A prolonged follow-up provides new insights into locally advanced pancreatic cancer treatment

We report the case of a 64-year-old woman treated for a locally advanced pancreatic adenocarcinoma, which could not undergo radical resection due to encasement of the superior mesenteric artery. After chemoradiotherapy (six weeks), normalization of plasma CA19.9 levels was documented and CT showed shrinkage of the pancreatic mass but persistent encasement of the SMA. Surgical exploration followed by radical resection was performed 18 months later. Resection of the pancreatic head was then performed and the final pathological analysis showed a complete response. This case is unique in terms of the duration of follow-up between chemoradiotherapy and radical resection and raises two main concerns regarding the current standard of care of locally advanced pancreatic tumors; first, the difficulty of assessing the tumor response to chemoradiotherapy, second, the unfeasibility of establishing the timing of surgery, its indications and the survival benefits for patients with an objective response to therapy.