Journal Article

Searching for novel multimodal treatments in oligometastatic pancreatic cancer

Palloni, A., Brandi, G., Filippini, D. M., Carloni, R., Ricci, C., Ercolani, G., Di Marco, M., Serra, C., Grassi, E., Casadei, R.

2020

Overview

Background Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. Case presentation We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. Conclusions Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: 5-Fluorouracil / Adenocarcinoma / Adenocarcinoma - secondary / Adenocarcinoma - therapy / Antigens / Biomedical and Life Sciences / Biomedicine / Biopsy / cancer imaging / Cancer metastasis / Cancer Research / Cancer therapies / Case Report / Chemoradiotherapy / Chemotherapy / Combined Modality Therapy / Computed tomography / Diagnosis / Disease-Free Survival / Drug therapy / Folinic acid / Gemcitabine / Health aspects / Health Promotion and Disease Prevention / Hematology / Hepatectomy / Humans / interventional therapeutics / Irinotecan / Liver / Liver cancer / Liver Neoplasms - secondary / Liver Neoplasms - therapy / Lungs / Lymph nodes / Male / Medical imaging / Medical prognosis / Medicine/Public Health / Metastasectomy / Metastases / Metastasis / Middle Aged / Multimodal treatment / Neoplasm Metastasis / Neoplasm Recurrence, Local / Neutropenia / Oligometastatic cancer / Oncology / Oxaliplatin / Pancreatic cancer / Pancreatic Neoplasms - pathology / Pancreatic Neoplasms - therapy / Pancreaticoduodenectomy / Patients / Radiation therapy / Radiofrequency Ablation / Surgery / Surgical Oncology / Survival / Therapeutics / Ultrasonic imaging