title: Pathological Complete Remission of Pancreatic Cancer Following Neoadjuvant Chemoradiation Therapy; Not the End of Battles.
abstract: In spite of controversial issues, pancreatectomy following neoadjuvant chemoradiation therapy (NeoCRT) has been applied in treating advanced pancreatic cancer. Cases of pathological complete remission (pCR) following NeoCRT is rare, and its long-term follow-up data are still lacking.From January 2000 to December 2012, medical records of the patients who underwent pancreatectomy for pancreatic ductal adenocarcinoma were retrospectively reviewed. Characteristics of the patients with pCR were summarized and their long-term follow-up data were analyzed.Among 86 patients with pancreatic cancer who underwent radical pancreatectomy following NeoCRT, 10 patients (11.6%) were reported to pCR. Nine out of 10 patients received gemcitabine-based chemoradiation therapy. Median pre-NeoCRT serum CA 19-9 was 313.5 U/ml, and post-NeoCRT serum CA 19-9 was 9.9 U/ml, which was shown to be significant difference between 2 serum CA 19-9 level (P = 0.005). Pylorus-preserving pancreaticoduodenectomy was done in 8 patients, and the others received distal pancreatosplenectomy. Postoperative chemotherapy was received in 6 patients. Disease-free survival was statistically superior in patients with pCR than patients without pCR (P < 0.05). However, 5 patients experienced cancer recurrence and no clinicopathologic variables including preoperative resectability could not predict the potential recurrence of tumor in patients with pCR (P > 0.05).pCR is rarely reported following NeoCRT, but this condition is not telling the cure of the disease. Early recurrence in the pattern of liver metastasis and peritoneal seeding can be expected. However, long-term survival could be maintained in patients without recurrence. Further investigation is necessary for predicting failure of treatment.
authors.affiliation: From the Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea (SHL, CMK, HKH, WJL); Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea (HK); Department of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea (SYS); Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea (JSS); Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea (MJK).
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Hogeun
authors.initials: H
authors.lastname: Kim
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
authors.forename: Myoung Jin
authors.initials: MJ
authors.lastname: Kim
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine