Hideo Ozaki

Effectiveness of multimodality treatment for resectable pancreatic cancer

SummarySince November 1983, 16 patients with resectable pancreatic cancer have been treated by a multimodality approach at the National Cancer Center Hospital. This therapy included extended pancreatic resection, intraoperative irradiation by 30 Gy of electrons, and intraoperative hepatic arterial or portal infusion of mitomycin C. Furthermore, postoperative chemotherapy with mitomycin C, using Seldinger’s method or intravenously, was added. The patients consisted of 12 with carcinoma of the pancreatic head and four with carcinoma of the body and tail. The 1- and 3-yr survival rates for these patients were 88 and 53%, respectively. The rates were markedly better than the 26 and 10% after conventional radical pancreatectomy from 1962 to 1983. The cancers consisted of Stage I, 1 case; II, 1; III, 11; and IV, 3 according to the p-TNM pathological classification by UICC, and the 1- and 3-yr survival rates for the 14 patients other than those with Stage I and II were 85 and 57%, respectively. According to our experience, pancreatic carcinoma usually pursues an aggressive course and is unlikely to be cured by surgery alone. A multimodality therapy in addition to radical surgery appears to be necessary in the treatment of resectable pancreatic cancer.

Modern surgical treatment of pancreatic cancer

ConclusionRecently, many reports on surgical treatment of pancreatic cancer from around the world showed better outcome than those of the past. However, it is not yet satisfactory. For better prognosis of this disease, the target of surgical treatment should be concentrated on stage III (UICC classification), which is the most common resectable pancreatic cancer. Multimodality treatment consisting of subtotal or total pancreatectomy with extended dissection of the lymph nodes and adjacent soft tissue, intensive radiotherapy, and chemotherapy seems to be preferable for better prognosis.

Multidisciplinary treatment for resectable pancreatic cancer

SummarySince November 1983, a multidisciplinary protocol for the treatment of pancreatic carcinoma has been used for eight patients at the National Cancer Center Hospital. This therapy includes an extended pancreatic resection, intra-operative irradiation with 3,000 rad of electrons using a microton, and an intra-operative hepatic arterial or portal infusion of mitomycin C, 10 mg. Furthermore, post-operative chemotherapy with mitomycin C (10 mg to 10 mg×3) is added by Seldingers method or intravenously (i.v.). The post-operative course was uneventful in all eight patients. Although the number of patients treated is small, the one-year survival rate was 86%. This rate is markedly better than the 28% after conventional radical pancreatectomy from 1962 to 1983. According to our experience, pancreatic carcinoma is unlikely to be cured by only radical operative procedures. A multidisciplinary treatment protocol as an adjunct to radical surgery appears necessary for a good prognosis of this disease.

Evidence of effective multidisciplinary treatment for resectable pancreatic cancer from the viewpoint of the CA19-9 level

SummaryNineteen patients with resectable pancreatic cancer have been treated by a multidisciplinary approach at the National Cancer Center Hospital. This therapy included extended pancreatic resection, intraoperative irradiation by 30 Gy of electrons, and intraoperative hepatic arterial or portal infusion of mitomycin C. Furthermore, postoperative chemotherapy with mitomycin C, using Seldingers method or iv administration, was added. The study consisted of 13 patients with carcinoma of the pancreatic head and six patients with carcinoma of the body and tail. The one- and three-year survival rates for these patients were 88 and 50%, respectively. The five-year survival rate was calculated as 28%, although there is only one five-year survivor. The effectiveness of this therapy was studied by changes in Carbohydrate Antigen 19-9 (CA19-9) level. Thirteen of the 15 patients with high CA19-9 levels showed a decrease to a level < 50 U/mL after this therapy. In the postoperative course, the patients showing a tendency of elevation of the CA19-9 level could be suspected of having cancer recurrence at this time without any physical sign or other laboratory findings.