title: Long-term complete response of multiple hepatic metastases from carcinoma of the papilla of Vater using intrahepatic infusion of 5-FU with low-dose cisplatin following pancreaticoduodenectomy.
abstract: Of all distant metastases from carcinoma of the papilla of Vater (CPV), the liver is the most frequent site (more than 60%) and should be specifically targeted in the effort to improve the prognosis. However, the optimal chemotherapy regimen for nonresectable liver metastasis has not been clearly established. In this preliminary report, we note a patient with multiple hepatic metastases from CPV successfully treated using intrahepatic infusion of 5-fluorouracil (FU) with low-dose cisplatin. A 62-year-old woman underwent curative pylorus-preserving pancreaticoduodenectomy for CPV. Four months after surgery, followup computed tomography (CT) demonstrated multiple liver metastases. Weekly intrahepatic arterial infusion chemotherapy of 5-FU, 350 mg/m(2), with low-dose cisplatin (7 mg/m(2)) was started. Ten months after starting chemotherapy, a complete response was obtained. To date, the patient continues to receive this weekly hepatic arterial infusion chemotherapy without any side effects, and she has successfully maintained a long-term complete response for 20 months. The patient remains well and was able to proceed with daily activity at the last follow up 30 months after starting this chemotherapy regimen. This regimen is safe and effective and is recommended as one of the treatment choices for liver metastases from CPV.
authors.affiliation: Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan. skomatsu@koto.kpu-m.ac.jp
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Hiroko
authors.initials: H
authors.lastname: Okamura
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012074:Remission Induction; D014057:Tomography, X-Ray Computed
chemical_list: D002945:Cisplatin; D005472:Fluorouracil