Abstract
Despite many reports of pancreatic cancer resection followed by postoperative adjuvant chemotherapy and chemoradiotherapy, few reports consider the treatment of locally recurrent lesions following primary surgery. We report a 49-years-old woman diagnosed with pancreatic head cancer due to obstructive jaundice. Pancreatoduodenectomy (R0 pT3, pN0, M0 fStageIII) was conducted in August 2002 without postoperative adjuvant therapy. Two years and seven months after primary surgical resection, her serum tumor marker (CA19-9) increased and local recurrence was diagnosed around the superior mesenteric artery was diagnosed by upper abdominal computed tomography scan in March 2005.Due to the difficulty of surgical resection, we combined chemoradiotherapy-chemotherapy with 5 times of Gemcitabine (400mg/m2/week) and radiation with 50 Gy divided into 25 times at 2.0 Gy/day-conducted without severe adverse events. Serum CA19-9 decreased immediately and the local tumor was found in CT to have shrunk. GEM (1, 000mg/m2) was administered biweekly for over two years after chemoradiotherapy. No sign of tumor progression has been in the five years since the first surgical resection of pancreatic head cancer. The combined chemoradiotherapy is thus feasible and an effective treatment option in local recurrence after primary pancreatic cancer surgery.
