Li BS, Shi H, Wen M, Xiao MY, Wang J. Widespread lymph node recurrence of major duodenal papilla cancer following pancreaticoduodenectomy. World J Gastroenterol 2015; 21(48): 13593-13598 [PMID: 26730173 DOI: 10.3748/wjg.v21.i48.13593]
Corresponding Author of This Article
Jian Wang, MD, PhD, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, No. 55, Section 4, South Renmin Road, Chengdu 610041, Sichuan Province, China. wangjian_59@sina.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 28, 2015; 21(48): 13593-13598 Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13593
Widespread lymph node recurrence of major duodenal papilla cancer following pancreaticoduodenectomy
Bai-Sen Li, Hui Shi, Min Wen, Ming-Yong Xiao, Jian Wang
Bai-Sen Li, Ming-Yong Xiao, Jian Wang, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China
Hui Shi, Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China
Min Wen, Department of Breast Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, Sichuan Province, China
Author contributions: Li BS and Shi H contributed equally to this work and should be considered co-first authors; Li BS researched and drafted the manuscript; Shi H conceived of the study and participated in the follow-up of the patient; Wang J was the primary radiation oncologist involved in the case; Wen M and Xiao MY substantially contributed to drafting and revision of the manuscript; All authors read and approved the final manuscript.
Supported by Sichuan Cancer Hospital and Institute, Chengdu, Sichuan Province, China.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Sichuan Cancer Hospital and Institute.
Informed consent statement: The patient provided informed written consent prior to all procedures.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian Wang, MD, PhD, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, No. 55, Section 4, South Renmin Road, Chengdu 610041, Sichuan Province, China. wangjian_59@sina.com
Telephone: +86-28-85420630 Fax: +86-28-85420690
Received: April 26, 2015 Peer-review started: April 27, 2015 First decision: September 29, 2015 Revised: November 6, 2015 Accepted: November 24, 2015 Article in press: November 24, 2015 Published online: December 28, 2015 Processing time: 241 Days and 11.2 Hours
Abstract
Major duodenal papilla cancer (MDPC) represents the primary type of duodenal cancer, and is typically considered a periampullary carcinoma as most tumors arise in this region. This report describes an extremely rare case involving a patient with rapidly and extensively recurrent MDPC following pancreaticoduodenectomy, who achieved complete response by concurrent image-guided radiation and intravenous oxaliplatin plus oral capecitabine therapies. The patient was a 50-year-old female who was admitted to our hospital 6 wk after resection for MDPC for evaluation of a nontender and enlarged node in the left side of her neck. After clinical work-up, the patient was diagnosed with postoperatively recurrent MDPC with widespread lymph node metastases at the bilateral cervix, mediastinum, abdominal cavity, and retroperitoneal area. She was administered whole field image-guided radiation therapy along with four cycles of the intravenous oxaliplatin plus oral capecitabine regimen. A complete response by positron emission tomography with 18-fluorodeoxyglucose was observed 4 months after treatment. The patient continues to be disease-free 2 years after the diagnosis of recurrence.
Core tip: Major duodenal papilla cancer (MDPC) is a rare malignancy, and there are limited data regarding its recurrence after radical resection. This report describes a case of recurrent MDPC with widespread lymph node involvement at the bilateral cervix, mediastinum, abdominal cavity, and retroperitoneal area, 6 wk after pancreaticoduodenectomy. The patient experienced a complete response to image-guided radiation therapy and a concomitant regimen of intravenous oxaliplatin plus oral capecitabine, and remains disease-free 2 years after the diagnosis of recurrence. This, to our knowledge, is the first case to demonstrate the role of chemoradiotherapy with improved survival in extensively recurrent MDPC.
