title: [Complete response obtained by preoperative chemotherapy in a case of T4 rectal cancer].
abstract: A 48-year-old man, who had presented with anal pain and cloudy urine, was referred to our hospital. Colonoscopy showed a type 2 circular tumor at the higher rectum, and a diagnosis of well-differentiated adenocarcinoma was made by biopsy. CT demonstrated increased thickness of the rectum wall, an equivocal boundary between the rectum and the bladder, and abnormal gas production in the bladder. Following diagnosis of T4 rectal cancer, preoperative chemotherapy was initiated with the aim of downstaging the tumor and avoiding total pelvic exenteration. After 5 courses of mFOLFOX+bevacizumab, the tumor showed a partial response on CT, which enabled the tumor to be resected without sacrificing the bladder. The whole tumor was resected by performing low anterior resection (D3) and partial resection of the bladder. Subsequent pathological examination of the resected specimen indicated complete response to chemotherapy due to the absence of malignant cells. Because higher response rate is reported for modern chemotherapy, including targeted therapy, preoperative intensive chemotherapy is an option for the local treatment of advanced rectal cancer. Downstaging chemotherapy is expected to enhance the role of function-preserving surgery for T4 rectal cancer.
authors.affiliation: Dept. of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Harue
authors.initials: H
authors.lastname: Akasaka
authors.forename: Hajime
authors.initials: H
authors.lastname: Morohashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Motoi
authors.initials: M
authors.lastname: Koyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Murata
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hakamada
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D009944:Organoplatinum Compounds; D000068258:Bevacizumab; D002955:Leucovorin; D005472:Fluorouracil