conclusion arterial infusion gemcitabine to gemcitabine and 5 Fu compared to peripheral venous infusion of gemcitabine and 5 Fu can improve the clinical benefit rate and survival of advanced pancreatic cancer, its safe and reliable method, and adverse reactions.
Key words Radiology Interventional pancreatic tumor clinical benefit rate of reaction survival
Pancreatic cancer is a common digestive tumors, the incidence of all pancreatic malignancies 85% to 95% . Progress in recent years in the treatment of pancreatic cancer is small, the traditional three conventional treatment (surgery, chemotherapy and radiotherapy) the effect of poor treatment of pancreatic cancer, the efficacy of advanced pancreatic cancer is particularly unsatisfactory . January 2000 to March 2005, 51 patients with advanced pancreatic cancer, clinical analysis, and to investigate the clinical efficacy and value of intra-arterial infusion chemotherapy in the treatment of advanced pancreatic cancer.
1 Materials and methods
1.1 General Information
Collected by the pathology and clinical diagnosis of January 2000 to the 2005 March admitted to the 51 cases in advanced pancreatic clinical data, of which 25 cases using arterial continuous infusion gemcitabine He Bin and 5 Fu program, 26 cases of adoption by the outer Week intravenous infusion of gemcitabine and 5 Fu program. UICC staging, clinical stage Ⅲ, Ⅳ period, 21 cases of Ⅲ, Ⅳ of 30 cases. 33 cases the tumor is located in the head of the pancreas, in 13 cases of pancreatic body and tail, and in five cases of total pancreatectomy, no prior surgery or radiotherapy and chemotherapy.
1.2.1 arterial infusion chemotherapy group (experimental group) using the Seldinger technique, celiac artery and superior mesenteric arteriography were performed first observed tumor. According to the site of the tumor, the extent of invasion and the blood supply to determine the target vessel to the tumor feeding arteries and then selective intubation. Adopted by the indwelling catheter infusion of gemcitabine and 5 Fu “program, through the femoral artery was cannulated catheter infusion of 15 cases, placed port-catheter system via the left subclavian artery cannulation infusion of 10 cases. Gemcitabine 1 000mg/m2, 1d medication, arterial infusion 30min every 4 weeks for a course of treatment. The 5 Fu600mg/m2, 1 ~ 5d continuous infusion to maintain 4h, every 4 weeks for a course of treatment. Evaluate the efficacy of two courses of medication.
1.2.2 intravenous chemotherapy group (control group) using peripheral intravenous injection of gemcitabine Bin +5 Fu “program, to gemcitabine 1 000mg/m2, 1,8 d medication peripheral vein to maintain 30min, every 4 weeks for a course of treatment. The 5 Fu600mg/m2, 1 ~ 5d continuous medication, peripheral vein to maintain 4h, every 4 weeks for a course of treatment . Evaluate the efficacy of two courses of medication.
The 1.3.1 objective efficacy of application of the World Health Organization (WHO) objective evaluation of the efficacy of solid tumor evaluation standard, the tumor volume measured by MRI or CT . Complete remission (Complete response, CR): to be seen visually, the tumors disappeared completely, and maintained at least more than 4 weeks; partial response (Partial response, PR): tumor volume was reduced by 50% or more, and maintained for 4 weeks or more; stability (Stable disease , SD): tumor volume decreases or increases less than 25%, and no new lesions; disease progression (Progression disease, PD): tumor volume increased more than 25%, or new lesions.
1.3.2 clinical benefit response clinical benefit response to make a comprehensive evaluation of pain, physical condition and body weight change situation, the criteria for any of the following indicators improved for four weeks or more, do not have any of the worsening defined as clinical benefit : (1) reduce the pain intensity ≥ 50%; (2) analgesic consumption decreased by ≥ 50%; (3) The physical condition standards improve by Karnofsky score ≥ 20 points; (4) If the degree of pain and physical condition stable The non-fluid retention, weight gain ≥ 7%.
1.3.3 Adverse reactions using WHO anticancer drug classification of acute and subacute toxicity grading standards, adverse reactions observed after treatment of patients, MAIN OUTCOME MEASURES including blood system, liver and kidney function and gastrointestinal reactions.
