A 6-year survival case of locally advanced unresectable pancreatic tail cancer treated with chemo-radiation therapy

We report a case of locally advanced unresectable pancreatic tail cancer patient who survived over 6 years by chemo-radiation therapy (CRT). A 61 -year-old male was pointed out by CT to have pancreatic tail cancer of 5.6 cm in diameter that invaded to the stomach, left kidney and adrenal gland, nerve plexus of celiac and superior mesenteric artery, was diagnosed as locally advanced unresectable pancreatic tail cancer. CRT of gemcitabine (GEM) with RT to a primary lesion was successful. After two years and 11 months, Schnitzler's metastasis appeared and RT was effective to recover from rectal stricture. At three years and 3 months, GEM was converted to S-1. After 4 years and 5 months, paraaortic lymph node metastasis was enlarged, so chemotherapy was changed to combination of GEM + S-1. After 4 years and 10 months, upper mediastinal lymph node metastasis appeared. At 6 years and 1 month, RT to upper mediastinum for pain control was performed. Finally, 6 years and 6 months after the first diagnosis, he died of pancreatic cancer. A long-term survival of locally advanced unresectable pancreatic cancer is very rare. In the case of pancreatic cancer that CRT is effective to the remission of primary lesion, CRT is potentially useful to perform for the control of metastatic lesion or palliative therapy.