title: Widespread lymph node recurrence of major duodenal papilla cancer following pancreaticoduodenectomy.
abstract: Major duodenal papilla cancer (MDPC) represents the primary type of duodenal cancer, and is typically considered a periampullary carcinoma as most tumors arise in this region. This report describes an extremely rare case involving a patient with rapidly and extensively recurrent MDPC following pancreaticoduodenectomy, who achieved complete response by concurrent image-guided radiation and intravenous oxaliplatin plus oral capecitabine therapies. The patient was a 50-year-old female who was admitted to our hospital 6 wk after resection for MDPC for evaluation of a nontender and enlarged node in the left side of her neck. After clinical work-up, the patient was diagnosed with postoperatively recurrent MDPC with widespread lymph node metastases at the bilateral cervix, mediastinum, abdominal cavity, and retroperitoneal area. She was administered whole field image-guided radiation therapy along with four cycles of the intravenous oxaliplatin plus oral capecitabine regimen. A complete response by positron emission tomography with 18-fluorodeoxyglucose was observed 4 months after treatment. The patient continues to be disease-free 2 years after the diagnosis of recurrence.
authors.affiliation: Bai-Sen Li, Ming-Yong Xiao, Jian Wang, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China.
authors.forename: Bai-Sen
authors.initials: BS
authors.lastname: Li
authors.affiliation: Bai-Sen Li, Ming-Yong Xiao, Jian Wang, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Shi
authors.affiliation: Bai-Sen Li, Ming-Yong Xiao, Jian Wang, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wen
authors.affiliation: Bai-Sen Li, Ming-Yong Xiao, Jian Wang, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China.
authors.forename: Ming-Yong
authors.initials: MY
authors.lastname: Xiao
authors.affiliation: Bai-Sen Li, Ming-Yong Xiao, Jian Wang, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine / Q000008:administration & dosage; D059248:Chemoradiotherapy; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D016577:Pancreaticoduodenectomy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012074:Remission Induction; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D019275:Radiopharmaceuticals; D000077150:Oxaliplatin; D019788:Fluorodeoxyglucose F18; D000069287:Capecitabine
keywords: Chemoradiotherapy; Complete response; Neoplasm recurrence; Pancreaticoduodenectomy; Periampullary cancer