title: Neoadjuvant chemoradiation therapy for borderline pancreatic adenocarcinoma: report of two cases.
abstract: Pancreatic cancer remains as one of the most aggressive human neoplasms, with overall poor survival rates. Radical surgery of the primary lesion is the best option for treatment. Borderline resectable pancreatic tumors (BRPT), defined as partial involvement of peripancreatic vasculature, may benefit from neoadjuvant therapy. We report on the first two BRPT cases treated with neoadjuvant chemoradiation at our institution. Preoperative CT and MRI demonstrated pancreatic tumors encasing the porto-mesenteric confluence suggestive of BRPT. Patients received neoadjuvant chemotherapy (gemcitabine/cisplatin), followed by radiochemotherapy. After treatment, follow-up images demonstrated tumor downsize, allowing for the tumors to be considered then as resectable. They underwent partial pancreatoduodenectomies (Whipple procedure). In case 1, histopathology revealed a complete, margin-free resection, whereas in case 2 there was a complete pathological response, with no evidence of residual tumor. According to the literature, our initial experience using neoadjuvant chemoradiotherapy on BRPT allowed us to downsize the tumor and, subsequently, to perform a curative surgery.
authors: Department of Digestive Surgery, Hospital Clínico Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile.
authors: José
authors: J
authors: Galindo
authors: Mauricio
authors: M
authors: Gabrielli
authors: Juan Francisco
authors: JF
authors: Guerra
authors: Juan Carlos
authors: JC
authors: Cassina
authors: Marcelo
authors: M
authors: Garrido
authors: Nicolás
authors: N
authors: Jarufe
authors: Yerko
authors: Y
authors: Borghero
authors: Jorge
authors: J
authors: Madrid
authors: Pablo
authors: P
authors: Zoroquiain
authors: Juan Carlos
authors: JC
authors: Roa
authors: Jorge
authors: J
authors: Martínez
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine
references: Ann Surg Oncol. 2006 Aug;13(8):1035-46
references: 16865597
references: HPB Surg. 2008;2008:839503
references: 19283083
references: J Gastrointest Surg. 2011 Nov;15(11):2059-69
references: 21913045
references: World J Gastroenterol. 2007 Dec 21;13(47):6433-5
references: 18081235
references: Am J Surg. 2008 Mar;195(3):318-21
references: 18308038
references: J Am Coll Surg. 2008 May;206(5):833-46; discussion 846-8
references: 18471707
references: Expert Rev Anticancer Ther. 2011 Oct;11(10):1555-65
references: 21999129
references: Cancer. 1990 Jul 1;66(1):56-61
references: 2354408
references: J Gastrointest Surg. 2000 Nov-Dec;4(6):567-79
references: 11307091
references: Surg Clin North Am. 2009 Feb;89(1):115-31, ix
references: 19186234
references: Cancer Radiother. 2009 Apr;13(2):123-43
references: 19167921
references: HPB (Oxford). 2010 Feb;12(1):73-9
references: 20495649
references: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references: 20610543