内容紹介
Two Cases of Unresectable Advanced Rectal Cancer with a Long-Term Survival for Which Pathological Complete Response Was Achieved through Neoadjuvant Effective Chemotherapy
Summary
We report 2 unusual cases of Stage Ⅳ rectal cancer for which pathological complete response was achieved with neoadjuvant chemotherapy(NAC)consisting of a combination of 5-fluorouracil(5-FU), oxaliplatin, Leucovorin(mFOLFOX6)or irinotecan(FOLFIRI), and bevacizumab, without radiotherapy. Case 1: A 65-year-old man was diagnosed as having rectal cancer with an invasive carcinoma of the prostate and lymph node metastasis. He refused to undergo surgery and received NAC instead. After NAC with mFOLFOX6 and FOLFIRI was performed, CT scan and colonoscopy revealed no evidence of disease. The subsequent result was compatible with a complete pathological response. The patient is currently alive 4 years after the first chemotherapy, without evidence of recurrence and adjuvant chemotherapy. Case 2: A 75-year-old man was diagnosed as having rectal cancer with an invasive carcinoma of the bladder and lymph node metastasis. After providing neoadjuvant bevacizumab-containing chemotherapy, low anterior resection of the rectum was performed. Operative findings showed that the tumor was only ulcer and the lymph nodes were not enlarged. The subsequent results indicated that pathological findings revealed no cancer and a complete pathological response. In conclusion, the survival benefits from NAC are still unclear for patients with an initially unresectable rectal cancer. We report 2 rare cases of rectal cancer with long survival and a complete pathological response after neoadjuvant chemotherapy.
要旨
直腸癌の治療において放射線治療をせずに,化学療法のみでpathological complete response(pCR)を得られることは極めて少ない。症例1は65歳,男性。直腸癌Stgae Ⅳ[Rb,ant-rt-lt,2型,tub,cAI(前立腺),cN3,cM1(No. 216)]の患者は化学療法治療を希望し,mFOLFOX6を7コース,FOLFIRIを2コース投与した。原発巣の効果判定はCRとなり,リンパ節転移は消失し,再発なく外来通院中である。症例2は75歳,男性。直腸癌Stage Ⅳ[(Ra-Rb,circ,2型,cAI(膀胱),cN3,cM1(No. 216)]の患者はmFOLFOX6+bevacizumabを12コース,FOLFIRI+bevacizumabを6コース終了後に,低位前方切除術を施行した。原発巣の効果判定はGrade 3であった。今回われわれは,臓器浸潤を伴う局所進行直腸癌に対し放射線治療を行わずに,全身化学療法のみを施行した後にpCRが得られた2症例を経験したので報告する。
目次
Summary
We report 2 unusual cases of Stage Ⅳ rectal cancer for which pathological complete response was achieved with neoadjuvant chemotherapy(NAC)consisting of a combination of 5-fluorouracil(5-FU), oxaliplatin, Leucovorin(mFOLFOX6)or irinotecan(FOLFIRI), and bevacizumab, without radiotherapy. Case 1: A 65-year-old man was diagnosed as having rectal cancer with an invasive carcinoma of the prostate and lymph node metastasis. He refused to undergo surgery and received NAC instead. After NAC with mFOLFOX6 and FOLFIRI was performed, CT scan and colonoscopy revealed no evidence of disease. The subsequent result was compatible with a complete pathological response. The patient is currently alive 4 years after the first chemotherapy, without evidence of recurrence and adjuvant chemotherapy. Case 2: A 75-year-old man was diagnosed as having rectal cancer with an invasive carcinoma of the bladder and lymph node metastasis. After providing neoadjuvant bevacizumab-containing chemotherapy, low anterior resection of the rectum was performed. Operative findings showed that the tumor was only ulcer and the lymph nodes were not enlarged. The subsequent results indicated that pathological findings revealed no cancer and a complete pathological response. In conclusion, the survival benefits from NAC are still unclear for patients with an initially unresectable rectal cancer. We report 2 rare cases of rectal cancer with long survival and a complete pathological response after neoadjuvant chemotherapy.
要旨
直腸癌の治療において放射線治療をせずに,化学療法のみでpathological complete response(pCR)を得られることは極めて少ない。症例1は65歳,男性。直腸癌Stgae Ⅳ[Rb,ant-rt-lt,2型,tub,cAI(前立腺),cN3,cM1(No. 216)]の患者は化学療法治療を希望し,mFOLFOX6を7コース,FOLFIRIを2コース投与した。原発巣の効果判定はCRとなり,リンパ節転移は消失し,再発なく外来通院中である。症例2は75歳,男性。直腸癌Stage Ⅳ[(Ra-Rb,circ,2型,cAI(膀胱),cN3,cM1(No. 216)]の患者はmFOLFOX6+bevacizumabを12コース,FOLFIRI+bevacizumabを6コース終了後に,低位前方切除術を施行した。原発巣の効果判定はGrade 3であった。今回われわれは,臓器浸潤を伴う局所進行直腸癌に対し放射線治療を行わずに,全身化学療法のみを施行した後にpCRが得られた2症例を経験したので報告する。