Continuous intra-arterial chemotherapy with 5-fluorouracil and cisplatin for locally advanced anaplastic carcinoma of the pancreas

Dear Editor, The majority of malignant tumors of the pancreas are of epithelial derivation. Undifferentiated malignancies are generally accepted to represent probable carcinomas, making up a small percentage of all pancreatic tumors (2– 7%). Anaplastic carcinomas of the pancreas (ACPs) are rare and frequently display a variety of growth pattern. ACPs generally occur with greater frequency in the head of the pancreas, usually in older men. They tend to have an aggressive nature with rapid local and distant spread. Weight loss, fatigue, loss of appetite, abdominal pain, nausea, vomiting, and diarrhea are the usual clinical presenting symptoms. Radiological findings of APCs are nonspecific. Currently, there are no established treatment options that can generally be recommended. Intra-arterial (i.a.) chemotherapy is a procedure used to apply higher concentrations of anticancer drugs directly into the artery supplying the vascular bed of a tumor. Hence, local concentration at the target site is significantly increased as compared to intravenous infusion with reduction of systemic effects. The feasibility and efficacy of i.a. chemotherapy in locally advanced or metastatic adenocarcinoma of the pancreas has been already investigated by different authors in the first-line and second-line setting, respectively, with response rates of up to 21.9%. Pain reduction and weight gain were also observed. We hereby report our experience with i.a. chemotherapy in a patient with locally advanced APC. This is, to our knowledge, the first report about locoregional chemotherapy for irresectable anaplastic carcinoma of the pancreas. A 53-year-old female patient presented in November 2006 to a nearby hospital for routine follow-up after breastpreserving therapy of a breast cancer (T1 N0 M0) which she had 7 years ago. On physical examination, she was found to have a suspect right cervical lymph node, which subsequently was completely removed. Histological examination revealed a metastasis of an anaplastic carcinoma. Computed tomography (CT) scan of both chest and abdomen was performed and showed a tumor of the cauda pancreatis, 7.5 cm in diameter with central necrosis and infiltration of surrounding tissue, splenic artery, and vein. There was no evidence of either hepatic or pulmonary metastases but enlarged retroperitoneal lymph nodes were found. Diagnosis of an anaplastic carcinoma of the tail of the pancreas was established histologically following a percutaneous CT-guided needle aspiration biopsy. Patient was referred to our hospital to discuss therapeutic options. Due to locally advanced tumor growth with irresectability, decision for primary i.a. chemotherapy followed by optional surgical intervention in case of adequate tumor response was made. The patient was given detailed information about the procedure and written informed consent was obtained. To assess the hemodynamic status around the pancreas and to establish whether there are congenital abnormalities with a potential risk of misperfusion, a preliminary selective angiography was conducted. It revealed normal vascular anatomy with vascular infiltration of the tumor Int J Colorectal Dis (2008) 23:729–731 DOI 10.1007/s00384-008-0441-0