Complete Response after Multidisciplinary Therapy for cStage IV Pancreatic Body Cancer with Liver Metastasis

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  • Idichi Tetsuya
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Kurahara Hiroshi
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Maemura Kousei
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Mataki Yuko
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Kawasaki Yota
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Sakoda Masahiko
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Iino Satoru
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University
  • Ueno Shinichi
    Department of Clinical Oncology, Kagoshima University
  • Shinchi Hiroyuki
    Faculty of Medicine School of Health Sciences, Kagoshima University
  • Higashi Michiyo
    Department of Pathology, Research Field in Medicine and Health Sciences, Kagoshima University
  • Natsugoe Shouji
    Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University

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  • 集学的治療で完全奏効が得られた肝転移を伴うcStage IV膵体部癌の1例

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<p>A 69-year-old woman was initially given a diagnosis of unresectable pancreatic body cancer with liver metastasis and involvement of the celiac plexus. The pretreatment diagnosis according to the General Rules of the Study of Pancreatic Cancer (7th edition) was TS3 (35 mm), cT3, cS1, cRP1, cPV1 (PVp, PVsp), cA1 (Asp), cPL1, cN0, cM1 (HEP), cStage IV. After 6 courses of systemic chemotherapy (gemcitabine and nab-paclitaxel), the liver metastasis disappeared, however, the primary tumor invading the root of the splenic artery remained. Therefore, we performed chemoradiotherapy (CRT: S-1+56 Gy) for further local treatment. After CRT, we continued S-1 administration. Reassessment 12 months after the initial treatment by imaging examinations was complete response (CR). Serum CA 19-9 levels decreased from 1,846 U/ml to 13.3 U/ml. In consideration of remaining histological cancer cells, we performed resection of the pancreatic body and tail with regional lymph node dissection, splenectomy, and partial hepatectomy. Histopathological examination revealed that the tumor was replaced by fibrosis and no cancer cells were observed in the pancreas and liver. The evaluation of histopathological response to the preoperative therapy was CR. The patient remains alive without recurrence at 18 months after initial treatment and 6 months after surgical resection.</p>

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