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CardioVascular and Interventional Radiology

, Volume 30, Issue 5, pp 912–921 | Cite as

Comparison of Intrahepatic and Pancreatic Perfusion on Fusion Images Using a Combined SPECT/CT System and Assessment of Efficacy of Combined Continuous Arterial Infusion and Systemic Chemotherapy in Advanced Pancreatic Carcinoma

  • Osama IkedaEmail author
  • Yoshitaka Tamura
  • Yutaka Nakasone
  • Shinya Shiraishi
  • Kouichi Kawanaka
  • Seiji Tomiguchi
  • Yasuyuki Yamashita
  • Hiroshi Takamori
  • Keiichiro Kanemitsu
  • Hideo Baba
Clinical Investigation

Abstract

Purpose

The purpose of this study was to compare intrahepatic and pancreatic perfusion on fusion images using a combined single-photon emission computed tomography (SPECT)/CT system and to evaluate the efficacy of combined continuous transcatheter arterial infusion (CTAI) and systemic chemotherapy in the treatment of advanced pancreatic carcinoma.

Materials and Methods

CTAI was performed in 33 patients (22 men, 11 women; age range, 35–77 years; mean age, 60 years) with stage IV pancreatic cancer with liver metastasis. The reservoir was transcutaneously implanted with the help of angiography. The systemic administration of gemcitabine was combined with the infusion of 5-fluorouracil via the reservoir. In all patients we obtained fusion images using a combined SPECT/CT system. Pancreatic perfusion on fusion images was classified as perfusion presence or as perfusion absent in the pancreatic cancer. Using WHO criteria we recorded the tumor response after 3 months on multislice helical CT scans. Treatment effects were evaluated based on the pancreatic cancer, liver metastasis, and factors such as intrahepatic and pancreatic perfusion on fusion images. For statistical analysis we used the chi-square test; survival was evaluated by the Kaplan Meier method (log-rank test).

Results

On fusion images, pancreatic and intrahepatic perfusion was recorded as hot spot and as homogeneous distribution, respectively, in 18 patients (55%) and as cold spot and heterogeneous distribution, respectively, in 15 (45%). Patients with hot spot in the pancreatic tumor and homogeneous distribution in the liver manifested better treatment results (< 0.05 and < 0.01, respectively). Patients with hot spot both in the pancreatic cancer and in the liver survived longer than those with cold spot in the pancreatic cancer and heterogeneous distribution in the liver (median ± SD, 16.0 ± 3.7 vs. 8.0 ± 1.4 months; < 0.05).

Conclusions

We conclude that in patients with advanced pancreatic cancer, CTAI with systemic chemotherapy appeared to be effective and may prolong their survival. The development of a reservoir port system allowing for the homogeneous distribution of anticancer drugs is necessary to improve the prognosis of patients with advanced pancreatic cancer.

