Cystadenocarcinoma of the pancreas is generally considered to be unresponsive to
chemotherapy and
radiation therapy. We present two cases of
laparotomy-proven unresectable
cystadenocarcinoma which responded to intravenous
5-fluorouracil (1,000 mg/m2/24 hr x 5 days x 2) and 4,000 rads of
radiation therapy. Both patients had objective response with marked shrinkage of the
tumor as determined by clinical examination and computed tomography. At reexploration both
tumors had become completely resectable with histologically clear margins and negative lymph nodes.
Carcinoembryonic antigen (CEA) levels were elevated in both patients at initial presentation (86 and 71 ng/ml). The CEA levels declined to 19.9 and 66.0 ng/ml, respectively, after neo-adjuvant
therapy, and both fell to normal levels after resection. Although surgical resection has been considered the only curative
therapy for patients with pancreatic
cystadenocarcinoma, we suggest that preoperative irradiation and
chemotherapy may reduce the size of seemingly unresectable
tumors. We also recommend serial CEA determinations in patients with levels initially elevated as a marker of the response to neo-adjuvant and operative
therapy.