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Complete pathological response after neoadjuvant chemotherapy and the benefit of subsequent surgery in oligometastatic pancreatic cancer patient


Authors: A. Langer 1;  M. Loveček 2;  O. Urban 3;  D. Kurfúrstová 4;  R. Kovář 5,6;  B. Mohelníková Duchoňová 1
Authors place of work: Onkologická klinika LF UP a FN Olomouc 1;  I. chirurgická klinika LF UP a FN Olomouc 2;  II. interní klinika – gastroenterologická a geriatrická LF UP a FN Olomouc 3;  Ústav klinické a molekulární patologie, FN Olomouc 4;  Radiologická klinika LF UP a FN Olomouc 5;  LF a FZV UP v Olomouci 6
Published in the journal: Rozhl. Chir., 2024, roč. 103, č. 11, s. 454-457.
Category: Case Report
doi: https://doi.org/10.48095/ccrvch2024454

Summary

Introduction: Pancreatic cancer is one of the most aggressive tumors diagnosed in local­ly advanced or metastatic stage in more than half of the cases. The standard of care is a systemic chemotherapy but the prognosis of metastatic patients remains extremely poor with a median overall survival less than one year.  However, there is increasing evidence of surgery treatment benefit in a carefully selected oligometastatic cases.  ­Because oligometastatic pancreatic cancer is rare, there is a lack of robust clinical trials defining strategy, efficacy and safety of this procedure.

Patient concerns: A 77-year-old man presented with a mass in the tail of the pancreas and solitary liver metastasis. After four cycles of chemotherapy, distal pancreatectomy with liver metastasectomy was performed, and the tissues were histologically examined. The complete pathological response was found in the primary tumor and residual adenocarcinoma in liver metastasis.

Outcomes: The patient is alive without recurrency more than two years from the diagnosis.

Keywords:

resection – Pancreas – carcinoma – oligometastatic


Zdroje
1.           ÚZIS. Novotvary 2019–2021 ČR. [online]. Dostupné z: https://www.uzis.cz/res/f/008447/novotvary2019-2021.pdf.
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3.           Crippa S, Bittoni A, Sebastiani E et al. Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol 2016; 42(10): 1533–1539. doi: 10.1016/j.ejso.2016.06.398.
4.           Frigerio I, Regi P, Giardino A et al. Downstaging in stage IV pancreatic cancer: a new population eligible for surgery? Ann Surg Oncol 2017; 24(8): 2397–2403. doi: 10.1245/s10434-017-5885-4.
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6.           Nagai M, Wright MJ, Ding D et al. Oncologic resection of pancreatic cancer with isolated liver metastasis: favorable outcomes in select patients. J Hepatobiliary Pancreat Sci 2023; 30(8): 1025–1035. doi: 10.1002/jhbp.1303.
7.           Sugawara T, Rodriguez Franco S, Sherman S et al. Neoadjuvant chemotherapy versus upfront surgery for resectable pancreatic adenocarcinoma: an updated nationwide study. Ann Surg 2024; 279(2): 331–339. doi: 10.1097/SLA.0000000000005925.
8.           Banks S, Hong W, Degeling K et al. Impact of neoadjuvant FOLFIRINOX over upfront resection in borderline resectable pancreatic cancer – an international, multicentre, real-world analysis. ESMO Real World Data Dig Oncol 2024; 3: 100022.
9.           Gebauer F, Damanakis AI, Popp F et al. Study protocol of an open-label, single arm phase II trial investigating the efficacy, safety and quality of life of neoadjuvant chemotherapy with liposomal irinotecan combined with Oxaliplatin and 5-fluorouracil/Folinic acid followed by curative surgical resection in patients with hepatic Oligometastatic adenocarcinoma of the pancreas (HOLIPANC). BMC Cancer 2021; 21(1): 1239. doi: 10.1186/s12885-021-08966-3.
10.         Wei M, Shi S, Hua J et al. Simultaneous resection of the primary tumour and liver metastases after conversion chemotherapy versus standard therapy in pancreatic cancer with liver oligometastasis: protocol of a multicentre, prospective, randomised phase III control trial (CSPAC-1). BMJ Open 2019; 9(12): e033452. doi: 10.1136/bmjopen-2019-033452.
MUDr. Aleš Langer
Onkologická klinika
LF UP a FN Olomouc
Zdravotníků 248/7
779 00 Olomouc
Štítky
Surgery Orthopaedics Trauma surgery

Článok vyšiel v časopise

Perspectives in Surgery

Číslo 11

2024 Číslo 11
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