Preoperative chemoradiotherapy followed by transanal local excision for T3 distal rectal cancer: A case report

Abstract

Local excision (LE) for rectal cancer is currently indicated for selected T1 stage tumors. However, preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer not only improves local disease control, but also leads to a decrease in the stage and size of the primary mural tumor, along with a decrease in the risk of regional lymphadenopathy. The present study reports the outcome of a patient with T3N0M0 rectal cancer who was treated with LE following preoperative CRT. The distal pole of the tumor was located 2 cm from the anal verge. Preoperative pelvic radiotherapy of 50.4 Gy was administered in 28 fractions. Chemotherapy using 5-fluorouracil and leucovorin was administered during the first and last weeks of radiotherapy. The tumor response to CRT, was found to be marked at 7 weeks after CRT completion, and a complete response was presumed clinically. Transanal full-thickness LE was performed, and pathological examination revealed the absence of residual cancer cells. After 30 months of close follow-up, the patient was alive with no evidence of disease, and treatment-associated severe toxicities were not observed. Although a longer follow-up period is required, this case report suggests that LE may also be a feasible alternative treatment for T3 rectal cancer, which exhibits a marked response to preoperative CRT, particularly in elderly and comorbid patients contraindicated for radical surgery, or patients who are reluctant to undergo sphincter-ablation surgery.

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

“…Conservative surgery includes transanal local excision and transanal endoscopic microsurgery. Local excision has the advantages of rapid postoperative recovery, no need for a permanent colostomy, and the absence of many morbidities associated with the radical operation [5][6][7]. This procedure removes only the primary mural tumor, leaving behind most mesorectal lymph nodes.…”

“…If metastatic tumor cells exist in the lymph nodes, CRT regresses them, along with the primary tumor cells [26][27][28]. Therefore, management subsequent to local excision is based on the ypT stage: close observation for those of ypT0-1 without unfavorable prognostic factors, but re-operation (TME) for others [5][6][7].…”

“…The first restricts the use of radiotherapy [3,4]. The second prescribes either no surgery or conservative surgery following neoadjuvant chemoradiotherapy (nCRT) [5][6][7][8][9]. The latter approach is more liberal in terms of radiotherapy than the first, but the common goal is to reduce treatment morbidity and improve functional outcomes.…”

Identification of CEA-interacting proteins in colon cancer cells and their changes in expression after irradiation

“…Since the standard-of-care for locally advanced rectal cancer changed from postoperative chemoradiotherapy to preoperative chemoradiotherapy, the tumor response of each patient can be identified early on by surgical pathology. Adjusted approaches, such as conservative local excision or no surgery, are currently under clinical investigation for selected patients with an excellent tumor response [ 8 , 9 ]. Many reports have shown that serum CEA levels are significantly associated with this chemoradiation response [ 7 ].…”