Peer Review Report For: Case Report: complete pathological response after chemotherapy for borderline pancreatic cancer [version 1; peer review: 1 not approved]

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Background : Patients with borderline pancreatic cancer have a poor prognosis despite the recent development of multidisciplinary treatments that include chemotherapy. Nowadays induction chemotherapy is developing into a powerful cure to convert borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancers (LAPC) into a resectable cancer. This report supplements published data on the management border line pancreatic cancer and emphasizes the possibility of complete pathological response after chemotherapy in such cases. Case presentation : A 60-year-old man, with a type 2 Diabetes Mellitus, was diagnosed with a 3-centimeter T2N1M0 borderline pancreatic head tumor. Ultrasound endoscopy found a close contact with the superior mesenteric vein (< 180°) and an endoscopically guided biopsy confirmed the diagnosis of ductal adenocarcinoma. The patient underwent systemic chemotherapy with six injections of FOLFIRINOX without radiotherapy. The radiological re-staging revealed a cancer down-sizing of 2cm and tumor became resectable. The patient underwent a Whipple procedure with uneventful follow-up. The pathological examination of the specimen concluded to pathological complete response. The twelve lymph nodes evaluated were negative. Following surgery, adjuvant chemotherapy FOLFIRINOX was given. After three years of follow-up, there is no evidence of recurrence.

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