1.3.4 Statistical Methods SPSS13.0 statistical package, χ2 test was used to compare the efficacy, survival analysis, comparison of the survival curves between the two groups by Kaplan Meier method, log rank test. P <0.05 was considered statistically significant.
2.1 Objective response
The Application World Health Organization (WHO) solid tumor efficacy evaluation criteria to evaluate the objective response. Arterial infusion chemotherapy group’s objective is more efficient than peripheral intravenous chemotherapy group, but the difference was not significant (P = 0.475, χ2 test), as shown in Table 1. Objective efficacy comparison of the two groups in Table 1
2.2 clinical benefit response (CBR)
Three indicators based on pain, physical condition and body weight change, the two groups of patients the CBR-standard in clinical beneficiaries were 20, 13 cases, the clinical benefit rate was 80.0% and 50.0%, respectively, peripheral arterial infusion chemotherapy group than intravenous chemotherapy group. The clinical benefit response (CBR) by χ2 test, significant differences, as shown in Table 2. Table 2 Comparison of clinical benefit response (CBR)
Kaplan Meier the calculation 6 months, 9 months, 1-year cumulative survival rate and median survival time arterial infusion chemotherapy group than in peripheral intravenous chemotherapy group, log rank test the difference between the two groups was significant ( P = 0.002), see Table 3, Figure 1. Survival rate between the two groups in Table 3
2.4 Adverse reactions
According to WHO classification criteria, the two groups of patients were not Ⅳ degree adverse treatment-related death, major adverse hematologic toxicity and I ~~ II degree of liver dysfunction. The χ2 test statistical analysis of adverse reactions between the two groups of patients with no significant sex difference (P> 0.05, χ2 test), are shown in Table 4. Two groups in Table 4 adverse reactions comparing 25 cases of arterial infusion chemotherapy, only 1 case of indwelling catheters shift appears no other complications.
In recent years, has been widely reported in the literature pancreatic regional arterial infusion chemotherapy for experimental and clinical applications. Aigner et al  reported that in advanced pancreatic cancer regional infusion chemotherapy and systemic chemotherapy randomized controlled trials, the PRAC group median survival of 33 weeks, and systemic intravenous chemotherapy for 11 weeks, the efficacy of cancer chemotherapy is proportional to the effective concentration of the drug and duration. , Fude Liang et al  experimental studies to prove the drug concentration in the target organ pancreas regional perfusion with intravenous chemotherapy several times, and surrounding tissue of the pancreas can produce significant inflammatory response.
Arterial infusion chemotherapy in advanced pancreatic cancer only see the individual reports. Homma et al  reported that ultra-selective intubation micro-coil block part of the pancreatic blood flow, hemodynamic, and then change the pancreas indwelling catheter in the splenic artery and (or) the hepatic artery (liver metastasis) The other end of the catheter is connected chemotherapy pump after chemotherapy pump infusion chemotherapy.
Compare the clinical efficacy of intra-arterial chemotherapy and peripheral intravenous chemotherapy research at home and abroad is relatively rare, the results are inconsistent. In this study, arterial infusion of gemcitabine and 5 Fu, treated 25 patients with advanced pancreatic cancer, objective response rate, clinical benefit rate and survival period were higher by χ2 test, in addition to objective response rate, and other indicators There was a significant difference. We believe that, proportional to tumor efficacy of the chemotherapy drug concentration and duration, as opposed to the one-time impact of systemic chemotherapy and transcatheter arterial infusion chemotherapy, arterial infusion chemotherapy prolong tumor localized high concentrations of chemotherapy drugs duration of action, so that chemotherapy The continuing role of drugs in very high concentrations in a longer period of time in the tumor tissue, thereby improving clinical benefit rate and survival of advanced pancreatic cancer, but still can not believe that arterial infusion chemotherapy in advanced pancreatic can improve objective response.
Arterial infusion chemotherapy is a minimally invasive the interventional treatment technology, safe and reliable, feasibility, but also there are some complications reported in the literature. The group 1 cases indwelling tube shift, and other complications. Thus, selective arterial infusion chemotherapy in the treatment of advanced pancreatic feasibility, the operation is relatively simple, safe and reliable method worthy of clinical application.