内容紹介
Summary
A 53-year-old woman was referred to our hospital with melena. Examinations revealed advanced rectal cancer involving the anal canal with invasion of the left-sided levator ani muscle. Neoadjuvant chemotherapy was administered to preserve anal function. A first course of capecitabine and oxaliplatin(CapeOX)plus bevacizumab was administered. CapeOX plus panitumumab was administered from the 2nd to the 8th courses after confirming the absence of RAS mutation. Endoscopy and computed tomography confirmed the disappearance of the tumor after completion of the chemotherapy. A biopsy of the scar tissue revealed no cancer cells. However, diffusion weighted-magnetic resonance imaging(MRI-DWI)revealed a suspected residual tumor. To determine the subsequent treatment, a transanal resection was performed. No carcinoma was identified in the specimen. Thus, additional surgical treatment and adjuvant chemotherapy were not administered. The patient was followed-up over 2.5 years post local resection and showed no recurrence.
要旨
症例は53歳,女性。血便を主訴に当科紹介受診となった。精査にて腫瘍下縁が歯状線に接する肛門挙筋に浸潤する半周性の直腸癌を認めた。肛門温存の強い希望があり術前化学療法を導入し,CapeOX+bevacizumab 1コース,RAS wildが判明した後にCapeOX+panitumumabを7コース施行した。化学療法後,腫瘍は瘢痕化し,生検では癌細胞は検出されなかったがMRIで拡散低下領域を認め,腫瘍残存が否定できなかった。治療方針の決定のために経肛門的局所切除術を施行し,病理学的に完全奏効が確認されたため追加切除は行わなかった。術後2年6か月経過観察中であるが,現在無再発生存中である。
目次
A 53-year-old woman was referred to our hospital with melena. Examinations revealed advanced rectal cancer involving the anal canal with invasion of the left-sided levator ani muscle. Neoadjuvant chemotherapy was administered to preserve anal function. A first course of capecitabine and oxaliplatin(CapeOX)plus bevacizumab was administered. CapeOX plus panitumumab was administered from the 2nd to the 8th courses after confirming the absence of RAS mutation. Endoscopy and computed tomography confirmed the disappearance of the tumor after completion of the chemotherapy. A biopsy of the scar tissue revealed no cancer cells. However, diffusion weighted-magnetic resonance imaging(MRI-DWI)revealed a suspected residual tumor. To determine the subsequent treatment, a transanal resection was performed. No carcinoma was identified in the specimen. Thus, additional surgical treatment and adjuvant chemotherapy were not administered. The patient was followed-up over 2.5 years post local resection and showed no recurrence.
要旨
症例は53歳,女性。血便を主訴に当科紹介受診となった。精査にて腫瘍下縁が歯状線に接する肛門挙筋に浸潤する半周性の直腸癌を認めた。肛門温存の強い希望があり術前化学療法を導入し,CapeOX+bevacizumab 1コース,RAS wildが判明した後にCapeOX+panitumumabを7コース施行した。化学療法後,腫瘍は瘢痕化し,生検では癌細胞は検出されなかったがMRIで拡散低下領域を認め,腫瘍残存が否定できなかった。治療方針の決定のために経肛門的局所切除術を施行し,病理学的に完全奏効が確認されたため追加切除は行わなかった。術後2年6か月経過観察中であるが,現在無再発生存中である。