A case of marked response to preoperative chemoradiotherapy for rectal cancer with para-aortic lymph node metastasis

Int Surg. 2011 Apr-Jun;96(2):139-43. doi: 10.9738/1389.1.

Abstract

A 67-year-old man had rectal cancer with para-aortic lymph node metastasis. Prior to surgical resection, tegafur-uracil and leucovorin had been administered orally as chemotherapy, and radiotherapy (50.4 Gy) was applied for the rectum and para-aortic lymph nodes. Low anterior resection was then performed, followed by 45 cycles of chemotherapy in total. Enlargement of the left axillary lymph nodes was noted during treatment, but nodes shrank in response to treatment with bevacizumab + FOLFIRI (i.e., irinotecan + 5-fluorouracil/leucovorin). As of the time of writing, 36 months after diagnosis, no swelling of the para-aortic lymph nodes was evident and chemotherapy was being continued. This patient was alive after achieving response to neoadjuvant therapy comprising chemotherapy and irradiation of the para-aortic lymph nodes, along with postoperative chemotherapy. This therapeutic approach of preoperative chemotherapy plus irradiation of the primary lesion and para-aortic lymph nodes has potential as an effective treatment.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antimetabolites, Antineoplastic / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab
  • Camptothecin / analogs & derivatives
  • Camptothecin / therapeutic use
  • Carcinoembryonic Antigen / blood
  • Colonoscopy
  • Fluorouracil / therapeutic use
  • Humans
  • Leucovorin / therapeutic use
  • Lymphatic Metastasis
  • Male
  • Neoadjuvant Therapy*
  • Preoperative Care*
  • Radiotherapy Dosage
  • Rectal Neoplasms / diagnosis
  • Rectal Neoplasms / drug therapy
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / radiotherapy
  • Rectal Neoplasms / surgery*
  • Tegafur / therapeutic use
  • Tomography, X-Ray Computed

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Antimetabolites, Antineoplastic
  • Carcinoembryonic Antigen
  • Tegafur
  • Bevacizumab
  • Leucovorin
  • Fluorouracil
  • Camptothecin

Supplementary concepts

  • IFL protocol