Keywords

Fusion image Pancreatic carcinoma Reservoir 

References

  1. 1.
    Zimmerman SE, Smith FP, Scein PS (1981) Chemotherapy of pancreatic carcinoma. Cancer 47:1724–1728PubMedCrossRefGoogle Scholar
  2. 2.
    Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, Miyazaki (1994) Clinical study of the lymphatic flow to pancreatic lymph nodes in carcinoma of the head of the pancreas. Cancer 73:1155–1162PubMedCrossRefGoogle Scholar
  3. 3.
    Hansen R, Quebbeman E, Ritch P, Chitamber C, Anderson T (1988) Continuous 5-FU infusion in carcinoma of the pancreas. Am J Med Sci 295:91–93PubMedCrossRefGoogle Scholar
  4. 4.
    Auerbach M, Wampler GL, Lockich JJ, Fryer D, Fryer JG, Ahlgren JD (1997) Treatment of advanced pancreatic carcinoma with a combination of protracted infusional 5-FU plus weekly cisplatin for pancreatic carcinoma. A Mid Atlantic Oncology Program Study. Ann Oncol 8:439–444PubMedCrossRefGoogle Scholar
  5. 5.
    Carmichael J (1997) Clinical response benefit in patients with advanced pancreatic cancer. Role of gemcitabine. Digestion 58:503–507PubMedGoogle Scholar
  6. 6.
    Rothenberg ML, Moore MJ, Cripps MC, et al. (1996) A phase II trial of gemicitabine in patients with 5-FU refractory pancreas cancer. Ann Oncol 7:347–353PubMedGoogle Scholar
  7. 7.
    Burris HA, Moore MJ, Andersen J, et al. (1997) Improvements in survival and clinical benefits gemicitabine as first-line therapy for patients with advanced pancreatic cancer. J Clin Oncol 15:2403–2413PubMedGoogle Scholar
  8. 8.
    Muchmore JH, Perslan JE, George WJ (1996) Regional chemotherapy for inoperable pancreatic carcinoma. Cancer 78 (Suppl 3):664–667PubMedGoogle Scholar
  9. 9.
    Civelek AC, Sitzmann JV, Chin BB, et al. (1993) Misperfusion of the liver during hepatic artery infusion chemotherapy: value of preoperative angiography and post operative pump scintigraphy. Am J Roentgenol 160:865–870Google Scholar
  10. 10.
    Ikeda O, Kusunoki S, Nakaura T, et al. (2004) Evaluation of fusion imaging using a combined SPECT/CT system; assessment of drug distribution in patients whose catheter was fixed into a branch of the hepatic artery. J Vasc Interv Radiol 19:393–397Google Scholar
  11. 11.
    Seki H, Kimura M, Kamura T, et al. (1996) Hepatic perfusion abnormalities during treatment with hepatic arterial infusion chemotherapy: value of CT arteriography using an implantable port system. J Comput Assist Tomogr 20:343–348PubMedCrossRefGoogle Scholar
  12. 12.
    Morimoto M, Satake M, Sekiguchi R, et al. (1999) Optimal injection protocol for CT evaluation during hepatic arterial infusion chemotherapy. Invest Radiol 34:744–750PubMedCrossRefGoogle Scholar
  13. 13.
    Krausz Y, Keidar Z, Kogant I, et al. (2003) SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours. Clin Endocrinol (Oxf) 59(5):565–573CrossRefGoogle Scholar
  14. 14.
    Even-Sapir E, Lerman H, Lievshitz G, et al. (2003) Lymphoscintigraphy for sentinel node mapping using a hybrid SPECT/CT system. J Nucl Med 44(9):1413–1420PubMedGoogle Scholar
  15. 15.
    Koral KF, Dewaraja Y, Li J, et al. (2003) Update on hybrid conjugate view SPECT tumor dosimetry and response in 131I-tositumomab therapy of previously untreated lymphoma patients. J Nucl Med 44(3):457–464PubMedGoogle Scholar
  16. 16.
    Ikeda O, Kusunoki S, Kudoh K, et al (2006) Evaluation of the efficacy of combined continuous arterial infusion and systemic chemotherapy for the treatment of advanced pancreatic carcinoma. Cardiovasc Interv Radiol 29(3):362–370CrossRefGoogle Scholar
  17. 17.
