Matsunaga Mototsugu, Miwa Keisuke, Oka Yosuke, Nagasu Sachiko, Sakaue Takahiko, Fukahori Masaru, Ushijima Tomoyuki, Akagi Yoshito
Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Fukuoka, Japan.
Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
Case Rep Oncol. 2016 Apr 26;9(1):249-54. doi: 10.1159/000446107. eCollection 2016 Jan-Apr.
Anal canal adenocarcinoma is a relatively rare malignancy without established diagnostic and treatment criteria. Case reports of chemotherapy for anal canal adenocarcinoma with distant metastasis are limited, and there is no convincing evidence for treatment effectiveness. A 62-year-old man complained of difficulty in defecation, anal pain, and bleeding during bowel movement. He was diagnosed with moderately differentiated primary anal canal adenocarcinoma. A computed tomography scan revealed multiple metastases in the lung and liver. The patient was treated with abdominoperineal resection to control local tumor growth and then with chemotherapy consisting of mFOLFOX6 + bevacizumab. Because he had an activating KRAS mutation, anti-EGFR therapy was not considered. A reduction in the size of lung and liver metastases was observed after 4 courses of mFOLFOX6 + bevacizumab, and after 22 courses, maximum reduction in the metastatic lesions was achieved. The patient demonstrated tolerable levels of oxaliplatin-related peripheral neurotoxicity (grades 1-2) and was considered as having partial response to treatment. He is currently at the partial response state for 1 year. We plan to continue the treatment unless the patient develops progressive disease or intolerable adverse reactions. This case demonstrates that anal canal adenocarcinoma with distant metastases could be successfully treated with mFOLFOX6 + bevacizumab therapy according to the guidelines for rectal carcinoma. However, as anal canal carcinoma has multiple histological subtypes, it is important to establish subtype-specific treatment strategies.
肛管腺癌是一种相对罕见的恶性肿瘤，目前尚无既定的诊断和治疗标准。关于远处转移的肛管腺癌化疗的病例报告有限，且没有令人信服的治疗有效性证据。一名62岁男性主诉排便困难、肛门疼痛及排便时出血。他被诊断为中度分化的原发性肛管腺癌。计算机断层扫描显示肺和肝有多处转移。患者接受了腹会阴联合切除术以控制局部肿瘤生长，随后接受了由mFOLFOX6加贝伐单抗组成的化疗。由于他存在KRAS激活突变，未考虑使用抗表皮生长因子受体（EGFR）治疗。在4个疗程的mFOLFOX6加贝伐单抗治疗后，观察到肺和肝转移灶缩小，在22个疗程后，转移病灶达到最大程度缩小。患者表现出可耐受程度的奥沙利铂相关外周神经毒性（1 - 2级），并被认为对治疗有部分缓解。他目前处于部分缓解状态已1年。我们计划继续治疗，除非患者出现疾病进展或无法耐受的不良反应。该病例表明，根据直肠癌治疗指南，远处转移的肛管腺癌可用mFOLFOX6加贝伐单抗治疗成功。然而，由于肛管癌有多种组织学亚型，制定亚型特异性治疗策略很重要。
