[An elderly patient with recurrent rectal cancer successfully responded to S-1 combined with CPT-11]

An 80-year-old female visited our hospital with a chief complaint of anal pain and bleeding. The patient was diagnosed by colonoscopy to have rectal cancer which invaded the perineal region. A pelvic CT also revealed metastases to the lymph node located in the femoral artery. Miles operation was performed and a curative resection was successfully achieved. The pathological findings were poorly differentiated adenocarcinoma with pMP and pN2. Adjuvant chemotherapy was refused by the patient. Paraaortic lymph node metastasis was diagnosed by abdominal CT 6 months after the surgery. The patient was treated with S-1 combined with CPT-11. The S-1 (80 mg/m2) was orally administered for 2 weeks followed by a 2-week interval and CPT-11 (100 mg/m2) was also simultaneously administered biweekly. One cycle of chemotherapy was 28 days. The patient experienced grade 2 leukocytopenia, neutropenia, diarrhea and grade 1 alopecia. Abdominal CT revealed a partial response after 2 cycles. After 10 cycles, the patient continued to demonstrate a partial response. The S-1 combined with CPT-11 regimen for elderly patients was thus found to be very feasible and convenient, and we obtained a good compliance. As a result, this regimen was thus found to be promising for unresectable or recurrent colorectal cancer in elder patients. In the future, the efficacy and safety of this regimen should be verified in phase II clinical trial for elderly patients.