Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13593
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
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.