Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer

Koji Yamaguchi, Kiichiro Kobayashi, Yasuhiro Ogura, Katsumasa Nakamura, kenji nakano, Kazuhiro Mizumoto, Masao Tanaka

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Background/Aims: The great majority of pancreatic cancers are unresectable due to local invasion and/or distant metastasis. The treatment options for such patients include bypass operation, celiac plexus block, radiation therapy (RT), chemotherapy and immunotherapy. RT is divided into intraoperative radiation therapy (IORT) and external radiation therapy (ERT). Appropriate palliative treatment remains controversial. Methodology: Our experience with palliative treatments including bypass operation, celiac plexus block and RT (IORT and ERT) was retrospectively reviewed in 31 Japanese patients with unresectable locally advanced pancreatic cancer. The 31 patients consisted of seven with no RT, six with ERT alone, seven with IORT alone and 11 with both IORT and ERT. Gastrojejunostomy was performed in 25 patients and biliary bypass was done in 29 patients for the therapeutic or prophylactic purpose. Results: No patients developed gastroduodenal obstruction or jaundice until death. Imaging findings after the treatment showed a decrease in tumor size in 11 of the 18 patients examined, an increase in four and no change in the other three. Of 19 patients complaining of back pain before the operation, the pain had disappeared in 12 but persisted in the other seven after the operation. No patients developed back pain after the treatment. Of the 12 patients with pain relief, nine had both RT and celiac plexus block, two RT alone and the other neither RT nor celiac block. Cumulative 0.5-year and 1.0-year survival rates in the group with RT(-), ERT alone, IORT alone IORT and ERT and IORT were 42.9%, 100%, 100%, 100% and 0%, 33.3%, 57.1% and 45.5%, respectively. The survival curve of the RT(-) group was significantly worse than that of the ERT alone group (P=0.0029), IORT alone group (P=0.0101) and IORT and ERT group (P=0.0109). The survival curves of the three RT groups were similar. Conclusions: RT significantly prolonged survival of patients with unresectable locally advanced pancreatic cancer and combined palliative treatments including bypass operation, celiac plexus block and RT (ERT or IORT) are recommended for such patients.

Original languageEnglish
Pages (from-to)1605-1612
Number of pages8
JournalHepato-gastroenterology
Volume52
Issue number65
Publication statusPublished - Sep 1 2005

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Celiac Plexus
Pancreatic Neoplasms
Radiotherapy
Palliative Care

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Yamaguchi, K., Kobayashi, K., Ogura, Y., Nakamura, K., nakano, K., Mizumoto, K., & Tanaka, M. (2005). Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer. Hepato-gastroenterology, 52(65), 1605-1612.

Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer. / Yamaguchi, Koji; Kobayashi, Kiichiro; Ogura, Yasuhiro; Nakamura, Katsumasa; nakano, kenji; Mizumoto, Kazuhiro; Tanaka, Masao.

In: Hepato-gastroenterology, Vol. 52, No. 65, 01.09.2005, p. 1605-1612.

Research output: Contribution to journalReview article

Yamaguchi, K, Kobayashi, K, Ogura, Y, Nakamura, K, nakano, K, Mizumoto, K & Tanaka, M 2005, 'Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer', Hepato-gastroenterology, vol. 52, no. 65, pp. 1605-1612.
Yamaguchi, Koji ; Kobayashi, Kiichiro ; Ogura, Yasuhiro ; Nakamura, Katsumasa ; nakano, kenji ; Mizumoto, Kazuhiro ; Tanaka, Masao. / Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer. In: Hepato-gastroenterology. 2005 ; Vol. 52, No. 65. pp. 1605-1612.
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abstract = "Background/Aims: The great majority of pancreatic cancers are unresectable due to local invasion and/or distant metastasis. The treatment options for such patients include bypass operation, celiac plexus block, radiation therapy (RT), chemotherapy and immunotherapy. RT is divided into intraoperative radiation therapy (IORT) and external radiation therapy (ERT). Appropriate palliative treatment remains controversial. Methodology: Our experience with palliative treatments including bypass operation, celiac plexus block and RT (IORT and ERT) was retrospectively reviewed in 31 Japanese patients with unresectable locally advanced pancreatic cancer. The 31 patients consisted of seven with no RT, six with ERT alone, seven with IORT alone and 11 with both IORT and ERT. Gastrojejunostomy was performed in 25 patients and biliary bypass was done in 29 patients for the therapeutic or prophylactic purpose. Results: No patients developed gastroduodenal obstruction or jaundice until death. Imaging findings after the treatment showed a decrease in tumor size in 11 of the 18 patients examined, an increase in four and no change in the other three. Of 19 patients complaining of back pain before the operation, the pain had disappeared in 12 but persisted in the other seven after the operation. No patients developed back pain after the treatment. Of the 12 patients with pain relief, nine had both RT and celiac plexus block, two RT alone and the other neither RT nor celiac block. Cumulative 0.5-year and 1.0-year survival rates in the group with RT(-), ERT alone, IORT alone IORT and ERT and IORT were 42.9{\%}, 100{\%}, 100{\%}, 100{\%} and 0{\%}, 33.3{\%}, 57.1{\%} and 45.5{\%}, respectively. The survival curve of the RT(-) group was significantly worse than that of the ERT alone group (P=0.0029), IORT alone group (P=0.0101) and IORT and ERT group (P=0.0109). The survival curves of the three RT groups were similar. Conclusions: RT significantly prolonged survival of patients with unresectable locally advanced pancreatic cancer and combined palliative treatments including bypass operation, celiac plexus block and RT (ERT or IORT) are recommended for such patients.",
author = "Koji Yamaguchi and Kiichiro Kobayashi and Yasuhiro Ogura and Katsumasa Nakamura and kenji nakano and Kazuhiro Mizumoto and Masao Tanaka",
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T1 - Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer

AU - Yamaguchi, Koji

AU - Kobayashi, Kiichiro

AU - Ogura, Yasuhiro

AU - Nakamura, Katsumasa

AU - nakano, kenji

AU - Mizumoto, Kazuhiro

AU - Tanaka, Masao

PY - 2005/9/1

Y1 - 2005/9/1

N2 - Background/Aims: The great majority of pancreatic cancers are unresectable due to local invasion and/or distant metastasis. The treatment options for such patients include bypass operation, celiac plexus block, radiation therapy (RT), chemotherapy and immunotherapy. RT is divided into intraoperative radiation therapy (IORT) and external radiation therapy (ERT). Appropriate palliative treatment remains controversial. Methodology: Our experience with palliative treatments including bypass operation, celiac plexus block and RT (IORT and ERT) was retrospectively reviewed in 31 Japanese patients with unresectable locally advanced pancreatic cancer. The 31 patients consisted of seven with no RT, six with ERT alone, seven with IORT alone and 11 with both IORT and ERT. Gastrojejunostomy was performed in 25 patients and biliary bypass was done in 29 patients for the therapeutic or prophylactic purpose. Results: No patients developed gastroduodenal obstruction or jaundice until death. Imaging findings after the treatment showed a decrease in tumor size in 11 of the 18 patients examined, an increase in four and no change in the other three. Of 19 patients complaining of back pain before the operation, the pain had disappeared in 12 but persisted in the other seven after the operation. No patients developed back pain after the treatment. Of the 12 patients with pain relief, nine had both RT and celiac plexus block, two RT alone and the other neither RT nor celiac block. Cumulative 0.5-year and 1.0-year survival rates in the group with RT(-), ERT alone, IORT alone IORT and ERT and IORT were 42.9%, 100%, 100%, 100% and 0%, 33.3%, 57.1% and 45.5%, respectively. The survival curve of the RT(-) group was significantly worse than that of the ERT alone group (P=0.0029), IORT alone group (P=0.0101) and IORT and ERT group (P=0.0109). The survival curves of the three RT groups were similar. Conclusions: RT significantly prolonged survival of patients with unresectable locally advanced pancreatic cancer and combined palliative treatments including bypass operation, celiac plexus block and RT (ERT or IORT) are recommended for such patients.

AB - Background/Aims: The great majority of pancreatic cancers are unresectable due to local invasion and/or distant metastasis. The treatment options for such patients include bypass operation, celiac plexus block, radiation therapy (RT), chemotherapy and immunotherapy. RT is divided into intraoperative radiation therapy (IORT) and external radiation therapy (ERT). Appropriate palliative treatment remains controversial. Methodology: Our experience with palliative treatments including bypass operation, celiac plexus block and RT (IORT and ERT) was retrospectively reviewed in 31 Japanese patients with unresectable locally advanced pancreatic cancer. The 31 patients consisted of seven with no RT, six with ERT alone, seven with IORT alone and 11 with both IORT and ERT. Gastrojejunostomy was performed in 25 patients and biliary bypass was done in 29 patients for the therapeutic or prophylactic purpose. Results: No patients developed gastroduodenal obstruction or jaundice until death. Imaging findings after the treatment showed a decrease in tumor size in 11 of the 18 patients examined, an increase in four and no change in the other three. Of 19 patients complaining of back pain before the operation, the pain had disappeared in 12 but persisted in the other seven after the operation. No patients developed back pain after the treatment. Of the 12 patients with pain relief, nine had both RT and celiac plexus block, two RT alone and the other neither RT nor celiac block. Cumulative 0.5-year and 1.0-year survival rates in the group with RT(-), ERT alone, IORT alone IORT and ERT and IORT were 42.9%, 100%, 100%, 100% and 0%, 33.3%, 57.1% and 45.5%, respectively. The survival curve of the RT(-) group was significantly worse than that of the ERT alone group (P=0.0029), IORT alone group (P=0.0101) and IORT and ERT group (P=0.0109). The survival curves of the three RT groups were similar. Conclusions: RT significantly prolonged survival of patients with unresectable locally advanced pancreatic cancer and combined palliative treatments including bypass operation, celiac plexus block and RT (ERT or IORT) are recommended for such patients.

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