Nonfunctioning islet cell carcinoma of the pancreas. Complete response to continuous 5-fluorouracil infusion

An unresectable, intraabdominal recurrence of a nonfunctioning islet cell carcinoma of the pancreas developed in a 56-year-old man 9 years after he achieved complete remission from extensive radiotherapy. Chronic renal failure secondary to radiation nephritis precluded the use of streptozotocin. 5-fluorouracil (5-FU) (300 mg/m2 per day) was given as a continuous, systemic infusion through a chronic indwelling central venous catheter for 1 year's duration. Treatment resulted in the prompt disappearance of all signs and symptoms of cancer, and computed tomography (CT) of the abdomen documented complete response. The patient continues in complete clinical remission 16 months after 5-FU was stopped. Continuous 5-FU infusion may be a potentially efficacious and less toxic alternative to streptozotocin in the treatment of islet cell carcinoma. Further clinical evaluation will be necessary to define its overall role in the management of these patients.