Intraoperative hyperthermia and chemoradiotherapy for inoperable pancreatic carcinoma |
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| Authors: | Kouloulias V E Nikita K S Kouvaris J R Golematis B C Uzunoglu N K Mystakidou K Vlahos L J |
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| Affiliation: | University of Athens, Medical School, Aretaieion Hospital, Department of Radiotherapy, Athens, Greece, and Institute of Communication and Computer Systems, Department of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece,; Institute of Communication and Computer Systems, Department of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece, and 1st Department of Propaedeutic Surgery, Medical School, University of Athens, Hippocration Hospital, Athens, Greece;, University of Athens, Medical School, Aretaieion Hospital, Department of Radiotherapy, Athens, Greece;, First Department of Propaedeutic Surgery, Medical School, University of Athens, Hippocration Hospital, Athens, Greece;, Institute of Communication and Computer Systems, Department of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece;, University of Athens, Medical School, Aretaieion Hospital, Department of Radiotherapy, Athens, Greece;, University of Athens, Medical School, Aretaieion Hospital, Department of Radiotherapy, Athens, Greece |
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| Abstract: | The aim of this study was to evaluate the tolerability and the possible clinical benefit of intraoperative hyperthermia combined with multischedule chemotherapy and bypass surgery for the palliative treatment of inoperable pancreatic cancer. Ten patients with unresectable adenocarcinoma of the pancreas received preoperative chemotherapy [5-fluorouracil (5-FU)], bypass surgery and postoperative chemotherapy (5-FU, doxorubicin and cisplatin) plus sandostatin and radiotherapy (45 Gy, 25 fractions, 5 days a week). A single session of intraoperative hyperthermia was performed, by using a waveguide-type applicator (433 MHz). The tumour region was heated to 43-45 degrees C for up to 60 min, while 500 mg 5-FU was infused simultaneously through the gastroduodenal into the splenic artery. Postoperative recovery was uneventful for all patients. A brief instrument was developed for evaluating patients' quality of life. Chemotherapy-related toxicity included myelosuppression, vomiting, alopecia and increase in blood urea nitrogen (BUN), creatinine, SGOT and SGPT. Glucose and amylase determinations remained within normal limits throughout the whole treatment. There was a significant improvement before and 1 month after combined treatment in Eastern Cooperative Oncology Group (ECOG) status (1.8 +/- 0.4), Scott-Huskinsson pain scale (3.2 +/- 0.8) and quality of life score (30.5 +/- 6.7). No progressive disease was noticed and the median overall survival was 11 (SE = 2.4) months. There was also a significant (P = 0.002, Wilcoxon test) decrease in values of both serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9), from 7.6 +/- 1.3 ng/mL and 875.7 +/- 104.8 U/mL to 3.5 +/- 0.7 ng/mL and 65.3 +/- 14.1 U/mL respectively. The first clinical results suggest a potential advantage of using combined intraoperative hyperthermia, chemotherapy and postoperative radiotherapy in the palliative treatment of the adenocarcinoma of the pancreas. The whole procedure seems to be free of perioperative morbidity, while the chemotherapy toxicity was rather moderate. However, the preliminary nature limits the general applicability of our results. |
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| Keywords: | pancreatic cancer intraoperative hyperthermia chemotherapy radiotherapy palliation quality of life |
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