Successful resection of locally advanced rectal carcinoma combined with preoperative chemoradiation

Chemoradiation increases the local control and colostomy-free survival in patients with advanced anal canal carcinomas. We recently experienced a 50-year-old female patient with locally advanced carcinoma of the rectum invading to the sacrum, which could not be surgically resected. Therefore, we performed a colostomy and transarterial infusion of anti-tumor drugs including 50 mg cisplatin and 10 mg mitomycin C via the inferior mesentery artery in September 1999. She then underwent radiotherapy with a total dose of 64 Gy for the primary tumor. After the radiotherapy the patient received 125 mg/body of 1-leucovorin by 2-hour infusion and, one hour after starting the 1-leucovorin infusion, she received an intravenous bolus of 250 mg/body of 5-fluorouracil. This regimen was conducted biweekly for 13 courses followed by oral administration of 400 mg 5'-deoxyfluorouridine for one year. Since the chemoradiation resulted in a successful response, the patient underwent curative resection of the primary tumor in June 2001. The resected tumor (32 x 35 mm) had clean margins. Although the carcinoma cells had disappeared, fibrous lesions were observed over a broad area. Based on these pathologic findings, the treatment effect was judged as grade Ib.