Some of these patients address the doctors in locally advanced stages, sometimes without the possibility to perform resection. The challenge of the multimodal oncologic treatment of those patients is to obtain conversion towards resection, and also the decrease of the local recurrence, thus ensuring the increase of the long-term survival, targets which are often difficult to obtain. We present the case of a year-old patient with locally advanced rectal cancer, who benefitted from multimodal treatment: neo-adjuvant chemotherapy and radiotherapy, and also from surgical intervention.
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O parte dintre aceşti pacienţi se prezintă în stadii avansate local, uneori nerezecabile. Provocarea tratamentului oncologic multimodal al acestor pacienţi rectal cancer outcomes de a obţine conversia către rezecabilitate, precum şi scăderea incidenţei recurenţei locale, asigurând astfel creşterea supravieţuirii la distanţă, deziderate ce sunt adesea greu de obţinut.
Vă prezentăm cazul unei paciente în vârstă de 54 de ani, diagnosticată cu neoplasm rectal local avansat, ce a beneficiat de tratament multimodal chimio-radioterapic neoadjvant şi adjuvant, precum şi chirurgical complex. A retrospective study of SEER CRC registry showed an increase in the incidence of rectal cancer in patients under 50 years of age 1,2,3.
The most common disorders are Lynch syndrome and familial adenomatous polyposis 1,2. Important improvements in the outcomes of patients with rectal cancer have occurred over the past 30 years. Advances in surgical pathology, refinements in surgical techniques and instrumentation, new imaging modalities, and the widespread use of neoadjuvant therapy have all contributed to these improvements.
Many new systemic treatment options have rectal cancer outcomes available for locally advanced rectal cancers, including: additional chemotherapeutic agents and targeted therapies vascular-endothelial growth factor and epidermal growth unguent plat pentru negi receptor inhibitors which can be added to neoadjuvant and adjuvant regimens or given in combination with radiotherapy as radio-sensitizing agents.
An important aim is to treat so that the risk of residual disease in the pelvis, frequently causing a disabling local recurrence, is very low. We report a case of a year-old patient diagnosed with locally advanced rectal cancer and treated with a multimodal approach.
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Figure 1. CT scan of the pelvic region Figure 1. CT scan of the pelvic region Figure 2. Treatment sequence Case report In Novembera year-old female, smoker patient, presented at the primary care physician accusing rectal bleeding, pain and perianal abscess. Rectal cancer outcomes colonoscopy was performed and she was diagnosed through a biopsy with rectal adenocarcinoma.
The CT scan performed showed a locally advanced rectal tumor - cT4cN1Mx, with a suspicion of paraaortic lymph node metastases lymphadenopathy around 8 mm - Figure 1.
Clinical examination revealed no pathological elements, with a good performance status and biologically within normal limits. The tumor board decided that the best treatment sequence was neoadjuvant chemo-radiotherapy and then surgery.
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A protective ileostomy was performed Figure 2. The response evaluation CT scan showed a small regression of the primary tumor and increased paraaortic lymph nodes. An MRI performed after 6 months showed an important response to treatment with a conversion to resectability, and surgery was indicated Figure 4. The patient underwent radical surgery in January total hysterectomy with bilateral ovariectomy, rectum amputation and colpectomy.
During chemotherapy, mild gastrointestinal nausea, vomiting, diarrhea and hematological toxicity was observed and the patient experienced for a short period of time fatigue, asthenia, muscle weakness, numbness in limbs.
Cancerul colo-rectal incipient – epidemiologie, diagnostic
During this period the patient presented dysuria and her chemistry work-up revealed increased serum creatinine 5. A urine summary, bacteriological examination of urine and abdominal ultrasound determined that she developed a urinary tract infection with grade 2 proteinuria and the administration of Bevacizumab was discontinued for a short period of time, until her biological parameters returned to normal ranges Figure 5.
Regarding prognostic factors in this case - stage IV rectal cancer, with a high risk of recurrence, paraaortic lymph nodes involvement, side effects of the treatment grade 2 proteinuria that can lead to discontinuation of Bevacizumab - we can establish a poor prognostic for this patient. Figure 3. The evaluation of treatment response on CT scan Figure 4.
The response to treatment on pelvic MRI Figure 5. Hematological toxicity hemoglobin and increase of serum creatinine Rectal cancer outcomes The sequence is the most important multimodal therapy in rectal cancer.
In this case, the choice of sequence radio-chemotherapy and targeted therapy resulted in rectal cancer outcomes remission and conversion to resectability of the tumor.
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Prevention from local failures rectal cancer outcomes the severe morbidity which may accompany them is very important. The prognosis is also influenced by late effects of treatment toxicity and radio-chemotherapy, with the patient having gastrointestinal toxicity, hematologic and even proteinuria during treatment 1,2,4,7, In a retrospective study published in by Hsueh-Ju Lu, with a total of 4, newly diagnosed CRC patients who were enrolled, the authors aimed to assess the prognostic role of visible paraaortic lymph nodes PALNs.
Our patient had para-aortic lymph nodes visible on MRI around 1. Ina meta-analysis performed on 16 studies that included 12, patients with various malignancies evaluated the risk of developing proteinuria by the addition of Bevacizumab to chemotherapy. The study showed that Bevacizumab added to chemotherapy significantly increased the risk for high-grade proteinuria in patients with different types of cancer.
The risk is different with dosage of Bevacizumab and tumor type. The incidence of high-grade grade 3 or 4 proteinuria with Rectal cancer outcomes was 2. Compared with chemotherapy alone, Tratamentul paraziților la un sugar combined with chemotherapy significantly increased the risk for high-grade proteinuria and nephrotic syndrome.
The authors concluded that the addition of Bevacizumab to chemotherapy significantly increases the risk for high-grade proteinuria and nephrotic syndrome, with the possibility of developing renal failure and cardiovascular complications. Our patient developed grade 2 proteinuria and the administration of Bevacizumab was discontinued for a short period of time.
At the moment, the patient has a normal biological profile, without any proteinuria and she is continuing her treatment in the adjuvant setting 1,2,9, Conclusions The neo-adjuvant chemotherapy and radiotherapy treatment have a special role in the management of locally rectal cancer outcomes rectal cancer, by being able to provide conversion to the stage in which resection can be performed, even if this fact might imply a complex surgical intervention.
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The association of the adjuvant chemotherapy treatment may improve the results and the long-term perspectives of the patients, by decreasing the incidence of local recurrence. Bibliografie 1. NCCN guidelines version 3.
Glimelius et al. Ciara R Huntington, et al. Yanhong Deng, et al. Joshua Smith et al.
Colorectal Cancer Screening
Chau et al. Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer, J Clin Oncol. Wasif Saif.
Rectal cancer outcomes
Shenhong Wu et al. G Cserni et al. Nodal staging of colorectal carcinomas and sentinel nodes, J Clin Pathol. Tomonori M.