Local Recurrence after Surgical Resection of Pancreatic Cancer Effectively Treated with Combined Chemoradiotherapy; A Case Report with 5-Year Survival

Noriaki Nakamura, Kazumi Nakajima*, Narihide Goseki* and Shigeki Arii

Department of Hepato-Pancreatic Biliary Surgery, Tokyo Medical and Dental University
Department of Surgery, Shuwa General Hospital*

Despite many reports of pancreatic cancer resection followed by postoperative adjuvant chemotherapy and chemoradiotherapy, few reports consider the treatment of locally recurrent lesions following primary surgery. We report a 49-years-old woman diagnosed with pancreatic head cancer due to obstructive jaundice. Pancreatoduodenectomy (R0 pT3, pN0, M0 fStageIII) was conducted in August 2002 without postoperative adjuvant therapy. Two years and seven months after primary surgical resection, her serum tumor marker (CA19-9) increased and local recurrence was diagnosed around the superior mesenteric artery was diagnosed by upper abdominal computed tomography scan in March 2005. Due to the difficulty of surgical resection, we combined chemoradiotherapy-chemotherapy with 5 times of Gemcitabine (400 mg/m²/week) and radiation with 50 Gy divided into 25 times at 2.0 Gy/day-conducted without severe adverse events. Serum CA19-9 decreased immediately and the local tumor was found in CT to have shrunk. GEM (1,000 mg/m²) was administered biweekly for over two years after chemoradiotherapy. No sign of tumor progression has been in the five years since the first surgical resection of pancreatic head cancer. The combined chemoradiotherapy is thus feasible and an effective treatment option in local recurrence after primary pancreatic cancer surgery.

Key words
pancreatic cancer, local recurrence, chemoradiotherapy

Reprint requests
Noriaki Nakamura Department of Hepato-Pancreatic Biliary Surgery, Tokyo Medical and Dental University
1-5-45 Yushima, Bunkyo-ku, 113-8519 JAPAN

Accepted
February 20, 2008

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