Soonchunhyang Med Sci.  2020 Jun;26(1):29-32. 10.15746/sms.20.008.

Rectal Cancer Patient with Complete Response to Neoadjuvant Chemoradiotherapy

Affiliations
  • 1Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Abstract

Personalized medicine for rectal cancer patients includes nonoperative management. This strategy is appropriate for select patients who exhibit a clinical complete response (cCR) to neoadjuvant chemoradiotherapy (nCRT). This study presents the case of a 70-year-old female with locally advanced rectal cancer. She received standard nCRT, consisting of 50.4 Gy pelvic radiotherapy and concurrent 5-fluorouracil chemotherapy. The response to nCRT was evaluated at 11 weeks after nCRT completion. Colonoscopy and computed tomography indicated cCR, but a partial residual tumor was suspected based on magnetic resonance imaging. Low anterior resection was performed with the creation of a protective colostomy. The pathological examination of the surgical specimen revealed only a fibrotic mass, no viable tumor cells. The stoma was maintained for 10 months until reversal after adjuvant chemotherapy ended. The patient remains alive with no evidence of disease 4 years later; however, the utility of this radical major surgery was questionable for this patient. Development of a risk-adapted strategy based on the nCRT response would avoid overtreatment, improving functional outcomes and quality of life while also retaining good oncological outcomes.

Keyword

Rectal neoplasms; Non-operative management; Watchful waiting; Radiotherapy; Complete regression; Case reports
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