Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
BMC Cancer. 2020 Mar 30;20(1):271. doi: 10.1186/s12885-020-06718-3.
Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases.
We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis.
Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.
转移性胰腺癌的总体中位生存期不足 12 个月，即使接受化疗也是如此。对于寡转移性疾病的选定患者，联合化疗和手术治疗或转移灶射频消融（RFA）的多模式治疗可能有益。
我们介绍了一位患有寡转移性胰腺癌复发的患者，他通过多模式治疗方法成功得到了治疗。一名 57 岁男性最初表现为可切除的胰腺癌，接受了胰十二指肠切除术。组织病理学诊断显示为导管腺癌，手术切缘阳性，淋巴结阴性。他完成了六周期的吉西他滨（1000mg/mq 1,8,15q 28）辅助治疗，随后进行了外部放疗（54Gy 分 25 次）联合每周两次吉西他滨 50mg/mq。三年后，患者出现多个肝转移，开始接受 FOLFIRINOX（奥沙利铂 85mg/mq、伊立替康 180mg/mq、亚叶酸钙 400mg/mq 和氟尿嘧啶 400mg/mq 作为推注，随后 2400mg/mq 作为 46 小时持续输注，1q 14）作为一线治疗。6 个周期后 CT 扫描显示部分缓解。经过多学科讨论，患者接受了三个肝转移灶的剖腹手术切除术。在完成 4 个周期的 FOLFIRINOX 方案后进行了额外的术后化疗，患者在 12 个月内无复发。CT 扫描显示新的单个肝转移灶，接受射频消融（RFA）治疗。在第一次 RFA 后 12 个月，当患者出现另一个单一肝病变时，进行了第二次 RFA；目前，患者无复发，总生存时间从诊断起为 6 年。
我们的病例受益于成功的多模式治疗，包括手术和局部消融技术以及全身化疗。对于寡转移性胰腺癌的选定患者，多模式方法可能是合理的，可以提高总体生存率。需要进一步研究来探讨这种方法。
