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We read with great interest an interesting report of a pancreatic metastasis from colon carcinoma nine years after a hemicolectomy managed by distal pancreatectomy and review of the literature regarding the role and outcome of pancreatic resection for colorectal metastasis by Norman Oneil Machado et al. published in the 2010 July issue of JOP. J Pancreas (Online) [1]. We agree with the authors that pancreatic metastasis from colorectal malignancy is rare and accounts for less than 2% of all pancreatic metastases [2]. We would like to add another case of colonic metastasis to the pancreas seen at our institution and discuss radiation therapy as another modality to treat such patients. Mr. J is a 51-year-old Ecuadorian male with a history of metastasis from colon carcinoma originally diagnosed in 2007 at which time he was resected and treated with oxaliplatin plus 5-fluorouracil plus leucovorin (FOLFOX-4) for 12 cycles completed in November 2007. In April 2009, he developed an intra-abdominal recurrence (confirmed by exploratory laparotomy and biopsy) which was treated with 5-fluorouracil plus leucovorin plus irinotecan (FOLFIRI) plus cetuximab completed in July 2009. Patient moved to our country and presented to emergency department in October 2009 with abdominal pain. He was found to have a recurrent lesion in the pancreatic head abutting the stomach measuring 3x5x5 cm. An EUS was performed and the biopsy was consistent with primary colorectal cancer. The patient was treated with mitomycin C and 5-fluorouracil plus leucovorin at days 1, 2, 3 every 21 days for 2 cycles completed on December 2009 but he continued to have abdominal pain. Therefore, systemic chemotherapy was held and the patient was then treated with a palliative course of external beam radiation therapy to a total dose of 30 Gy in 10 fractions completed on February 2010 with significant improvement in his pain. Due to improvement is his performance status secondary to better pain control, he was enrolled on a phase I study including irinotecan in combination with PHY906 [3], a Chinese herbal drug, but a repeat CT scan showed progressive disease at the end of 4 cycles (8 weeks) evidenced by increased size of pulmonary metastasis as well as increased size of the necrotic air containing mass in the head of the pancreas on June 2010. Mr. J's chemo regimen was changed to panitumumab but prior to initiation on July 2010 the patient was admitted through emergency department after a CT …

Pancreatic metastasis from colon carcinoma treated with radiotherapy with palliative benefit.