Neoadjuvant Treatment in a Locally Advanced Pancreatic Neuroendocrine Tumor: Case Report
DOI:
https://doi.org/10.32635/2176-9745.RBC.2026v72n2.5661Keywords:
Pancreatic Neoplasms/diagnosis, Neoadjuvant Therapy/ methods, Pancreatectomy/methods, Case ReportsAbstract
Introduction: Pancreatic neuroendocrine tumors (pNETs) originate from the endocrine cells of the islets of Langerhans in the pancreas. These are neoplasms with heterogeneous clinical behavior and variable prognosis, whose therapeutic approach includes chemotherapy, targeted therapies, arterial embolization, somatostatin analogues, peptide receptor radionuclide therapy, and surgical resection – the latter considered the only potentially curative treatment. Case report: A 38-year-old patient, previously asymptomatic, was diagnosed with a pancreatic mass in the body of the pancreas, measuring 5.0 x 5.7 x 4.7 cm, with characteristics of a locally advanced and unresectable tumor. Pancreatic biopsy, together with anatomopathological and immunohistochemical examinations, confirmed the diagnosis of grade 2 (G2) pNET of intermediate grade. The patient was submitted to neoadjuvant treatment with two cycles of capecitabine and temozolomide, which resulted in sufficient tumor regression to enable complete surgical resection by distal pancreatectomy with splenectomy. Conclusion: The use of neoadjuvant chemotherapy may be an effective strategy in the management of locally advanced and initially unresectable pNET. Although there is still no consensus on the ideal neoadjuvant regimen for G2 pNETs, CAPTEM therapy enabled sufficient tumor reduction for complete surgical resection with good postoperative outcomes. Continuous clinical and radiological follow-up remains essential due to the risk of late recurrence.
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