title: Metastasized pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy and R0 resection.
abstract: Patients with metastasized carcinoma of the pancreas have a very poor prognosis, and long-term survival cannot be expected. This case report describes two patients with an initial diagnosis of metastatic pancreatic cancer, both with hepatic metastases and one with an additional peritoneal carcinomatosis. Initially, both patients were treated intravenously with the FOLFIRINOX chemotherapy regimen, consisting of 5-FU, folinic acid, irinotecan and oxaliplatin. Surprisingly, the FOLFIRINOX treatment resulted in complete resolution of the hepatic metastases in both patients, with no lesions detectable by computed tomography scan. Furthermore, treatment response included decreased diameter of the primary tumor in the tail of the pancreas and disappearance of the additional peritoneal carcinomatosis. Both patients were discussed by our multidisciplinary tumor board, which recommended surgical resections of the carcinoma. The R0 resection of the primary tumor was successful in both cases and, interestingly, the resected tissues showed no evidence of the hepatic metastases intraoperatively. In the first case, the patient received a postoperative 6-mo course of adjuvant chemotherapy with gemcitabine. In the second case, the patient continued to receive the FOLFIRINOX regimen for an additional 6 mo postoperatively. At 12 mo after the operation, a nonresectable retroperitoneal lymph node metastasis was detected in the first patient, whereas the second patient remained in complete remission at the time of this report (5 mo after the adjuvant therapy was discontinued). This case report is the first of its kind to describe two cases of hepatic metastatic pancreatic carcinoma that were resectable following treatment with FOLFIRINOX. Further studies are required to examine the role of FOLFIRINOX as a neoadjuvant treatment option in subgroups of patients with initially metastasized pancreatic carcinoma.
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Sophie
authors.initials: S
authors.lastname: Schneitler
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Riemer
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
authors.affiliation: Sophie Schneitler, Dieter Häussinger, Dirk Graf, Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Graf
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D021441:Carcinoma, Pancreatic Ductal / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006498:Hepatectomy; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D012074:Remission Induction; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin; D000093542:Gemcitabine
keywords: Chemotherapy; Curative operation; FOLFIRINOX; Metastatic pancreatic neoplasm; Neoadjuvant treatment of pancreatic neoplasms