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Stereotactic ablative radiation therapy as a potential curative treatment in duodenal adenocarcinoma: a case report

Abstract

Purpose

One of the rarest gastrointestinal neoplasm is small bowel cancer. Experience with its treatment modalities is limited. Stereotactic ablative radiation therapy (SABR) has improved, with image-guided radiation therapy becoming a curative option in many tumors. Especially when surgery cannot be performed due to comorbidities, SABR provides a good toxicity profile and an excellent tumor control rate owing to its specific schedule: high dose on a limited and well-defined area.

Methods

An 83-year-old man had arterial hypertension and congestive cardiomyopathy, with recent history of upper abdominal pain, weight loss over 10 kg, and progressive severe fatigue. The patient underwent endoscopy that showed a large mass partially obstructing the second part of the duodenum; a biopsy revealed a moderately differentiated adenocarcinoma. A staging CT scan confirmed localized disease. Due to the patient’s age and comorbidities, a SABR was proposed as the preferred treatment. In order to localize the tumor during radiotherapy sessions, surgical clips were placed endoscopically next to the lesion as fiducial markers. The patient received 25 Gy in 5 fractions on alternate days.

Results

Resolution of duodenal obstruction and bleeding lasted for 14 months. The patient died of myocardial infarction.

Conclusions

This case suggests that SABR could have a role in the palliative treatment of small bowel cancers, with good toxicity profile, particularly in patients for whom surgical treatment is not a viable option.

Post author correction

Article Type: CASE REPORT

DOI:10.5301/tj.5000611

Authors

Francesco Maria Aquilanti, Maria Cristina Barba, Federico Bianciardi, Barbara Tolu, Barbara Nardiello, Giorgio Hamid Raza, Randa El Gawhary, Chiara D’Ambrosio, PierCarlo Gentile

Article History

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.

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Authors

Affiliations

  • UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy
  • Radiation Therapy Department, San Pietro Fatebenefratelli Hospital, Rome - Italy

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