Takenoya Takashi, Kobayashi Yukari, Suda Kouichi, Shimizu Kazuki, Kikuichi Masahiro
Dept. of Surgery, Tokyo-West Tokushukai Hospital.
Gan To Kagaku Ryoho. 2014 Nov;41(12):1617-9.
A 62-year-old man with lower rectal cancer underwent abdominoperineal resection and dissection of the lateral pelvic lymph nodes. The cancer was staged at pT3pN0cM0, pStage II and did not show recurrence. Two years later, the patient had dysphagia and was diagnosed with esophageal cancer based on upper gastrointestinal endoscopy. Positron emission tomography-computed tomography (PET/CT) performed to detect distant metastasis revealed fluorodeoxyglucose (FDG) uptake in the left obturator lymph nodes, indicating rectal cancer recurrence. The patient received radiation therapy (60.4 Gy) for the recurrence. A PET/CT scan obtained 2 years 6 months after the initial rectal cancer resection revealed no FDG uptake. Uraciltegafur plus Leucovorin (UFT+LV) was started and continued for 6 months, but tumor enlargement was noted. Treatment was changed to LV, 5-fluorouracil, and irinotecan (FOLFIRI), but after 4 courses, the patient's carcinoembryonic antigen (CEA) levels rose. The patient then received 4 courses of bevacizumab plus FOLFIRI. A CT scan revealed tumor shrinkage, so the patient received 4 more courses of this regimen. Five years postoperatively, the patient's CEA levels rose again. A PET/CT scan 4 months later revealed FDG uptake in the left obturator lymph nodes, indicative of rectal cancer recurrence. One month later, the lymph nodes were resected. The patient was subsequently recurrence free. Tumor marker measurement and PET/CT helped to assess the patient's condition. When cancer recurs in the lateral pelvic lymph nodes with no involvement of the pelvis and R0 resection is possible, resection should be considered if the patient is capable of undergoing surgery.
一名62岁的低位直肠癌男性患者接受了腹会阴联合切除术及盆腔外侧淋巴结清扫术。癌症分期为pT3pN0cM0，pII期，未出现复发。两年后，患者出现吞咽困难，经上消化道内镜检查诊断为食管癌。为检测远处转移而进行的正电子发射断层扫描-计算机断层扫描（PET/CT）显示左闭孔淋巴结有氟脱氧葡萄糖（FDG）摄取，提示直肠癌复发。患者接受了针对复发灶的放射治疗（60.4 Gy）。在初次直肠癌切除术后2年6个月进行的PET/CT扫描显示无FDG摄取。开始使用优福定（UFT）联合亚叶酸钙（LV）并持续6个月，但发现肿瘤增大。治疗改为LV、5-氟尿嘧啶和伊立替康（FOLFIRI）方案，但4个疗程后，患者的癌胚抗原（CEA）水平升高。随后患者接受了4个疗程的贝伐单抗联合FOLFIRI治疗。CT扫描显示肿瘤缩小，因此患者又接受了4个疗程的该方案治疗。术后5年，患者的CEA水平再次升高。4个月后的PET/CT扫描显示左闭孔淋巴结有FDG摄取，提示直肠癌复发。1个月后，切除了淋巴结。患者随后未再复发。肿瘤标志物检测和PET/CT有助于评估患者病情。当盆腔外侧淋巴结出现癌症复发且未累及盆腔且有可能进行R0切除时，如果患者能够耐受手术，则应考虑进行切除。
