Pathological complete response after S-1 therapy for an unresectable pancreatic head cancer with liver metastasis

Abstract

A 58-year-old man was found to have borderline resectable pancreatic head cancer that involved the superior mesenteric artery. After preoperative chemoradiotherapy (S-1, 120 mg/body, and radiation therapy (RT), 50.4 Gy/28 Fr), pancreatoduodenectomy was scheduled. On laparotomy, a nodule on the liver was found. We performed total biopsy. The frozen section examination of the nodule revealed adenocarcinoma. S-1 (120 mg/body) therapy was resumed for the treatment of unresectable pancreatic cancer. After 7 therapy courses, CT and PET-CT demonstrated the main tumor was remarkably reduced, and there was no new lesion of liver metastasis. We therefore performed operation: pancreatoduodenectomy combined with resection of the superior mesenteric vein. Histopathological examination revealed no cancer cells in the pancreas or the dissected lymph nodes. The pathological effect was judged as grade IV. The patient has had no recurrence for 24 months since pancreatectomy. In spite of recent progression in diagnostic imaging modalities, surgical procedures, and other systemic therapies, the prognosis of pancreatic ductal carcinoma with distant metastases is extremely poor. However, if disease progression is not present during the treatment process, the surgical procedure could be a chance for treatment. We need further evaluation of the indications and efficacy of chemotherapy for conversion to surgical treatment of pancreatic cancer with distant metastasis.