    Ikeda O, Kusunoki S, Nakaura T, et al (2006) Comparison of fusion imaging using a combined SPECT/CT system and intra-arterial CT: assessment of drug distribution by an implantable port system in patients undergoing hepatic arterial infusion chemotherapy. Cardiovasc Interv Radiol. 29(3):371–379CrossRefGoogle Scholar
  18. 18.
    Niederhuber JE, Brennan MF, Menck HR (1995) The National Cancer Data Base Report on pancreatic cancer. Cancer 76:1671–1677PubMedCrossRefGoogle Scholar
  19. 19.
    Bakkevold KE, Amesjo B, Dahl O, Kambestad B (1993) Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater: results of a controlled, prospective randomized multicentre study. Eur J Cancer 29A:698–703PubMedCrossRefGoogle Scholar
  20. 20.
    Arbuck SG (1990) Overview of chemotherapy for pancreatic cancer. Int J Pancreatol 7:209–212PubMedGoogle Scholar
  21. 21.
    Wagener DJT, Hoogenraad WJ, Rougier P, et al. (1996) Results of a phase II trial of epirubicin and cisplatin (EP) before and after irradiation and 5-fluorouracil in locally advanced pancreatic cancer. An EORTC GITCCG study. Eur J Cancer 32A:1310–1313PubMedCrossRefGoogle Scholar
  22. 22.
    Muchmore JH, Preslan JE, George WJ (1996) Regional chemotherapy for inoperable pancreatic carcinoma. Cancer 78:664–673PubMedGoogle Scholar
  23. 23.
    Douglass H (1993) Current approaches to multimodality management of advanced pancreatic cancer. Hepato-Gastroenterology 40:433–442PubMedGoogle Scholar
  24. 24.
    Gudjonsson B (1995) Carcinoma of pancreas: critical analysis of cost, results of resection, and the need for standardized reporting. J Am Coll Surg 181:483–453PubMedGoogle Scholar
  25. 25.
    Zimmeman SE, Smith FP, Scein PS (1981) Chemotherapy of pancreatic carcinoma. Cancer 47:1724–1728CrossRefGoogle Scholar
  26. 26.
    Gastrointestinal Tumor Study Group (1981) Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. Cancer 48:1705–1715CrossRefGoogle Scholar
  27. 27.
    Cantore M, Fiorentini G, Bassi C, et al. (1997) Intra-arterial chemotherapy for stage-III/IV pancreatic cancer. Dig Surg 14:113–118Google Scholar
  28. 28.
    Cohen L, Hendrickson FR, Lennox AJ, Kroc TK, Hatcher MA, Bennett BR (1996) Pancreatic cancer: treatment with neutron irradiation alone and with chemotherapy. Radiology 200:627–630PubMedGoogle Scholar
  29. 29.
    Palmer KR, Kerr M, Knowles G, Cull A, Carter DC, Leonard RCF (1994) Chemotherapy prolongs survival in inoperable pancreatic carcinoma. Br J Surg 81:882–885PubMedCrossRefGoogle Scholar
  30. 30.
    Evans TRJ, Lofts FJ, Mansi JL, Glees JP, Dalgleish AG, Knight MJ (1996) A phase II study of continuous-infusion 5-fluorouracil with cisplatin and epirubicin in inoperable pancreatic cancer. Br J Cancer 73:1260–1264PubMedGoogle Scholar
  31. 31.
    Ishikawa O, Ohigashi H, Sasaki Y, et al. (1994) Liver perfusion chemotherapy via both the hepatic artery and portal vein to prevent hepatic metastasis after extended pancreatectomy for adenocarcinoma of the pancreas. Am J Surg 168:361–364PubMedCrossRefGoogle Scholar
  32. 32.
    Ishida H, Makino T, Kobayashi M, Tsuneoka K (1983) Laparoscopic measurement of pancreatic blood flow. Endoscopy 15:107–110PubMedCrossRefGoogle Scholar
  33. 33.
    Aigner KR, Muller H, Basserman R (1990) Intra-arterial chemotherapy with MMC, CDDP and 5-FU for nonresectable pancreatic cancer. A phase II study. Reg Cancer Treat 3:1–6Google Scholar
  34. 34.
    Muchmore JH (1995) Treatment of advanced pancreatic cancer with regional chemotherapy plus hemofiltration. Int J Pancreatol 7:209–222Google Scholar
  35. 35.
    Gansauge F, Link KH, Rilinger N, Kunz R, Beger HG (1995) Regional chemotherapy in advanced pancreatic carcinoma. Med Klin 90:501–515Google Scholar
  36. 36.
    Link KH, Gansauge F, Rilinger N, Beger HG (1997) Celiac artery adjuvant chemotherapy. Results of a prospective trial. Int J Pancreatol 21:65–69PubMedGoogle Scholar
  37. 37.
    Cantore M, Fiorentini G, Bassi C, et al. (1996) Intra-arterial chemotherapy for locally advanced and metastatic pancreatic cancer. J Chemother 8:80–83Google Scholar
  38. 38.
    Link KH, Gansauge F, Gorich J, Leder GH, Rilinger N, Beger HG (1997) Palliative and adjuvant regional chemotherapy in pancreatic cancer. Eur J Surg Oncol 23:409–414PubMedCrossRefGoogle Scholar
  39. 39.
    Beger HG, Gansauge F, Buchler MW, Link KH (1999) Intra-arterial adjuvant chemotherapy after pancreaticoduodectomy for pancreatic cancer: Significant reduction in occurrence of liver metastases. World J Surg 23:946–949PubMedCrossRefGoogle Scholar
  40. 40.
    Archer SG, Gray BN (1989) Vascularization of small liver metastases. Br J Surg 76:545–548PubMedCrossRefGoogle Scholar
  41. 41.
    Kemeny NE (1995) Regional chemotherapy of colorectal cancer. Eur J Cancer 31A:1271–1276PubMedCrossRefGoogle Scholar
  42. 42.
    Burris HA III, Moore MJ, Andersen J, et al. (1997) Improvenments in survival and clinical benefits with gemicitabine as first-line therapy for patients with advanced pancreatic cancer: a randomized trial. J Clin Oncol 15: 2403–2413PubMedGoogle Scholar
  43. 43.
    Zanon C, Alabiso O, Grosso M, et al. (2000) Intra-arterial continuous infusion for treatment of pancreatic and biliary tract cancer. Int J Pancreatol 27:225–233PubMedGoogle Scholar
  44. 44.
    Takamori H, Kanemitsu K, Tsuji T, et al. (2005) 5-Fluorouracil intra-arterial infusion combined with systemic gemicitabine for unresectable pancreatic cancer. Pancreas 30:223–226PubMedCrossRefGoogle Scholar
  45. 45.
    Civelek AC, Sitzmann JV, Chin BB, et al. (1993) Misperfusion of the liver during hepatic artery infusion chemotherapy: value of preoperative angiography and post operative pump scintigraphy. Am J Roentgenol 160:865–870Google Scholar
  46. 46.
    Honma H, Doi T, Mezawa S, et al. (2000) A novel infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization. Cancer 89:303–313CrossRefGoogle Scholar
  47. 47.
    Ikeda O, Tamura Y, Nakasone Y, et al. (2007) Evaluation of intrahepatic perfusion on fusion imaging using a combined CT/SPECT system: influence of anatomic variations on hemodynamic modification before installation of implantable port systems for hepatic arterial infusion chemotherapy. Cardiovasc Interv Radiol 30(3):383–391CrossRefGoogle Scholar
  48. 48.
    Ikeda O, Tamura Y, Nakasone Y, et al. (2007) Evaluation of extrahepatic perfusion of anticancer drugs in the right gastric arterial region on fused images using combined CT/SPECT: Is extrahepatic perfusion predictive of gastric toxicity? Cardiovasc Interv Radiol 30(3):392–397CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Osama Ikeda
    • 1
    Email author
  • Yoshitaka Tamura
    • 1
  • Yutaka Nakasone
    • 1
  • Shinya Shiraishi
    • 1
  • Kouichi Kawanaka
    • 1
  • Seiji Tomiguchi
    • 1
  • Yasuyuki Yamashita
    • 1
  • Hiroshi Takamori
    • 2
  • Keiichiro Kanemitsu
    • 2
  • Hideo Baba
    • 2
  1. 1.Department of Diagnostic RadiologyKumamoto University Graduate School of Medical and Pharmaceutical SciencesHonjo KumamotoJapan
  2. 2.Department of Gastroenterological SurgeryKumamoto University Graduate School of Medical and Pharmaceutical SciencesHonjo KumamotoJapan

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