Complete Response of an Initially Non-surgical Adenocarcinoma of the Duodenum to Chemotherapy with the Folfox 4 Regimen

Abstract

The FOLFOX 4 regimen seems to be efficacious for some small-bowel adenocarcinomas and can be expected to lead to downstaging. If the outcome of a few months of chemotherapy is favorable, it is appropriate for a multidisciplinary expert committee to consider further surgery. This case underscores the value of multidisciplinary expert committees in scrutinizing therapeutic decisions in rare and difficult cases.

Advances in Molecular Pathology and Treatment of Periampullary Cancers

“…After 4 months of treatment, there was significant downstaging and the patient underwent curative resection with no recurrence at 27 months. 75 …”

The incidence and prognosis of true duodenal carcinomas

“…The same applies concerning young, fit patients with unresectable PDC after evaluation. Case reports [27,28] indicate that tumor downstaging can be effective in PDC patients and making them candidates for curative surgery. Adding to these case stories, we found one patient who initially was treated with a GEA because of locally advanced disease, but after receiving palliative chemotherapy responded to such an extent that he was curatively resected and is still alive after 84 months.…”

Factors Impacting Survival Outcomes after Curative Resection for Primary Duodenal Adenocarcinoma

“…Adjuvant chemoradiation reportedly improved locoregional control after surgery for PDA in some studies (12)(13)(14)(15), while another group documented adjuvant chemoradiation to neither decrease local recurrence nor prolong overall survival (16). The role of preoperative chemotherapy remains to be determined, as this approach is supported by no more than a few case series (17)(18)(19). As yet, we have no standardized evidence supporting the concept of perioperative chemotherapy/chemoradiotherapy prolonging OS in patients with PDA.…”