Hepatobiliary & Pancreatic Oncology

Introduction

The Division of Hepatobiliary and Pancreatic Oncology deals with cancers of the liver, biliary system, and pancreas. The prognosis of patients with advanced or metastatic hepatobiliary or pancreatic cancers is dismal. A multidisciplinary treatment strategy is important for treating cancers at these sites, and the treatment strategies are carefully discussed by surgeons, radiologists, and medical oncologists at our conferences.

Routine Activities

Systemic chemotherapy is indicated in patients with unresectable hepatobiliary and pancreatic cancers; however, as a regimen, it is unsatisfactory and inadequate. Therefore, clinical trials are required prior to practical therapy in order to elucidate the optimum regimens that can be applied as standard treatment regimens.
In advanced pancreatic cancer, gemcitabine alone has been recognized as the standard therapy since its approval by the Ministry of Health, Labour, and Welfare in 2001. Furthermore, S-1 has also been approved for pancreatic cancer in August, 2006. In principle, gemcitabine is the first-line chemotherapy, and S-1 alone or a combination of gemcitabine and S-1 is applied as the second-line chemotherapy.
In Japan, gemcitabine was approved for the treatment of biliary tract cancers in June 2006 based on a phase II study conducted in Japan. S-1 was also approved in August 2007. For treatment of biliary tract cancers, gemcitabine alone is currently used as the first-line chemotherapy, and S-1 is the second-line chemotherapy.
In hepatocellular carcinoma (HCC), distant metastasis or carcinoma refractory to chemoembolization are recognized as indications for systemic chemotherapy. However, no standard regimen of systemic chemotherapy has been established, and the only agents available are those under clinical trial.
Percutaneous ablation therapy, including ethanol injection (PEI) or radiofrequency ablation (RFA), is indicated as the standard treatment for HCC in patients having 3 tumors, each <3 cm in diameter. rfa has been the first choice for treating small HCCs. Transcatheter arterial chemoembolization (TACE) is routinely used to treat advanced or recurrent HCC when hepatectomy or ablation therapy is not indicated. Hepatic arterial infusion (HAI) chemotherapy with cisplatin has been used to treat very advanced HCCs in which TACE is not indicated.
Percutaneous transhepatic biliary drainage (PTBD), cholangiography, and cholangioscopy are performed in patients with obstructive jaundice to relieve jaundice and determine the cause of bile duct obstruction. Patients with obstructive jaundice are treated with metallic stents in order to improve their quality of life. In fact, PTBD tube removal is indicated in almost all patients with obstructive jaundice to further improve the quality of life of these patients.

● J. Furuse ●

Number of Patients Treated during 2003-2007
  2003 2004 2005 2006 2007
New referrals 246 285 223 291 304
HCC 91 116 77 97 120
Biliary tract cancer 43 49 42 60 66
Pancreatic cancer 91 103 104 134 118
Re-admission 285 311 323 478 666
HCC 193 222 212 289 346
Biliary tract cancer 31 32 30 47 139
Pancreatic cancer 61 56 81 142 181
Total 531 596 546 769 989
HCC 284 338 289 386 485
Biliary tract cancer 74 81 72 107 205
Pancreatic cancer 152 159 185 276 299

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