Salvage Pancreaticoduodenectomy After Complete Response to Chemoradiotherapy for a Previously Unresectable Pancreatic Adenosquamous Carcinoma

Abstract

Pancreatic cancer is known for its typically late presentation and poor survival rates, with overall 5-year survival of less than 5%. The role of chemotherapy alone or with radiotherapy in the management of locally advanced tumors continues to be an area of debate.We report a case of locally advanced, pancreatic adenosquamous carcinoma that was initially deemed unresectable intraoperatively. Nonetheless, the tumor was resected after radiological response to gemcitabine-capecitabine chemoradiotherapy regimen similar to the Selective Chemoradiation in Advanced LOcalised Pancreatic cancer trial. Histological examination revealed complete pathological response with extensive fibrosis (ypT0 N0). On 12-month follow-up CT, a single liver lesion in the left lateral segment was identified and confirmed to be a metastasis with cytological diagnosis via EUS and FNA. The disease remained stable and confined to the solitary hepatic metastasis after further gemcitabine chemotherapy. Therefore, a further successful resection was performed.The 2 main strategies for the management of locally advanced unresectable pancreatic cancer are chemotherapy induction followed by consolidation chemoradiotherapy or chemotherapy alone, with conflicting published evidence. Evidence for the optimal management of the rare histological type of adenosquamous carcinoma is scant. We present a case of such tumor with a complete pathological response to chemoradiotherapy. The results of future studies in the area are eagerly awaited.

Pathological complete response after neoadjuvant therapy for pancreatic ductal adenocarcinoma does not equal cure

“…1). 6–17,20–41 The level of evidence was graded as level 4 in all included studies. The descriptive characteristics of the included patients are illustrated in Table 1 and crude individual patients' data are shown in Table S1.…”

Complete pathological response following neoadjuvant FOLFIRINOX in borderline resectable pancreatic cancer - a case report and review

“…In patients with borderline resectable or locally advanced pancreatic cancer, neoadjuvant therapy has been shown to lead to pCR in 13.6 % of patients [ 38 ]. However, these studies considered all forms of neoadjuvant therapy and currently, most existing reports of pCR in pancreatic cancer involve chemoradiation rather than chemotherapy alone [ 6 , 15 – 20 , 39 – 49 ]. Other reports of complete responses have been only radiologically confirmed [ 34 , 50 – 52 ].…”

“…Early intervention in non-metastatic pancreatic cancer is crucial as metastases have been shown to occur unexpectedly before clinical detection is possible [ 3 – 5 ]. Surgical resection is thought to be the only curative treatment for pancreatic adenocarcinoma and offers a five year survival rate of 10–15 % [ 1 , 6 , 7 ]. Neoadjuvant chemotherapy is often implemented in an effort to increase the incidence of R0 resections, reduce local recurrences, treat occult micrometastases, and to downstage a borderline resectable tumor to the point of possible resection [ 1 ].…”