CT from a 54-year-old man with PC. A, Initial CT before therapy reveals a 32 × 25 mm, T4N1M0 pancreatic head tumor. B, After EUS-FNI of 76 mg gemcitabine followed by conventional chemoradiation, the CT revealed tumor regression and downstaging. Surgical pathology after open pancreaticoduodenectomy with en-bloc segmental superior mesenteric vein resection and segmental superior mesenteric artery resection revealed a 2.3 × 2.3 × .8 cm fibrotic mass with multiple foci of microscopic adenocarcinoma without any vascular invasion and an R0 resection and T2N0M0 disease. The patient remains alive 72.1 months after therapy without evidence of malignancy. PC, pancreatic cancer; FNI, fine-needle injection.