title: [Long-Term Survival after Locally Advanced Pancreatic Ductal Adenocarcinoma Treated with Multidisciplinary Therapy - A Case Report].
abstract: A 60-year-old man visited a hospital with concerns about his physical health, including weight loss, thirst, and polyuria. He was diagnosed with acute onset of diabetes, and a pancreatic head tumor was observed on imaging studies. Computed tomography(CT)indicated that the tumor infiltrated the surrounding major vessels, portal vein(PV, 360 degrees), and superior mesenteric artery(SMA, <180 degrees). Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)was performed, and he was diagnosed with a borderline resectable(BR)clinical Stage IV a pancreatic ductal adenocarcinoma (PDAC). Chemoradiation therapy(CRT, S-1 plus gemcitabine [GEM] concurrent with 50.4 Gy radiation)followed by chemotherapy( GEM)was performed until a tumor response indicating sufficient reduction of SMA infiltration was observed on imaging studies. Twelve months after initiation of treatment, a pancreaticoduodenectomy and PV resection/reconstruction were performed. The pathological stage was ypT3N0M0(ypStage III ), and SMA infiltration was not detected in the resected specimen. He was discharged after an uneventful course following surgery, and adjuvant S-1 chemotherapy was continued from post-operative day 67 for 4 months. Now at post-operative 57 month, he has survived without recurrence. There have been some reports detailing long-term survival of patients with BR tumors who underwent multidisciplinary therapy as curative resection following preoperative CRT and postoperative adjuvant chemotherapy. During preoperative treatment, it is important to monitor the effects and determine the suitable timing to perform surgery to achieve long-term survival.
authors.affiliation: Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University.
authors.forename: Goro
authors.initials: G
authors.lastname: Ueno
authors.forename: Daisaku
authors.initials: D
authors.lastname: Yamada
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Tadafumi
authors.initials: T
authors.lastname: Asaoka
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawamoto
authors.forename: Kunihito
authors.initials: K
authors.lastname: Goto
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004338:Drug Combinations; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008297:Male; D010094:Oxonic Acid / Q000008:administration & dosage; D016577:Pancreaticoduodenectomy; D005641:Tegafur / Q000008:administration & dosage; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine