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Organ Preservation in the Treatment of Stage II and III Rectal Cancer
Diseases of the Colon & Rectum ( IF 3.2 ) Pub Date : 2020-09-01 , DOI: 10.1097/dcr.0000000000001767
Edward R. Hagen 1 , Robert K. Cleary 2
Affiliation  

CASE SUMMARY: 

A 65-year-old man underwent colonoscopy to evaluate rectal bleeding and was found to have a low rectal mass. Biopsy revealed moderately differentiated microsatellite stable adenocarcinoma. The tumor was palpable at the fingertip in the anterior rectum with the inferior border 5 cm from the anal verge by rigid proctoscopy. CEA was 0.8 ng/mL. CT imaging of the chest, abdomen, and pelvis showed no evidence of distant metastases. MRI confirmed a 5-cm mass with one 8-mm mesorectal lymph node metastasis and no extramural venous invasion. The tumor penetrated the mesorectal fat to a depth of 4 mm, and the circumferential margin was estimated to be 1 mm from the tumor (Fig. 1). He was presented at the multidisciplinary tumor board conference and interviewed and examined at the multidisciplinary clinic. He was dismayed at the prospect of his surgical options, a low anterior resection versus abdominoperineal resection, and wished to keep the options for organ preservation available. Standard long-course chemoradiation was initiated, with resolution of his bleeding after 2 weeks. He then completed 6 cycles of folinic acid, fluorouracil, and oxaliplatin (FOLFOX) chemotherapy (consolidation total neoadjuvant therapy (TNT)). The tumor was no longer palpable on office examination. A complete clinical response (cCR) was confirmed by flexible sigmoidoscopy (Fig. 2) and MRI (Fig. 3). He was entered into the nonoperative management program with intense surveillance scheduling and has no evidence of recurrent disease almost 2 years after completion of TNT.



中文翻译:

器官保存治疗II和III期直肠癌

案例摘要: 

一名65岁的男子接受了结肠镜检查以评估直肠出血,并发现其直肠质量低。活检显示中分化微卫星稳定腺癌。通过刚性直肠镜检查,该肿瘤可触及前直肠指尖,下边界距肛门边缘5 cm。CEA为0.8 ng / mL。胸部,腹部和骨盆的CT成像未显示远处转移的证据。MRI证实为5 cm肿块,其中1个8 mm直肠系膜淋巴结转移,且无壁外静脉浸润。肿瘤穿透直肠直肠脂肪的深度为4 mm,估计周缘距肿瘤约1 mm(图1)。他参加了多学科肿瘤委员会会议,并在多学科诊所接受了采访和检查。他对手术选择的前景感到失望,前路切除术相对于腹部手术切除术低,并希望保留可供选择的器官保存方法。开始进行标准的长程化学放射治疗,并在2周后止血。然后,他完成了6个亚叶酸,氟尿嘧啶和奥沙利铂(FOLFOX)化疗(合并总新辅助治疗(TNT))周期。在办公室检查中,肿瘤不再明显。柔性乙状结肠镜检查(图2)和MRI(图3)证实了完整的临床反应(cCR)。TNT结束后将近2年,他进入了非手术管理程序并进行了严格的监视计划,并且没有复发疾病的证据。并希望保留器官保存的可用选项。开始进行标准的长程化学放射治疗,并在2周后止血。然后,他完成了6个亚叶酸,氟尿嘧啶和奥沙利铂(FOLFOX)化疗(合并总新辅助治疗(TNT))周期。在办公室检查中,肿瘤不再明显。柔性乙状结肠镜检查(图2)和MRI(图3)证实了完整的临床反应(cCR)。TNT结束后将近2年,他进入了非手术管理程序并进行了严格的监视计划,并且没有复发疾病的证据。并希望保留器官保存的可用选项。开始进行标准的长程化学放射治疗,并在2周后止血。然后,他完成了6个亚叶酸,氟尿嘧啶和奥沙利铂(FOLFOX)化疗(合并总新辅助治疗(TNT))周期。在办公室检查中,肿瘤不再明显。柔性乙状结肠镜检查(图2)和MRI(图3)证实了完整的临床反应(cCR)。TNT结束后将近2年,他进入了非手术管理程序并进行了严格的监视计划,并且没有复发疾病的证据。和奥沙利铂(FOLFOX)化疗(合并总新辅助治疗(TNT))。在办公室检查中,肿瘤不再明显。柔性乙状结肠镜检查(图2)和MRI(图3)证实了完整的临床反应(cCR)。TNT结束后将近2年,他进入了非手术管理程序并进行了严格的监视计划,并且没有复发疾病的证据。和奥沙利铂(FOLFOX)化疗(合并总新辅助治疗(TNT))。在办公室检查中,肿瘤不再明显。柔性乙状结肠镜检查(图2)和MRI(图3)证实了完整的临床反应(cCR)。TNT结束后将近2年,他进入了非手术管理程序并进行了严格的监视计划,并且没有复发疾病的证据。

更新日期:2020-08-17
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