Two Cases of Unresectable Pancreatic Cancer Achieving Pathological Complete Response with Multimodal Therapy

Abstract

A 68-year-old woman (Case 1) presenting with high HbA1c level was pointed out having a pancreatic head tumor and was referred to our hospital. The superior mesenteric artery was diagnosed to be involved by the tumor in whole circumference, and chemoradiation therapy was inifially selected. After 7 courses of Gem + nab-paclitaxel and chemoradiation theory (S-1 + RT) pancreaticoduodenectomy (PD) with combined resection of the portal vein was performed. The resected specimen showed alesentuiable of tumor cells that meant pathological complete response (pCR). In 4 years 5 months after surgery, the patient has been alive without recurrence. Another patient (Case 2) who presented to our hospital with obstructive jaundice was diagnosed with pancreatic head cancer and multiple hepatic metastases and underwent 21 courses of modified FOLFIRINOX, followed by PD and hepatectomy in S8 and S1. Viable tumor cells were absent in the pancreas head and also in the liver that coincided with findings of pCR. In 8 months after surgery the patient is doing well without recurrence. Since pCR can rarely be achieved by preoperative multimodal therapy for unresectable pancreatic cancer, we report these two cases with literature review.