Complete pathological response (ypT0N0M0) after preoperative chemotherapy alone for stage IV rectal cancer

BMC Surgery

Pascal Gervaz²  Philippe Morel²  Gilles Mentha²  Arnaud Roth¹  Theodoros Thomopoulos²  Laura Rubbia-Brandt³  Christian Toso²  Surennaidoo P Naiken² 

[1] Service d’oncochirurgie, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Genève 14 1211, Suisse;Services de chirurgie viscérale et transplantation, Département de chirurgie, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Genève 14 1211, Suisse;Services de pathologie clinique, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Genève 14 1211, Suisse

关键词: Oxaliplatin;    Preoperative chemotherapy;    Stage iv rectal cancer;    Pathological complete response;   

Others  :  866890
DOI  :  10.1186/1471-2482-14-4

 received in 2013-03-25, accepted in 2013-12-11,  发布年份 2014

【 摘 要 】

Background

Complete pathological response occurs in 10–20% of patients with rectal cancer who are treated with neoadjuvant chemoradiation therapy prior to pelvic surgery. The possibility that complete pathological response of rectal cancer can also occur with neoadjuvant chemotherapy alone (without radiation) is an intriguing hypothesis.

Case presentation

A 66-year old man presented an adenocarcinoma of the rectum with nine liver metastases (T3N1M1). He was included in a reverse treatment, aiming at first downsizing the liver metastases by chemotherapy, and subsequently performing the liver surgery prior to the rectum resection. The neoadjuvant chemotherapy consisted in a combination of oxaliplatin, 5-FU, irinotecan, leucovorin and bevacizumab (OCFL-B). After a right portal embolization, an extended right liver lobectomy was performed. On the final histopathological analysis, all lesions were fibrotic, devoid of any viable cancer cells. One month after liver surgery, the rectoscopic examination showed a near-total response of the primary rectal adenocarcinoma, which convinced the colorectal surgeon to perform the low anterior resection without preoperative radiation therapy. Macroscopically, a fibrous scar was observed at the level of the previously documented tumour, and the histological examination of the surgical specimen did not reveal any malignant cells in the rectal wall as well as in the mesorectum. All 15 resected lymph nodes were free of tumour, and the final tumour stage was ypT0N0M0. Clinical outcome was excellent, and the patient is currently alive 5 years after the first surgery without evidence of recurrence.

Conclusion

The presented patient with stage IV rectal cancer and liver metastases was in a unique situation linked to its inclusion in a reversed treatment and the use of neoadjuvant chemotherapy alone. The observed achievement of a complete pathological response after chemotherapy should promote the design of prospective randomized studies to evaluate the benefits of chemotherapy alone in patients with stages II-III rectal adenocarcinoma (without metastasis).

【 授权许可】

   
2014 Naiken et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

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