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Open Access Case report

Neoadjuvant chemoradiation therapy for borderline pancreatic adenocarcinoma: report of two cases

José Galindo1, Mauricio Gabrielli1, Juan Francisco Guerra1, Juan Carlos Cassina1, Marcelo Garrido2, Nicolás Jarufe1, Yerko Borghero2, Jorge Madrid2, Pablo Zoroquiain3, Juan Carlos Roa3 and Jorge Martínez1*

Author Affiliations

1 Department of Digestive Surgery, Hospital Clínico Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile

2 Department of Hemato-Oncology, Hospital Clínico Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile

3 Department of Pathology, Hospital Clínico Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile

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World Journal of Surgical Oncology 2013, 11:37  doi:10.1186/1477-7819-11-37

Published: 5 February 2013

Abstract

Pancreatic cancer remains as one of the most aggressive human neoplasms, with overall poor survival rates. Radical surgery of the primary lesion is the best option for treatment. Borderline resectable pancreatic tumors (BRPT), defined as partial involvement of peripancreatic vasculature, may benefit from neoadjuvant therapy. We report on the first two BRPT cases treated with neoadjuvant chemoradiation at our institution. Preoperative CT and MRI demonstrated pancreatic tumors encasing the porto-mesenteric confluence suggestive of BRPT. Patients received neoadjuvant chemotherapy (gemcitabine/cisplatin), followed by radiochemotherapy. After treatment, follow-up images demonstrated tumor downsize, allowing for the tumors to be considered then as resectable. They underwent partial pancreatoduodenectomies (Whipple procedure). In case 1, histopathology revealed a complete, margin-free resection, whereas in case 2 there was a complete pathological response, with no evidence of residual tumor. According to the literature, our initial experience using neoadjuvant chemoradiotherapy on BRPT allowed us to downsize the tumor and, subsequently, to perform a curative surgery.

Keywords:
Borderline resectable pancreatic cancer; Neoadjuvant chemoradiation