J Korean Med Sci.  2008 Oct;23(5):916-919. 10.3346/jkms.2008.23.5.916.

Complete Remission of Unresectable Colon Cancer after Preoperative Chemotherapy Selected by Adenosine Triphosphate-Based Chemotherapy Response Assay

• Huh JW
• Park YA
• Jung EJ
• Lee KY
• Kwon JE
• Sohn SK

• KMID: 1783085
• DOI: http://doi.org/10.3346/jkms.2008.23.5.916

Abstract

The adenosine triphosphate-based chemotherapy response assay (ATP-CRA) is a chemosensitivity test that offers the potential of selecting cancer treatments based on the responsiveness of individual tumors. We report a case of 47-yr-old male, presented with sigmoid colon cancer with multiple liver and peritoneal metastases, in which there was a complete response for the primary colon cancer after administration of preoperative chemotherapy selected by ATP-CRA. Oxaliplatin was the most sensitive drug based on the ATP-CRA where the specimen obtained by ultrasound- guided percutaneous liver biopsy was used. After twelve cycles of oxaliplatincapecitabine chemotherapy, abdominopelvic computed tomography revealed marked shrinkage of the liver metastases and positron emission tomography showed no uptake of (18)F-fluoro-deoxy-glucose (FDG) either in the liver or peritoneum except localized uptake in the sigmoid colon. The patient underwent an anterior resection and radiofrequency ablation of the liver metastases, which resulted in a macroscopic curative resection of the cancer cells. Histological examination revealed no residual cancer cells in the resected specimen of the sigmoid colon. This result suggested that preoperative chemotherapy chosen by ATP-CRA may be useful for treating advanced colon cancer with unresectable liver and peritoneal metastases.

Keyword

Adenosine Triphosphate; Drug Screening Assays, Antitumor; Colonic Neoplasms; Complete Remission

MeSH Terms

Adenosine Triphosphate/*metabolism
Antineoplastic Agents/*pharmacology
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Colonic Neoplasms/*diagnosis/*drug therapy
Deoxycytidine/administration & dosage/analogs & derivatives
Fluorouracil/administration & dosage/analogs & derivatives
Humans
Liver Neoplasms/drug therapy/secondary
Male
Medical Oncology/methods
Middle Aged
Neoplasm Metastasis
Organoplatinum Compounds/administration & dosage
Positron-Emission Tomography
Remission Induction
Treatment Outcome

Figure

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  Fig. 1 Multiple liver metastases in sigmoid colon cancer. (A) Before chemotherapy. (B) After chemotherapy.

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  Fig. 2 Primary sigmoid colon cancer. (A) Before chemotherapy, an exophytic tumor mass (arrow) invading the distal left ureter. (B) After chemotherapy, a slight decrease in the size of the tumor mass (arrow) but no definite interval change. A Hanaro Colorectal Stent® and a double J ureteral stent were visible.

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  Fig. 3 Tumor suppression rate at peak plasma concentration (PPC). Longer bars indicate greater in vitro tumor suppression (p=NS).

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  Fig. 4 After chemotherapy, PET scan showed a localized uptake of 18F-fluoro-deoxy-glucose (FDG) and no uptake in the liver or peritoneum.

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  Fig. 5 Histological features of sigmoid colon cancer. (A) Before chemotherapy, a biopsy of the lesion showed adenocarcinoma (H&E ×200). (B) No residual cancer cells were present in the resected specimen (CR) (H&E ×40).

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