Eight Months' Recurrence-free Survival after Tumorectomy and Fractionated Stereotactic Radiotherapy for Brain Metastasis of a Pancreatic Tumor

Abstract

A 63-year-old woman was referred to our hospital after presenting at a local clinic complaining of epigastric pain. Investigations showed cancer of the pancreatic tail with left adrenal metastasis, and distal pancreatectomy, splenectomy, and left adrenalectomy were performed. The histopathological diagnosis was pT3N1M1, pStage IV b, with R0 surgery. S-1 monotherapy was administered as adjuvant chemotherapy, but multiple lung metastases appeared 10 months postoperatively, and GnP therapy was initiated. The patient was subsequently switched to S-1 and GEM, but progressive disease was diagnosed, and FOLFIRINOX therapy was started. The lung lesions regressed, but 5 years 2 months postoperatively, the patient started staggering, and tumor markers were elevated ; cranial magnetic resonance imaging showed cerebellar metastasis. Chemotherapy was discontinued, and brain tumorectomy and fractionated stereotactic radiotherapy were performed. Tumor marker levels subsequently normalized, and the patient currently remains recurrence-free.

The prognosis for distant metastatic pancreatic cancer is extremely poor, and long-term survival is rare. There have also been almost no reported cases of brain metastasis of pancreatic cancer. The case of a patient with left adrenal metastasis of cancer of the pancreatic tail who has achieved long-term survival through multimodal treatment is reported.