Management of the pelvic recurrence of rectal cancer with radiofrequency thermoablation: a case report and review of the literature.
BACKGROUND
The results of rectal cancer surgery are limited by the development of local recurrence (LR) that represents a great challenge to the surgeon. In the presence of unfavourable conditions for performing a curative operation, various forms of palliative treatment are indicated to control the patient's symptoms and the disease's complications. Recently, radiofrequency thermoablation (RFTA) has become a complimentary alternative therapy for malignant inoperable liver tumours. The present paper reports the use of RFTA in the management of pelvic recurrence of rectal adenocarcinoma.


METHODS
Fourteen months after abdominoperineal resection, a 32-year-old woman began to complain of progressive pelvic and lumbar pain. A large pelvic mass was found and serum CEA was elevated (66.4 ng/ml) at that time. Due to the dimensions of the presacral tumour (8 x 5 x 4 cm3) and the associated refractory pain, the patient underwent RFTA of the recurrent disease. Under epidural anaesthesia, a computed tomography-guided percutaneous needle electrode was introduced into the tumour. Although the procedure provided immediate pain control, the patient developed an intestinal obstruction 3 months later. This complication required surgical treatment to release adherences from the necrosed tumour.


CONCLUSIONS
Apart from this complication, RFTA allowed prolonged relief of the pelvic pain and improved quality of life. Faced with an unresectable pelvic recurrence, RFTA proved to be a viable option for controlling pain, although a relatively high cost and eventual complications may limit its use.
Department of Gastroenterology, Colorectal Surgery Unit, Hospital das Clínicas, University of São Paulo Medical School, Rua Padre João Manuel 222, (CEP 01420-002) São Paulo, Brazil. fgmcampos@terra.com.br
Fábio Guilherme
FG
Campos
Angelita
A
Habr-Gama
Desidério Roberto
DR
Kiss
Andréa Furlan
AF
Leite
Víctor
V
Seid
Joaquim
J
Gama-Rodrigues
D000328:Adult; D000767:Anesthesia, Epidural; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010148:Intractable Pain / Q000209:etiology; D010386:Pelvic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*