Organ Preservation in the Treatment of Stage II and III Rectal Cancer

Autor: Robert K. Cleary, Edward R Hagen
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Organoplatinum Compounds
Colorectal cancer
medicine.medical_treatment
Leucovorin
Rectum
Adenocarcinoma
03 medical and health sciences
0302 clinical medicine
FOLFOX
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Mesentery
Neoplasm Invasiveness
Watchful Waiting
Colectomy
Neoadjuvant therapy
Aged
Neoplasm Staging
Mesorectal
Proctectomy
medicine.diagnostic_test
Rectal Neoplasms
Abdominoperineal resection
business.industry
Remission Induction
Gastroenterology
Sigmoidoscopy
Chemoradiotherapy
General Medicine
medicine.disease
Magnetic Resonance Imaging
Neoadjuvant Therapy
Proctoscopy
medicine.anatomical_structure
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Fluorouracil
Lymph Nodes
Radiology
business
Organ Sparing Treatments
medicine.drug
Zdroj: Diseases of the Colon & Rectum. 63:1185-1189
ISSN: 0012-3706
Popis: CASE SUMMARY A 65-year-old man underwent colonoscopy to evaluate rectal bleeding and was found to have a low rectal mass. Biopsy revealed moderately differentiated microsatellite stable adenocarcinoma. The tumor was palpable at the fingertip in the anterior rectum with the inferior border 5 cm from the anal verge by rigid proctoscopy. CEA was 0.8 ng/mL. CT imaging of the chest, abdomen, and pelvis showed no evidence of distant metastases. MRI confirmed a 5-cm mass with one 8-mm mesorectal lymph node metastasis and no extramural venous invasion. The tumor penetrated the mesorectal fat to a depth of 4 mm, and the circumferential margin was estimated to be 1 mm from the tumor (). He was presented at the multidisciplinary tumor board conference and interviewed and examined at the multidisciplinary clinic. He was dismayed at the prospect of his surgical options, a low anterior resection versus abdominoperineal resection, and wished to keep the options for organ preservation available. Standard long-course chemoradiation was initiated, with resolution of his bleeding after 2 weeks. He then completed 6 cycles of folinic acid, fluorouracil, and oxaliplatin (FOLFOX) chemotherapy (consolidation total neoadjuvant therapy (TNT)). The tumor was no longer palpable on office examination. A complete clinical response (cCR) was confirmed by flexible sigmoidoscopy () and MRI (). He was entered into the nonoperative management program with intense surveillance scheduling and has no evidence of recurrent disease almost 2 years after completion of TNT.
Databáze: OpenAIRE
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