A case of successful resection after FOLFIRINOX in a patient with borderline resectable pancreatic adenocarcinoma

Pancreatic adenocarcinoma (PAC), one of the most aggressive human neoplasms, continues to have an exceedingly poor prognosis. With the advance of diagnostic techniques, a distinct subset of pancreatic cancer labeled “borderline resectable pancreatic cancer” has emerged. Optimal treatment of this disease with a multidisciplinary approach including neoadjuvant and adjuvant therapy remains controversial. We describe a case of borderline resectable PAC treated with FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin) followed by successful pancreaticoduodenectomy. CT scan demonstrated a pancreatic head tumor attached to the superior mesenteric artery, subsequent to which the patient received FOLFIRINOX. Follow-up images showed no lymph node involvement or metastatic disease, suggesting that radical surgery would be curative. The patient underwent pancreaticoduodenectomy with negative margins and was subsequently diagnosed as Stage III (T3N0M0). Though requiring precise case selection and toxicity management, recent literature suggests that FOLFIRINOX is an effective neoadjuvant regimen in the setting of borderline resectable PAC.