Local recurrence after surgical resection of pancreatic cancer effectively treated with combined chemoradiotherapy

We report a patient for whom systemic chemotherapy using gemcitabine was effective against local recurrence of pancreatic cancer. A 59-year-old man underwent pancreatoduodenectomy for pancreatic head cancer. The diagnosis was moderately-differentiated tubular adenocarcinoma (tubular type, pT2, pN0, fM0, fStage II). Ten months after surgery, the patient had a CT examination which revealed a mass at the cut-end of the pancreas. The serum CAI9-9 level was found to be elevated 790 (U/mL). Chemotherapy with GEM (1,000 mg/m²) was administered intravenously on days 1, 8, and 15. Courses were repeated every 28 days. The patient received 8 courses of chemotherapy by GEM, and the regimen was changed to every two weeks because of the adverse event, leucopenia (grade 2) and thrombocytopenia (grade 2). Twenty-one months after chemotherapy, CT examination revealed regrowth at the same location at the cut-end of the pancreas, and so radiotherapy was performed at a total 63 Gy. The serum CA19-9 level dropped to within the normal range. The patient had been receiving systemic chemotherapy as an outpatient for 48 months without deterioration of quality of life. Unfortunately, the patient died of bacteriogenous meningitis 56 months after recurrence. Our experience suggests that this chemotherapy is simple and possible to continue safely on an ambulatory basis while maintaining quality of life.