Resection of Small Bowel Adenocarcinoma Liver Metastasis Combined with Neoadjuvant and Adjuvant Chemotherapy Results in
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CASE REPORT
Resection of Small Bowel Adenocarcinoma Liver Metastasis Combined with Neoadjuvant and Adjuvant Chemotherapy Results in Extended Disease-Free Period—A Case Report Tatjana Eigenbrod & Frank Kullmann & Frank Klebl
Published online: 6 July 2007 # Humana Press Inc. 2007
Abstract Small bowel adenocarcinoma (SBA) is a very rare tumor entity but occurs in up to 5% of patients suffering from familiar adenomatous polyposis (FAP). Because of nonspecific symptoms, diagnosis is usually made with delay, which contributes to high rates of metastatic disease at the time of diagnosis. The overall prognosis of SBA is poor with 5-year survival rates of 15–35%. For localized disease, complete surgical resection is the treatment of choice, whereas systemic chemotherapy is deemed indicated in tumors with metastatic spread. The optimal regimen has not been defined as yet. In October 2001, a 51-year-old woman with attenuated FAP, that had total proctocolectomy in 1994 was diagnosed with a jejunal adenocarcinoma. She subsequently underwent small bowel resection. Because a computed tomography (CT) scan in April 2002 revealed multiple liver metastases, chemotherapy with nine cycles FOLFOX6 was initiated. Afterwards, a small residual lesion in segment VIII was seen in CT scan but could not be identified by PET and at laparotomy in November 2002. In December 2003, again, a lesion was detected in S VIII. This solitary residual liver metastasis was resected in January 2004. Postoperatively, the patient received adjuvant chemotherapy with three cycles (with six applications in each cycle) 5-fluorouracil/folinic acid/irinotecan according to the AIO protocol. To date, more than 3 years after liver resection, the patient is still in complete remission and undergoes regular restaging investigations. Resection of liver metastases
T. Eigenbrod (*) : F. Kullmann : F. Klebl Department of Internal Medicine I, University Hospital of Regensburg, 93042 Regensburg, Germany e-mail: [email protected]
from SBA combined with neoadjuvant and adjuvant chemotherapy can result in extended disease-free survival and should undergo further investigation. Keywords small bowel adenocarcinoma . liver metastasis . neoadjuvant chemotherapy . adjuvant chemotherapy
Inroduction Primary small bowel malignancies are very rare tumors and constitute less than 2% of all gastrointestinal malignancies [1, 2]. Thirty to fifty percent of all small bowel neoplasms are adenocarcinoma, 25–30% are carcinoids, and 15–20% are lymphomas [1]. Although the overall prevalence is low, approximately 5% of adenomatous polyposis (FAP) patients will develop small bowel cancer [2, 3]. A variety of factors including high cell turnover, absence of bacteria, rapid transit time, and high levels of IgA have been suggested as reasons for the low incidence of small bowel adenocarcinoma (SBA as compared to colorectal cancer [1, 3]. SBA usually presents with nonspecific symptoms like abdominal pain, weight loss, anemia, intestinal obstruction, or jaundice and is often d
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