Safety assessment of preoperative oil chemoembolization with nanoparticle albumin-bound paclitaxel in patients with pancreatic head adenocarcinoma

Abstract

Results of combined treatment of 36 patients suffering from pancreatic head ductal adenocarcinoma are evaluated, including preoperative chemotherapy using nanodispersed albumin-stabilized paclitaxel (nab-paclitaxel) in intraarterial oil chemoembolization or intravenous administration and radical surgical treatment. Intraarterial oily chemoembolization of the pancreatic head consisted of the introduction of 17 patients (main group) into the gastroduodenal artery of an emulsion of super-liquid lipiodol (Lipiodol Ultra Fluid) in an aqueous solution of nab-pacliaxel 50 mg/m2 and gemcitabine 400 mg/m2. 19 patients (control group) were administered nab-paclitaxel 100 mg/m2 and gemcitabine 1000 mg/m2 intravenously according to standard guidelines. Safety and tolerability assessment of combined treatment with preoperative application of nab-paclitaxel was carried out in advance. Pil-preserving pancreatoduodenal resection is considered safe on day 7–10, after completion of preoperative chemotherapy with nab-paclitaxel. The use of nab-paclitaxel in preoperative intraarterial oily chemoembolization of the pancreatic head requires extension of the pancreatic crossing boundary to body level. Postoperative lethality and 4th degree complications according to the Clavien-Dindo classification were not observed. In the main group, grade 3a complication was observed in 2 (12%) patients and was represented by bleeding from acute gastric erosions resolved endoscopically. In the control group, complications of degree 3 were also noted in 2 (11%) patients and were represented by: one bleeding from acute stomach erosions that required endoscopic hemostasis and an intraabdominal abscess allowed by percutaneous drainage. In the main group, complications of the 2nd degree were recorded in 8 (47%) patients: in 3 (17%) patients the formation of pancreatic fistula was noted, in 4 (23%) postoperative pancreatitis was detected, and in 1 (6%) gastrostasis phenomena that required conservative therapy. In the control group, complications of the 2nd degree were observed in 11 (58%) patients and were presented: pancreatic fistulae – in 2 (10%) patients, postoperative pancreatitis – in 6 (31%) and gastrostasis – in 3 (16%) patients. The most common complication observed in both groups was the suppression of a postoperative wound, corresponding to the 1st degree of severity: in the main group in 5 (29%) patients, in the control group in 7 (37%) patients. Thus, the use of intraarterial oil chemoembolization with nab-paclitaxel as a preoperative antitumor treatment can be considered safe.

Keywords

pancreatic cancer / pancreatoduodenal resection / neoadjuvant / preoperative chemotherapy / nanoparticles albumin-bound paclitaxel / intra-arterial oil chemoembolization

References

[1] Гранов, Д.А. Неоадъювантная внутриартериальная масляная химиоэмболизация и адъювантная регионарная химиоинфузия в комбинированном лечении рака поджелудочной железы / Д.А. Гранов [и др.] // Вопр. онкологии. – 2008. – № 15 (4). – С. 501–503.

[2] Гранов, Д.А. Оценка безопасности внутриартериальной химиотерапии гемцитабином и оксалиплатином в комбинированном лечении аденокарциномы головки поджелудочной железы / Д.А. Гранов [и др.] // Анналы хирургической гепатологии. – 2017. – № 22(2). – С. 54–59.

[3] Каприн, А.Д. Злокачественные новообразования в России в 2017 году (заболеваемость и смертность) / А.Д. Каприн, В.В. Старинский, Г.В. Петрова. -Лушников, Е.Ф. Лечебный патоморфоз опухолей / Е.Ф. Лушников // Патологоанатомическая диагностика опухолей человека. – М.: Медицина, 1993. – 560 с.

[4] Покатаев, И. А. Эффективность и безопасность индукционной химиотерапии по схеме FOLFIRINOX при погранично резектабельном и нерезектабельном раке поджелудочной железы / И. А. Покатаев [и др.] // Научн.-практ. журн. по онкологии «Злокачественные опухоли». – 2018. – Т. 8, № 1. – С. 38–47.

[5] Bassi, C. Postoperative pancreatic fistula: an International Study Group (ISGPF) definition / C. Bassi [et al.] // Surgery. –2005. – № 138 (1). – Р. 8–13.

[6] Conroy, T. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer / T. Conroy [et al.] // N Engl J. Med. – 2018. – № 379. – Р. 2395–406.

[7] Del Chiaro, M. Pancreatectomy with arterial resection is superior to palliation in patients with borderline resectable or locally advanced pancreatic cancer / M. Del Chiaro [et al.] // HPB. – 2019. – № 21. – Р. 219–25.

[8] Dennison, A.R. Laparoscopic pancreatic surgery: a review of present results and future prospects / A R. Dennison [et al.] // HPB (Oxford). – 2010. – Vol. 4, № 12. – Р. 239–43.

[9] Dindo, D. Classification of Surgical Complications. A new proposal with Evaluation in a Cohort of 6336 Patients and Results of a surrey / D. Dindo [et al.] // Ann. Sirg. – 2004. – № 240. – Р. 205–231.

[10] Giordano, G. Nano albumin bound-paclitaxel in pancreatic cancer: Current evidences and future directions / G. Giordano [et al.] // World J. Gastroenterol. – 2017. – Vol. 23. – № 32 – P. 5875–5886.

[11] Ottaiano, A. Nab-Paclitaxel and Gemcitabine in Advanced Pancreatic Cancer: The One-year Experience of the National Cancer Institute of Naples / A. Ottaiano [et al.] // Anticancer Res. – 2017. – Vol. 4. – № 37. – Р. 1975–1978.

[12] Siegel, R.L. Cancer statistics / R.L. Siegel [et al.] // CA Cancer J. Clin. – 2018. – № 68 (1). – Р. 7–30.

[13] Tee, M.C. Indications and perioperative outcomes for pancreatectomy with arterial resection / M.C. Tee [et al.] // J. Am. Coll. Surg. – 2018. – № 227. – Р. 255–69.

[14] Von Hoff, D.D. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine / D.D. Von Hoff [et al.] // N. Engl. J. Med. – 2013. – № 369 (18). – Р. 1691–703.

[15] Wagner, M. CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma / M. Wagner [et al.] // EurRadiol. – 2017. – № 27 (3104). – P. 16.

RIGHTS & PERMISSIONS

Pavlovskii A.V., Statsenko A.A., Popov S.A., Moiseenko V.E., Polikarpov A.A.