Helene Hofmann1, Rebecca von Haken2, Jens Werner3, Nikolas Kortes4, Frank Bergmann5, Peter Schemmer3, Dirk Jäger6, Boris Radeleff4, Henning Schulze-Bergkamen7. 1. National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany. Electronic address: Helene.Hofmann@med.uni-heidelberg.de. 2. Department of Anesthesiology, University Clinic of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. 3. Department of Surgery, University Clinic of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. 4. Department of Radiology, University Clinic of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. 5. Department of Pathology, University Clinic of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany. 6. National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany. 7. National Center for Tumor Diseases, University of Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Marienhospital Wesel, Medical Department II, Pastor-Janssen-Strasse 8-38, 46483 Wesel, Germany.
Abstract
BACKGROUND/ OBJECTIVES: Solid pseudopapillary neoplasms of the pancreas (SPN) are rare tumors. For patients with unresectable liver metastases of SPN, no standard treatment has been defined so far. Here we report a case of a 40-year-old woman with SPN and metastases confirmed to the liver, and disease progression in the liver after primary tumor resection and chemotherapy with gemcitabine and cisplatin. METHODS: Chemosaturation with percutaneous hepatic perfusions is a minimally invasive, repeatable regional therapy which delivers chemotherapy directly to the liver while limiting systemic toxicity. As an individual treatment approach, the patient was treated with chemosaturation with percutaneous hepatic perfusions of melphalan. RESULTS: The procedure was performed twice within 8 weeks after which the liver metastases showed a marked reduction in size and vascularization (partial response). Grade 3 leukopenia after the second procedure was managed effectively with granulocyte colony-stimulating factor. No other toxicities were observed. Ten months after initiating treatment, the patient had a good performance status and remained stable. CONCLUSIONS: For SPN with unresectable liver metastases and progression despite systemic treatment, repeat chemosaturation with high-dose melphalan may also offer an effective regional treatment option.
BACKGROUND/ OBJECTIVES: Solid pseudopapillary neoplasms of the pancreas (SPN) are rare tumors. For patients with unresectable liver metastases of SPN, no standard treatment has been defined so far. Here we report a case of a 40-year-old woman with SPN and metastases confirmed to the liver, and disease progression in the liver after primary tumor resection and chemotherapy with gemcitabine and cisplatin. METHODS: Chemosaturation with percutaneous hepatic perfusions is a minimally invasive, repeatable regional therapy which delivers chemotherapy directly to the liver while limiting systemic toxicity. As an individual treatment approach, the patient was treated with chemosaturation with percutaneous hepatic perfusions of melphalan. RESULTS: The procedure was performed twice within 8 weeks after which the liver metastases showed a marked reduction in size and vascularization (partial response). Grade 3 leukopenia after the second procedure was managed effectively with granulocyte colony-stimulating factor. No other toxicities were observed. Ten months after initiating treatment, the patient had a good performance status and remained stable. CONCLUSIONS: For SPN with unresectable liver metastases and progression despite systemic treatment, repeat chemosaturation with high-dose melphalan may also offer an effective regional treatment option.
Authors: Eleonora M de Leede; Mark C Burgmans; Christian H Martini; Fred G J Tijl; Arian R van Erkel; Jaap Vuyk; Ellen Kapiteijn; Cornelis Verhoef; Cornelis J H van de Velde; Alexander L Vahrmeijer Journal: J Vis Exp Date: 2016-07-31 Impact factor: 1.355
Authors: Arndt Vogel; Sanjay Gupta; Martin Zeile; Rebecca von Haken; Roland Brüning; Gösta Lotz; Alexander Vahrmeijer; Thomas Vogl; Frank Wacker Journal: Adv Ther Date: 2016-10-31 Impact factor: 3.845