Complete response of an initially non-surgical adenocarcinoma of the duodenum to chemotherapy with the FOLFOX 4 regimen

Abstract

Introduction: The incidence of adenocarcinoma of the small bowel is very low in comparison with that of colorectal cancer. Radical surgery is the only curative treatment, and results with chemotherapy and radiotherapy are disappointing. No standard chemotherapy is defined for non-surgical adenocarcinoma of the small bowel. In France, it is usually treated with the same chemotherapy regimens as used for colorectal cancer.

Case report: We report here the case of a young patient with an initially non-surgical adenocarcinoma of the duodenum treated in a palliative setting with the FOLFOX 4 chemotherapy regimen. After 4 months of treatment, CT scan showed no residual tumor and the patient was well. A multidisciplinary committee decided that a second surgical investigation was necessary, and a duodenal resection was performed, with no residual tumor in the final specimen. After 27 months of follow-up the patient was well and without recurrence.

Conclusion: The FOLFOX 4 regimen seems to be efficacious for some small-bowel adenocarcinomas and can be expected to lead to downstaging. If the outcome of a few months of chemotherapy is favorable, it is appropriate for a multidisciplinary expert committee to consider further surgery. This case underscores the value of multidisciplinary expert committees in scrutinizing therapeutic decisions in rare and difficult cases.