内容紹介
A Case of a Patient with Advanced Rectal Cancer and Urinary Bladder Fistula Surviving for 6 Years after Chemoradiotherapy without Surgery
Summary
A 60-year-old man with advanced rectal cancer and urinary bladder fistula received preoperative chemoradiotherapy with S-1(120 mg/m2/day)on weekdays and concurrent radiotherapy(65 Gy). After chemoradiotherapy, the clinical symptoms resolved and the tumor shrunk, as observed on endoscopic and radiologic examinations. However, remnant cancer was suspected; therefore, modified oxaliplatin, 5-fluorouracil, and Leucovorin(mFOLFOX6)therapy was initiated, although it was stopped after 3 cycles because of numbness in the lower extremities. Finally, clinical and pathological complete response(CR)was achieved by administering additional doses of S-1 for approximately 1 year after treatment initiation; CR was confirmed by using endoscopy and computed tomography(CT), and there has been no recurrence for 6 years. This case suggests that treatment without surgery is a viable alternative for advanced rectal cancer with pathological CR after chemoradiotherapy.
要旨
症例は膀胱瘻を伴う進行直腸癌の60歳,男性。化学放射線治療を希望されたためS-1(120 mg/body,月～金投与,土日休薬)と放射線治療65 Gyを行い腫瘍は縮小,膀胱瘻は消失し組織診では癌を認めなかった。MRIでは大腸壁肥厚を認め腫瘍残存が懸念されたため追加治療としてmFOLFOX6を行ったが,下肢のしびれが強く3サイクルで中止し,S-1の再投与となった。その後,CT,MRIでもCRとなり,治療から6年経過後の現在まで再発を認めない。
目次
Summary
A 60-year-old man with advanced rectal cancer and urinary bladder fistula received preoperative chemoradiotherapy with S-1(120 mg/m2/day)on weekdays and concurrent radiotherapy(65 Gy). After chemoradiotherapy, the clinical symptoms resolved and the tumor shrunk, as observed on endoscopic and radiologic examinations. However, remnant cancer was suspected; therefore, modified oxaliplatin, 5-fluorouracil, and Leucovorin(mFOLFOX6)therapy was initiated, although it was stopped after 3 cycles because of numbness in the lower extremities. Finally, clinical and pathological complete response(CR)was achieved by administering additional doses of S-1 for approximately 1 year after treatment initiation; CR was confirmed by using endoscopy and computed tomography(CT), and there has been no recurrence for 6 years. This case suggests that treatment without surgery is a viable alternative for advanced rectal cancer with pathological CR after chemoradiotherapy.
要旨
症例は膀胱瘻を伴う進行直腸癌の60歳,男性。化学放射線治療を希望されたためS-1(120 mg/body,月～金投与,土日休薬)と放射線治療65 Gyを行い腫瘍は縮小,膀胱瘻は消失し組織診では癌を認めなかった。MRIでは大腸壁肥厚を認め腫瘍残存が懸念されたため追加治療としてmFOLFOX6を行ったが,下肢のしびれが強く3サイクルで中止し,S-1の再投与となった。その後,CT,MRIでもCRとなり,治療から6年経過後の現在まで再発を認めない。