Miyamoto Ryoichi, Kikuchi Kazunori, Uchida Atsushi, Ozawa Masayoshi, Sano Naoki, Tadano Sosuke, Inagawa Satoshi, Oda Tatsuya, Ohkohchi Nobuhiro
Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558, Japan; Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Department of Pathology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558, Japan.
Int J Surg Case Rep. 2019;62:85-88. doi: 10.1016/j.ijscr.2019.08.010. Epub 2019 Aug 17.
In Japan, the significance and efficacy of preoperative chemotherapy alone for locally advanced rectal cancer remain controversial. This case report presents the apparent effectiveness of preoperative FOLFOX plus bevacizumab as shown by pathological complete response (pCR). Additionally, we review the relevant literature and discuss the clinical management of locally advanced rectal cancer with preoperative chemotherapy.
A 59-year-old male presented with severe constipation, bloody stool and a loss of 10% of his body weight over 3 months. Preoperative examination revealed locally advanced rectal cancer with extensive invasion of the bladder wall and enlarged regional lymph nodes. Thus, this lesion was assigned a preoperative classification of T4bN2bM0 stage IIIC according to the 8 Union for International Cancer Control (UICC) guidelines. Therefore, the patient initially underwent an external loop colostomy of the transverse colon. Next, the patient received chemotherapy including FOLFOX plus bevacizumab. After 12 cycles of chemotherapy, the tumor size was markedly decreased, and all lymph node metastases had disappeared. Therefore, the patient underwent conventional resection of the rectum with D3 lymph node dissection and closure of the colostomy. Histopathological analysis of the resected specimen revealed that all lesions were fibrotic and devoid of any viable cancer cells. Thus, this lesion was assigned a final classification of ypT0N0M0 stage 0.
We present the rare case of a patient with surgically resected locally advanced rectal cancer who demonstrated an impressive pCR with preoperative chemotherapy, which included FOLFOX plus bevacizumab.
在日本，单纯术前化疗对局部晚期直肠癌的意义和疗效仍存在争议。本病例报告展示了术前使用FOLFOX方案联合贝伐单抗化疗取得的显著效果，即达到了病理完全缓解（pCR）。此外，我们回顾了相关文献，并讨论了局部晚期直肠癌术前化疗的临床管理。
一名59岁男性，出现严重便秘、便血，且在3个月内体重减轻了10%。术前检查发现局部晚期直肠癌，膀胱壁广泛受侵，区域淋巴结肿大。因此，根据国际癌症控制联盟（UICC）第8版指南，该病变术前分类为T4bN2bM0 ⅢC期。于是，患者最初接受了横结肠外置造口术。接下来，患者接受了包括FOLFOX方案联合贝伐单抗的化疗。化疗12个周期后，肿瘤大小明显缩小，所有淋巴结转移灶均消失。因此，患者接受了直肠癌根治术及D3淋巴结清扫，并关闭了造口。对切除标本的组织病理学分析显示，所有病变均纤维化，未发现任何存活的癌细胞。因此，该病变最终分类为ypT0N0M0 0期。
我们报告了一例罕见的局部晚期直肠癌患者，该患者术前接受包括FOLFOX方案联合贝伐单抗的化疗后，取得了令人瞩目的病理完全缓解，并接受了手术切除。
