1. Principles of interventional treatment.
(1) Have a digital subtraction angiography machine.
(2) Must strictly master the clinical indications.
(3) Must emphasize the standardization and individualization of treatment.
2. Indications for interventional treatment.
(1) Locally advanced pancreatic cancer that is estimated to be inoperable by imaging.
(2) Pancreatic cancer that has lost the chance of surgery due to medical reasons.
(3) Pancreatic cancer with liver metastasis.
(4) Control of pain, bleeding and other disease-related symptoms.
(5) Perfusion chemotherapy as a special form of neoadjuvant chemotherapy.
(6) Postoperative prophylactic infusion chemotherapy or adjuvant chemotherapy.
(7) Obstructive jaundice (drainage, internal stent placement).
3. Contraindications to interventional therapy.
(1) Relative contraindications.
(1) Mild allergy to contrast media.
(2) KPS score <70.
(3) Those with bleeding and coagulation disorders that cannot be corrected and obvious bleeding tendency.
④White blood cells <4000, platelets <70,000.
(2) Absolute contraindications.
(①Severe hepatic and renal dysfunction: total bilirubin > 51umol/L, ALT > 120U/L.
(2) Large amount of ascites, systemic multiple metastases.
(iii) Systemic failure.
4. Interventional treatment operation specification.
(1) Selectively place the catheter in the celiac artery and superior mesenteric artery respectively for action vein imaging, and if the tumor blood supply vessel is visible, perfuse chemotherapy through the artery.
(2) If no tumor-supplying artery is seen, the target vessels will be determined according to the location, invasion and blood supply of the tumor. In principle, pancreatic head and pancreatic neck tumors should be treated by infusion chemotherapy via gastroduodenal artery; pancreatic tail tumors should be treated by infusion chemotherapy via celiac artery, superior mesenteric artery or splenic artery.
(3) If liver metastasis is present, hepatic artery infusion chemotherapy or/and embolization therapy should be administered simultaneously.
(4) Drug administration: usually platinum, adriamycin, gemcitabine alone or in combination. The dosage of drugs is decided according to the patient’s body surface area, liver and kidney function, blood routine and other indicators.
5, transarterial interventional therapy (TAIT) based on “individualized” program.
(1) Patients with obstructive jaundice can undergo internal stenting.
(2) Patients with symptomatic abdominal or retroperitoneal lymph node metastases may be treated with combined radiation therapy.
Follow-up is performed 3 to 6 weeks after interventional treatment, and the efficacy is determined by the international standard for evaluating the efficacy of solid tumor treatment. The treatment interval is usually 1 month to 1 or 5 months, or the time to repeat TAIT is determined by the time of recurrence of pain in the patient.