Hepatobiliary and Pancreatic Oncology

Introduction
The Hepatobiliary and Pancreatic Oncology Group employs diagnostic ultrasonography and nonsurgical treatments for patients with tumors in the liver, biliary system, and pancreas. These tumors are often refractory with a single treatment modality. We, medical oncologists, therefore, fully discuss the possible therapeutic strategies with surgeons and radiologists at routine clinical conferences. Thus, new and/or multimodality treatments are employed in daily clinical practice.

Routine Activities
Abdominal cavity ultrasonography is used mainly for screening and thorough examinations for malignancies. A total of 6,639 patients were examined in 1997. Percutaneous transhepatic biliary drainage, cholangiography and cholangioscopy are performed for patients with obstructive jaundice. A total of 171 patients underwent this procedure in 1997.
In addition, 103 patients underwent percutaneous needle biopsy under ultrasonography for the differential diagnosis of abdominal tumors, and 36 hepatocellular carcinoma (HCC) patients were treated with percutaneous ethanol injection (PEI), which is a standard treatment modality for small HCCs, when the number of tumors is 3 or less and each tumor is 3 cm or less in diameter. If the lesion is hard to detect ultrasonographically with this procedure, our new treatment modality established in 1995, i.e., fluoroscopic CT-guided PEI with angiography, is employed.
Multimodality treatments are indicated for patients with advanced disease. Those with advanced HCCs undergo combination therapy, consisting of PEI, transcatheter arterial embolization (TAE) and radiation therapy. Those with unresectable advanced bile duct cancer are treated with combined radiation therapy, consisting of external beam radiation therapy (EBRT) and brachytherapy. Those with locally advanced pancreatic cancer receive chemoradiation consisting of intravenous injection of 5-fluorouracil (5FU), intraoperative radiation (IORT) and EBRT.
Systemic chemotherapy is carried out as a clinical trial in patients with hepatobiliary and pancreatic cancer with distant metastases. Hepatic arterial infusion of 5-FU is used for hepatic metastases from pancreatic or colorectal cancer.

New Developments
1. Color Doppler ultrasonography: This equipment allows visualization of blood flow, and is useful when differentiating small HCCs from other hepatic nodules. In 1997, we evaluated a new instrument, i.e., ﾒpower Doppler ultrasonography,ﾓ and found its capability in detecting blood flow signals to be equal to that of angiography in small HCC cases.
2. Brachytherapy with 192Ir for portal vein tumor thrombus in HCC: This treatment was performed as a pilot study in 3 patients after TAE, and we are now planning a phase I study.
3. Clinical trials (Phase II studies)
1) IORT+EBRT and 5FU: those with locally advanced pancreatic cancer.
2) Hepatic arterial infusion of 5-FU: those with hepatic metastases from pancreatic or colorectal cancer.
3) Systemic chemotherapy of CDDP, epirubicin and 5-FU for biliary tract cancer.
4) Taxotere for pancreatic cancer and/or its hepatic metastases, as a multi-institutional trial.

Statistics

Number of Inpatients in 1997

HCC Biliary tract Pancreas Liver metastasis
from colon ca.

PEI alone 26

TAE alone 73

TAE+PEI 10

HAI alone
1
2

RT alone
3

RT+TAE 11

RT+HAI
3

Chemoradiation therapy
5

Systemic chemotherapy 2 12 6 3

Supportive care 17 11 8 1

Total 139 27 22 6
PEI, percutaneous ethanol injection; TAE, transcather arterial embolization; HAI, hepatic arterial infusion; RT, radiation therapy.

Number of Inpatients in 1997
	HCC	Biliary tract	Pancreas	Liver metastasis from colon ca.
PEI alone	26
TAE alone	73
TAE+PEI	10
HAI alone		1		2
RT alone		3
RT+TAE	11
RT+HAI		3
Chemoradiation therapy		5
Systemic chemotherapy	2	12	6	3
Supportive care	17	11	8	1
Total	139	27	22	6

(J. Furuse)

Table of Contents