doiSerbia

Can multidisciplinary approach win the battle against metastatic rectal cancer?

Stojanović-Rundić Suzana (Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Plešinac-Karapandžić Vesna (Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Dedović-Stojaković Jelena (Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia), dedovicstojakovic@gmail.com
Mijalković Nenad (Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Department of Digestive Oncology, Belgrade, Serbia)
Škrelja Violeta (Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Department of Digestive Oncology, Belgrade, Serbia)
Miletić Nebojša (Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia)
Đurić-Stefanović Aleksandra (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Center of Serbia, Unit of Digestive Radiology, Center of Radiology and MR, Belgrade, Serbia)

Introduction. Colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths in men and women worldwide. The contemporary multidisciplinary approach has decreased rates of local recurrence and improved outcomes in metastatic colorectal cancer. We present a case of a primarily metastatic rectal cancer patient who underwent multidisciplinary planned treatment and showed complete response with now three years disease-free survival. Case outline. A 61-year-old female was diagnosed with a T4N2M1a rectal adenocarcinoma at the age of 58. She underwent six cycles of systemic chemotherapy capecitabine-oxaliplatin plus bevacizumab with partial response confirmed by diagnostic imaging procedures. According to multidisciplinary board decision, preoperative radiotherapy treatment was administered with concomitant capecitabinebased chemotherapy. A 50.4 Gy total dose was delivered with 1.8 Gy fraction dose. After concomitant chemoradiotherapy treatment, two more cycles of systemic chemotherapy capecitabine-oxaliplatin plus bevacizumab were administered. One month after completion of systemic chemotherapy, primary rectal cancer was operated with a complete response on histopathologic specimens. Six weeks following previous surgery, metastasectomy of lung deposits was performed; histopathology confirmed metastatic adenocarcinoma of colorectal origin. Three more cycles of postoperative chemotherapy capecitabineoxaliplatin plus bevacizumab were administered. Conclusion. On regular follow-up, no evidence of disease was shown, with disease-free survival of three years. The treatment improved the patient’s quality of life.

Keywords: chemotherapy, radiotherapy, rectal cancer, stage IV, surgical treatment