内容紹介
A Successful Multimodality Therapy for a Case of Recurrent Rectal Cancer with KRAS Mutation
Summary
A man in his 50s underwent high anterior resection for rectosigmoid cancer in January 2010. The primary tumor was diagnosed as a moderately differentiated adenocarcinoma with KRAS mutation, pStage Ⅲa. In May 2011, the patient had a recurrent lung tumor detected by computed tomography(CT); the tumor was resected using video-assisted thoracoscopic surgery. However, additional recurrent lung tumors arose, and radiofrequency ablation(RFA)was performed to treat these in February 2012. After RFA therapy, capecitabine was administered as adjuvant chemotherapy. Unfortunately, 10 months later, positron emission tomography(PET)/CT suggested a new recurrence in a left lateral lymph node. Although the pelvic lymph node was surgically removed immediately, a new lung recurrence was found on CT three months after the surgery. RFA was again used to treat this lung lesion. After the second RFA, the patient is doing well without any evidence of recurrence. We describe a case of recurrent rectal cancer successfully treated with multimodality therapy. The combination of appropriate local therapy with systemic chemotherapy is an essential strategy to treat advanced colorectal cancer, especially in patients with KRAS mutation when anti-EGFR antibodies are not effective.
要旨
進行・再発大腸癌に対する新規抗癌剤や分子標的薬の登場により多くの患者が生存期間の延長を得られるようになった。しかしさらなる長期生存を得るためには全身化学療法のみではなく,転移巣に対する局所療法も組み合わせる必要がある。とりわけKRAS変異を伴う大腸癌は有効薬剤が限られるため,より集学的な治療が必要となる。今回われわれは,KRAS変異を伴う直腸癌術後肺再発・骨盤内リンパ節再発を来した50代の男性に対して全身化学療法に加え,肺切除,経皮的ラジオ波焼灼術(radiofrequency ablation: RFA),リンパ節切除といった集学的治療を行うことにより,初回再発時より3年以上,活動性病変のない状態で生存している症例を報告する。
目次
Summary
A man in his 50s underwent high anterior resection for rectosigmoid cancer in January 2010. The primary tumor was diagnosed as a moderately differentiated adenocarcinoma with KRAS mutation, pStage Ⅲa. In May 2011, the patient had a recurrent lung tumor detected by computed tomography(CT); the tumor was resected using video-assisted thoracoscopic surgery. However, additional recurrent lung tumors arose, and radiofrequency ablation(RFA)was performed to treat these in February 2012. After RFA therapy, capecitabine was administered as adjuvant chemotherapy. Unfortunately, 10 months later, positron emission tomography(PET)/CT suggested a new recurrence in a left lateral lymph node. Although the pelvic lymph node was surgically removed immediately, a new lung recurrence was found on CT three months after the surgery. RFA was again used to treat this lung lesion. After the second RFA, the patient is doing well without any evidence of recurrence. We describe a case of recurrent rectal cancer successfully treated with multimodality therapy. The combination of appropriate local therapy with systemic chemotherapy is an essential strategy to treat advanced colorectal cancer, especially in patients with KRAS mutation when anti-EGFR antibodies are not effective.
要旨
進行・再発大腸癌に対する新規抗癌剤や分子標的薬の登場により多くの患者が生存期間の延長を得られるようになった。しかしさらなる長期生存を得るためには全身化学療法のみではなく,転移巣に対する局所療法も組み合わせる必要がある。とりわけKRAS変異を伴う大腸癌は有効薬剤が限られるため,より集学的な治療が必要となる。今回われわれは,KRAS変異を伴う直腸癌術後肺再発・骨盤内リンパ節再発を来した50代の男性に対して全身化学療法に加え,肺切除,経皮的ラジオ波焼灼術(radiofrequency ablation: RFA),リンパ節切除といった集学的治療を行うことにより,初回再発時より3年以上,活動性病変のない状態で生存している症例を報告する。