内容紹介
A Case of Advanced Rectal Cancer That Showed Complete Response to the Addition of XELOX+Bevacizumab Therapy to Preoperative Chemoradiotherapy with S-1/CPT-11
Summary
A 51-year-old man presented with a chief complaint of constipation. Rectal cancer was detected up to 13 cm proximal to the anal verge. The cancer was a fully circumferential typeⅡ tumor that was accompanied by prostate invasion and lymph node metastasis. After sigmoid colostomy, preoperative chemoradiotherapy with S-1/irinotecan(CPT-11; total 50 Gy)was administered, resulting in tumor volume reduction. However, because of residual invasion in some parts of the prostate, therapy with capecitabine and oxaliplatin(XELOX)plus bevacizumab was added to avoid pelvic exenteration. Because magnetic resonance imaging revealed no invasion prostate after 7 courses of the therapy, abdominoperineal resection of the rectum was performed. Pathological examination revealed no residual tumor cells, and a pathological complete response was thus confirmed. The addition of chemotherapy to preoperative chemoradiotherapy was considered to be an effective strategy for locally advanced rectal cancer in this case.
要旨
症例は51歳,男性。主訴は便秘。肛門縁直上から13 cmの長さにわたる直腸癌を認めた。2型の全周性腫瘍で,前立腺浸潤とリンパ節転移を伴っていた。S状結腸人工肛門造設後,S-1/irinotecan(CPT-11)を用いた術前化学放射線療法(計50 Gy)を行い,腫瘍の縮小を認めた。しかし前立腺への浸潤が一部残っていたため,骨盤内臓全摘術を回避する目的でcapecitabine+oxaliplatin(XELOX)+bevacizumab(Bev)療法を追加した。7コース施行後,MRIで前立腺浸潤を認めなくなったため,腹会陰式直腸切断術を行った。病理検査では腫瘍細胞の残存を認めず,完全奏効(pathological complete response: pCR)の判定であった。術前化学放射線療法への化学療法の追加治療は,局所進行直腸癌に対する有効な治療法と考えられた。
目次
Summary
A 51-year-old man presented with a chief complaint of constipation. Rectal cancer was detected up to 13 cm proximal to the anal verge. The cancer was a fully circumferential typeⅡ tumor that was accompanied by prostate invasion and lymph node metastasis. After sigmoid colostomy, preoperative chemoradiotherapy with S-1/irinotecan(CPT-11; total 50 Gy)was administered, resulting in tumor volume reduction. However, because of residual invasion in some parts of the prostate, therapy with capecitabine and oxaliplatin(XELOX)plus bevacizumab was added to avoid pelvic exenteration. Because magnetic resonance imaging revealed no invasion prostate after 7 courses of the therapy, abdominoperineal resection of the rectum was performed. Pathological examination revealed no residual tumor cells, and a pathological complete response was thus confirmed. The addition of chemotherapy to preoperative chemoradiotherapy was considered to be an effective strategy for locally advanced rectal cancer in this case.
要旨
症例は51歳,男性。主訴は便秘。肛門縁直上から13 cmの長さにわたる直腸癌を認めた。2型の全周性腫瘍で,前立腺浸潤とリンパ節転移を伴っていた。S状結腸人工肛門造設後,S-1/irinotecan(CPT-11)を用いた術前化学放射線療法(計50 Gy)を行い,腫瘍の縮小を認めた。しかし前立腺への浸潤が一部残っていたため,骨盤内臓全摘術を回避する目的でcapecitabine+oxaliplatin(XELOX)+bevacizumab(Bev)療法を追加した。7コース施行後,MRIで前立腺浸潤を認めなくなったため,腹会陰式直腸切断術を行った。病理検査では腫瘍細胞の残存を認めず,完全奏効(pathological complete response: pCR)の判定であった。術前化学放射線療法への化学療法の追加治療は,局所進行直腸癌に対する有効な治療法と考えられた。