Roehrig Sandra, Wein Axel, Albrecht Heinz, Maennlein Gudrun, Wolff Kerstin, Muskoski Dane, Amann Kerstin, Janka Rolf, Hohenberger Werner, Hahn Eckhart G, Siebler Jürgen, Neurath Markus F, Boxberger Frank
Department of Internal Medicine 1, University of Erlangen, Erlangen, Witten, Germany.
Case Rep Oncol. 2011 May;4(2):413-9. doi: 10.1159/000331239. Epub 2011 Aug 24.
The prognostic outlook for patients suffering from pancreatic cancer is generally poor. Particularly in cases of advanced and metastatic disease, long-term relapse-free survival may be achieved only in a few cases.
A 45-year-old patient presented with metastatic pancreatic cancer. Liver metastases had been intra-operatively confirmed by histology. Prior to initiating treatment, a portacath was surgically implanted. Subsequently, the patient received a weekly dose of 1,000 mg/m(2) gemcitabine combined with 2,000 mg/m(2) high-dose 5-fluorouracil as a 24-hour infusion for palliative treatment. As the patient was suffering from a stenosis of the ductus hepaticus communis, an endoprosthesis was primarily implanted. After 18 applications of chemotherapy during which only low toxic side effects such as nausea, vomiting and alopecia (NCI-CTC grade 1) presented, a partial remission of the primary tumor was observed. In the course of chemotherapy treatment, the carbohydrate antigen 19-9 tumor marker value normalized. Thus, the interdisciplinary tumor board of the University of Erlangen decided to perform a laparoscopy to evaluate the status of liver metastases after palliative chemotherapy treatment. Subsequently, the primary tumor could be completely resected (pT2, pN0, pM0, L0, V0, G2, R0); liver metastases were not observed. Eight years after the initial diagnosis, the patient is relapse-free, professionally fully integrated and presents with an excellent performance status.
Patients suffering from metastatic pancreatic cancer may benefit from treatment combinations with palliative intent. In singular cases, patients may even have a curative treatment option, provided a close interdisciplinary collaboration exists.
胰腺癌患者的预后通常较差。特别是在晚期和转移性疾病的情况下，只有少数病例能实现长期无复发生存。
一名45岁患者被诊断为转移性胰腺癌。术中经组织学证实存在肝转移。在开始治疗前，通过手术植入了一个输液港。随后，患者接受每周一次的姑息治疗，剂量为1000mg/m²吉西他滨联合2000mg/m²高剂量5-氟尿嘧啶持续24小时静脉输注。由于患者存在肝总管狭窄，首先植入了一个内支架。在进行了18次化疗后，仅出现了如恶心、呕吐和脱发等低毒性副作用（美国国立癌症研究所常见毒性标准1级），并观察到原发肿瘤部分缓解。在化疗过程中，糖类抗原19-9肿瘤标志物值恢复正常。因此，埃尔朗根大学的多学科肿瘤委员会决定进行腹腔镜检查，以评估姑息化疗后肝转移的情况。随后，原发肿瘤得以完全切除（pT2，pN0，pM0，L0，V0，G2，R0）；未观察到肝转移。在初次诊断八年后，患者无复发，已完全融入职业生活，且表现状态极佳。
转移性胰腺癌患者可能从姑息性联合治疗中获益。在个别情况下，只要存在密切的多学科协作，患者甚至可能有治愈性的治疗选择。
