Neoadjuvant chemotherapy in locally advanced duodenal adenocarcinoma

Abstract

Duodenal adenocarcinoma (ADC) represents only 0.3% of gastrointestinal neoplasms. With the frequency being higher between the ages of 40 and 60, it is predominantly located in the second part of the duodenum and around the periampullary region. Symptoms are nonspecific, so the majority of patients present with advanced disease. Neoadjuvant chemotherapy is a therapeutic option that has not been well studied. The global literature includes only isolated reports on this subject. This is why we are presenting the following case: a 60-year-old female patient with a locally advanced, inoperable duodenal ADC received neoadjuvant chemotherapy. Having presented a favourable response as observed in the post-neoadjuvant extension studies, a pancreaticoduodenectomy was performed without any perioperative complications and with satisfactory progress. The final biopsy reported a complete pathological response. After being monitored for 34 months, the patient was free from locoregional and distant metastatic disease. During the last weeks of monitoring, she developed a second primary breast tumour, which has been corroborated by immunohistochemistry.

Simple Versus Radical Resection for Duodenal Adenocarcinoma: A Propensity Score Matched Analysis of National Cancer Database

“…Approximately 1% of malignant gastrointestinal neoplasms occur in the small bowel, of which nearly half are primary duodenal adenocarcinoma. [1][2][3][4][5] Clinical management of these tumors is a challenge, and prognosis depends on factors such as margin status and lymph node metastasis, among others. [6][7][8][9][10][11] While surgical resection has been demonstrated to improve survival relative to nonsurgical or palliative treatment, questions remain regarding the optimal extent of surgical resection-simple or radical-as most existing studies are limited by small numbers of patients and are primarily single-institution retrospective reviews.…”

A pathological complete response by chemotherapy with S-1 and oxaliplatin for a locally advanced duodenal adenocarcinoma in Lynch syndrome: a case report

“…On the other hand, several articles reported that chemotherapy for unresectable DAs achieved pCRs [23–27]. In all of the cases with pCR, the regimens used were a combination of a fluoropyrimidine and oxaliplatin, such as FOLFOX [23, 24], CapOX [26, 27], and SOX [25]. Some cases of conversion from unresectable to resectable DA by chemotherapy using a fluoropyrimidine and cisplatin have been reported.…”

Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad

“…Duodenal adenocarcinomas are rare, represent 0.3% of gastrointestinal and 33-45% of the small bowel tumors, and with nonspecific symptoms, the diagnosis is incidental. [1][2][3][4][5][6][7][8][9][10] They are prevalent in the second duodenal portion of people between 40 and 60 years. 10 Risk factors include alcohol, smoked or salt-cured foods, red meats, refined sugars, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis.…”

“…[1][2][3][4][5][6][7][8][9][10] They are prevalent in the second duodenal portion of people between 40 and 60 years. 10 Risk factors include alcohol, smoked or salt-cured foods, red meats, refined sugars, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis. 2,7,8 Duodenal adenocarcinoma is strongly associated with the rare tubulovillous and villous adenomas, a phenomenon favoring misdiagnosis or late cancer diagnosis.…”

“…1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options. 10,11 Adjuvant or neoadjuvant chemotherapy are tools for patients considered inoperable. 7,10 Saint's triad (ST) includes hiatus hernia, cholecystopathy, and colon diverticulosis, but aortic aneurysm and dilated cardiomyopathy are additional changes of the pentad.…”