Fujishiro Takeshi, Mashiko Taro, Masuoka Yosihito, Yamada Misuzu, Furukawa Daisuke, Yazawa Naoki, Kawashima Yohei, Ogawa Masami, Hirabayashi Kenichi, Nakagohri Toshio
Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1193, Japan.
Department of Gastroenterology, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1193, Japan.
Surg Case Rep. 2018 Sep 10;4(1):112. doi: 10.1186/s40792-018-0522-4.
Pancreatic cancer has a very high mortality rate worldwide, and about 30-40% of all patients have extensive vascular involvement at initial diagnosis that precludes surgical intervention. Here, we describe our experience in a patient with locally advanced pancreatic cancer (LAPC) who underwent R0 conversion surgery after undergoing a combination of chemotherapy and carbon-ion radiotherapy (CIRT), which led to long-term relapse-free survival (23 months).
A 41-year-old woman presented a month ago with epigastralgia referred to our facility and was subsequently diagnosed with pancreatic cancer cStage III (Ph, TS2 (35 mm), cT4, cCH1, cDU1, cS1, cRP1, cPL1, cVsm0, cAsm1, cN0, cM0) that was also categorized as an unresectable LAPC. She immediately underwent 3 cycles of induction chemotherapy (gemcitabine + nanoparticle albumin-bound (nab-) paclitaxel) followed by CIRT with concurrent gemcitabine. Although significant shrinkage of the primary tumor occurred, frequent cholangitis due to duodenal stenosis of unknown etiology prevented continued chemotherapy, and 9 months after the first visit, she underwent a radical, subtotal, stomach-preserving, pancreaticoduodenectomy (SSPPD). Histopathologic examination of the resected tissue revealed a R0 resection with a histological response of Evans grade IIB. She was administered an almost full dose of S-1 as adjuvant chemotherapy for 6 months and has shown no signs of recurrence in 23 months.
We report a first case of successful conversion surgery for an initially unresectable LAPC after rapid induction GEM + nab-PTX chemotherapy followed by CIRT. Rapid induction GEM + nab-PTX chemotherapy followed by CIRT for LAPC might be a safe and effective treatment option.
胰腺癌在全球范围内死亡率极高，约30%-40%的患者在初诊时就有广泛的血管受累，从而无法进行手术干预。在此，我们描述了一名局部晚期胰腺癌（LAPC）患者的治疗经历，该患者在接受化疗和碳离子放疗（CIRT）联合治疗后接受了R0根治性手术，实现了23个月的长期无复发生存。
一名41岁女性于1个月前因上腹部疼痛前来我院就诊，随后被诊断为胰腺癌c期III（Ph，TS2（35mm），cT4，cCH1，cDU1，cS1，cRP1，cPL1，cVsm0，cAsm1，cN0，cM0），也被归类为不可切除的LAPC。她立即接受了3个周期的诱导化疗（吉西他滨+纳米白蛋白结合型（nab-）紫杉醇），随后进行CIRT并同时使用吉西他滨。尽管原发肿瘤显著缩小，但由于病因不明的十二指肠狭窄导致频繁发生胆管炎，无法继续化疗。在首次就诊9个月后，她接受了根治性、保留胃的胰十二指肠次全切除术（SSPPD）。切除组织的组织病理学检查显示为R0切除，组织学反应为埃文斯IIB级。她接受了近全剂量的S-1辅助化疗6个月，在23个月内未出现复发迹象。
我们报告了首例在快速诱导吉西他滨+nab-紫杉醇化疗后进行CIRT，成功将最初不可切除的LAPC转化为可手术切除的病例。对于LAPC，快速诱导吉西他滨+nab-紫杉醇化疗后进行CIRT可能是一种安全有效的治疗选择。
