Intraperitoneal Paclitaxel Treatment for Patients with Pancreatic Ductal Adenocarcinoma with Peritoneal Dissemination Provides a Survival Benefit

Tomohisa Yamamoto; Sohei Satoi; So Yamaki; Daisuke Hashimoto; Mitsuaki Ishida; Tsukasa Ikeura; Satoshi Hirooka; Yuki Matsui; Shogen Boku; Shinji Nakayama; Koh Nakamaru; Nobuhiro Shibata; Utae Katsushima; Mitsugu Sekimoto

doi:10.3390/cancers14051354

Intraperitoneal Paclitaxel Treatment for Patients with Pancreatic Ductal Adenocarcinoma with Peritoneal Dissemination Provides a Survival Benefit

Cancers (Basel). 2022 Mar 7;14(5):1354. doi: 10.3390/cancers14051354.

Authors

Affiliations

¹ Department of Surgery, Kansai Medical University, Osaka 573-1010, Japan.
² Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO 80204, USA.
³ Department of Pathology and Clinical Laboratory, Kansai Medical University, Osaka 573-1010, Japan.
⁴ The Third Department of Internal Medicine, Kansai Medical University, Osaka 573-1010, Japan.
⁵ Cancer Treatment Center, Kansai Medical University Hospital, Osaka 573-1010, Japan.
⁶ Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, Osaka 573-1010, Japan.

Abstract

Background: Intraperitoneal chemotherapy using paclitaxel (i.p.-PTX) is expected to be a new therapeutic strategy for patients with pancreatic ductal adenocarcinoma (PDAC) and peritoneal dissemination. We evaluated the survival benefit of i.p.-PTX compared with standard systemic chemotherapy. Methods: Clinical data of 101 consecutive PDAC patients with peritoneal dissemination between 2007 and 2018 were analyzed. All patients were determined to have no other sites of distant organ metastasis to the lung, bone, or liver on contrast-enhanced CT imaging. Patients underwent staging laparoscopy or open laparotomy to confirm pathological evidence of peritoneal dissemination, and to exclude occult liver metastasis. Survival curves were estimated using the Kaplan−Meier method, and differences were compared using the log-rank test. Results: Forty-three patients were treated with i.p.-PTX (i.p.-PTX group) and forty-nine patients received standard systemic chemotherapy (Ctrl group). Nine patients did not receive any treatment (BSC group). The median survival time (MST) in the i.p.-PTX group was significantly longer than that in the Ctrl group (17.9 months vs. 10.2 months, p = 0.006). Negative peritoneal washing cytology was observed in 24 out of 43 patients in the i.p.-PTX group. The i.p.-PTX group tended to have a higher proportion of clinical responses than the Ctrl group (30% vs. 18%, p = 0.183). Conversion surgery was performed in 10 patients in the i.p.-PTX group and 2 patients in the Ctrl group after confirming disappearance of peritoneal dissemination with staging laparoscopy or open laparotomy (p = 0.005). The MST in patients who underwent surgical resection was significantly longer than that in patients who did not (27.4 months vs. 11.3 months; p < 0.0001). Conclusion: i.p.-PTX therapy provided improved survival in PDAC patients with peritoneal dissemination, and conversion surgery enhanced it in patients with favorable responses to chemotherapy. i.p.-PTX might become one of the treatment options to PDAC patients with peritoneal dissemination.

Keywords: intraperitoneal therapy; paclitaxel; pancreatic cancer; peritoneal dissemination.