PDF(Pubmed)
Abstract：
BACKGROUND: With recent dramatic developments in chemotherapy, attempts to incorporate surgery into the multidisciplinary treatment of unresectable pancreatic ductal adenocarcinoma with metastasis (UR-M PDAC) have emerged. Maintenance therapy with olaparib after chemotherapy including a platinum-based regimen, which inhibits the poly ADP-ribose polymerase (PARP) involved in DNA repair, was approved for UR-M PDAC with positive BRCA mutations.
METHODS: A 47-year-old male patient with a high carbohydrate antigen 19-9 (CA19-9) level was diagnosed with PDAC in the pancreatic tail. Staging laparoscopy revealed occult liver metastasis. Because BRCA2 mutation was confirmed, triple combination chemotherapy with SOXIRI (S-1/oxaliplatin/irinotecan) was introduced and continued for 16 weeks, followed by 14 weeks of olaparib. After that, CA19-9 was normalized, and no obvious liver metastases of any size could be seen on imaging studies during chemotherapy. Since staging laparoscopy after chemotherapy proved that the liver metastasis had disappeared, laparoscopic distal pancreatectomy was performed, and curative resection was completed. After adjuvant chemotherapy with olaparib for 12 months, the patient is alive 36 months from his initial diagnosis and 27 months postoperatively without recurrence.
CONCLUSIONS: We report a case of PDAC with liver metastasis and BRCA mutation-positivity who underwent conversion surgery and achieved long-term survival after irinotecan-based chemotherapy followed by maintenance therapy with olaparib.
METHODS: A 47-year-old male patient with a high carbohydrate antigen 19-9 (CA19-9) level was diagnosed with PDAC in the pancreatic tail. Staging laparoscopy revealed occult liver metastasis. Because BRCA2 mutation was confirmed, triple combination chemotherapy with SOXIRI (S-1/oxaliplatin/irinotecan) was introduced and continued for 16 weeks, followed by 14 weeks of olaparib. After that, CA19-9 was normalized, and no obvious liver metastases of any size could be seen on imaging studies during chemotherapy. Since staging laparoscopy after chemotherapy proved that the liver metastasis had disappeared, laparoscopic distal pancreatectomy was performed, and curative resection was completed. After adjuvant chemotherapy with olaparib for 12 months, the patient is alive 36 months from his initial diagnosis and 27 months postoperatively without recurrence.
CONCLUSIONS: We report a case of PDAC with liver metastasis and BRCA mutation-positivity who underwent conversion surgery and achieved long-term survival after irinotecan-based chemotherapy followed by maintenance therapy with olaparib.
摘要：
背景：随着化疗的最新进展，已出现将手术纳入不可切除的胰腺导管腺癌转移(UR-MPDAC)的多学科治疗的尝试.化疗后奥拉帕尼维持治疗，包括铂类药物方案，抑制参与DNA修复的多聚ADP-核糖聚合酶（PARP），被批准用于BRCA突变阳性的UR-MPDAC。
方法：一名47岁的男性患者，其高碳水化合物抗原19-9（CA19-9）水平被诊断为胰尾PDAC。腹腔镜分期显示隐匿性肝转移。因为BRCA2突变得到证实,采用SOXIRI三联化疗（S-1/奥沙利铂/伊立替康）并持续16周，随后是14周的奥拉帕利。之后,CA19-9正常化，在化疗期间的影像学研究中，没有明显的任何大小的肝转移。自化疗后腹腔镜分期证明肝转移已消失，进行了腹腔镜胰体远端切除术，治愈性切除完成。奥拉帕尼辅助化疗12个月后，患者从最初诊断开始存活36个月,术后27个月无复发.
结论：我们报告了一例PDAC肝转移和BRCA突变阳性，在伊立替康为基础的化疗和奥拉帕尼维持治疗后，接受了转换手术并获得了长期生存。
方法：一名47岁的男性患者，其高碳水化合物抗原19-9（CA19-9）水平被诊断为胰尾PDAC。腹腔镜分期显示隐匿性肝转移。因为BRCA2突变得到证实,采用SOXIRI三联化疗（S-1/奥沙利铂/伊立替康）并持续16周，随后是14周的奥拉帕利。之后,CA19-9正常化，在化疗期间的影像学研究中，没有明显的任何大小的肝转移。自化疗后腹腔镜分期证明肝转移已消失，进行了腹腔镜胰体远端切除术，治愈性切除完成。奥拉帕尼辅助化疗12个月后，患者从最初诊断开始存活36个月,术后27个月无复发.
结论：我们报告了一例PDAC肝转移和BRCA突变阳性，在伊立替康为基础的化疗和奥拉帕尼维持治疗后，接受了转换手术并获得了长期生存。
