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Metastasized pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy and R0 resection

World Journal of Gastroenterology 2015年第20期21卷 6384-6390页

作者： Sophie Schneitler Patric Krpil Jasmin Riemer Gerald Antoch Wolfram Trudo Knoefel Dieter Hussinger Dirk Graf Department of Gastroenterology Hepatology and Infectious DiseasesMedical FacultyUniversity Düsseldorf Department of Diagnostic and Interventional Radiology Medical FacultyUniversity Düsseldorf Department of Pathology Medical FacultyUniversity Düsseldorf Department of General Surgery Medical FacultyUniversity Düsseldorf

Patients with metastasized carcinoma of the pancreas have a very poor prognosis, and long-term survival cannot be expected. This case report describes two patients with an initial diagnosis of metastatic pancreatic cancer, both with hepatic metastases and one with an additional peritoneal carcinomatosis. Initially, both patients were treated intravenously with the FOLFIRINOX chemotherapy regimen, consisting of 5-FU, folinic acid, irinotecan and oxaliplatin. Surprisingly, the FOLFIRINOX treatment resulted in complete resolution of the hepatic metastases in both patients, with no lesions detectable by computed tomography scan. Furthermore, treatment response included decreased diameter of the primary tumor in the tail of the pancreas and disappearance of the additional peritoneal carcinomatosis. Both patients were discussed by our multidisciplinary tumor board, which recommended surgical resections of the carcinoma. The R0 resection of the primary tumor was successful in both cases and, interestingly, the resected tissues showed no evidence of the hepatic metastases intraoperatively. In the first case, the patient received a postoperative 6-mo course of adjuvant chemotherapy with gemcitabine. In the second case, the patient continued to receive the FOLFIRINOX regimen for an additional 6 mo postoperatively. At 12 mo after the operation, a nonresectable retroperitoneal lymph node metastasis was detected in the first patient, whereas the second patient remained in complete remission at the time of this report(5 mo after the adjuvant therapy was discontinued). This case report is the first of its kind to describe two cases of hepatic metastatic pancreatic carcinoma that were resectable following treatment with FOLFIRINOX. Further studies are required to examine the role of FOLFIRINOX as a neoadjuvant treatment option in subgroups of patients with initially metastasized pancreatic carcinoma.

关键词： FOLFIRINOX Neoadjuvant treatment ofpancreatic neoplasms Chemotherapy metastaticpancreatic neoplasm Curative operation

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