title: Intra- and postoperative radiation therapy for an alpha-fetoprotein-producing pancreatic carcinoma.
abstract: We describe an alpha-fetoprotein (AFP)-producing pancreatic cancer irradiated intra- and postoperatively. A 64-year-old man with a hypoechic lesion in the pancreatic head and body was referred to us. On admission, his serum AFP level was markedly elevated (441 ng/ml). Computed tomography showed a 65 x 35 mm diameter tumor in the pancreatic head and body. The tumor periphery was enhanced with contrast medium. Angiography revealed faint tumor staining. After laparotomy, curative resection was impossible, because several arteries were embedded in the metastatic lymph nodes. Core needle biopsy was performed. The tumor was irradiated intraoperatively (25 Gy; area, 8 cm(2)). The diagnosis was moderately to poorly differentiated pancreatic adenocarcinoma. Immunohistochemical staining revealed AFP-positive cytoplasm in some cancer cells. The tumor shrunk significantly (longest axis, from 65 to 30 mm) after postoperative external beam radiation therapy (total, 40 Gy). The serum AFP level fell dramatically (from 441 to 2.5 ng/ml). However, distal gastrectomy for postradiation gastric ulceration was required. The patient did well without tumor regrowth or signs of liver or lymph node metastases 1 year 10 months after his first operation. In conclusion, we treated a rare AFP-producing pancreatic cancer with radiotherapy, which was effective. However, care is needed to avoid external beam radiation-induced gastrointestinal ulceration.
authors: First Department of Surgery, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
authors: Ichiro
authors: I
authors: Hirai
authors: Wataru
authors: W
authors: Kimura
authors: Masahiro
authors: M
authors: Kamiga
authors: Hiroyuki
authors: H
authors: Shibasaki
authors: Kiyoshi
authors: K
authors: Kawaguchi
authors: Akira
authors: A
authors: Fuse
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000532:radiotherapy*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000532:radiotherapy*; D011184:Postoperative Period; D000509:alpha-Fetoproteins / Q000096:biosynthesis*
chemical_list: D000509:alpha-Fetoproteins