[A case of increased resectability with preoperative chemotherapy FOLFOX4 for unresectable rectal cancer]

The patient was a 57-year-old man. The chief complaints were bleeding upon defecation and decreased body weight. He came to our department in May 2006 because the bleeding had been observed since summer 2005 and he had lost 7 kg in one year. A tumor was palpable on the rectum, approximately 5 cm proximal to the anal verge. Abdominal CT revealed a large tumor within the pelvis and enlarged paraaortic lymph nodes. CEA was 14.0 ng/mL. The patient underwent surgery in June 2006, but the tumor was firmly fixed anterior to the sacrum. We judged it unresectable and performed double-barrel descending colostomy. FOLFOX4 chemotherapy commenced following the surgery, and the tumor marker level normalized following three cycles. Abdominal CT following five cycles showed that the size of the tumor had reduced significantly. Later, the patient developed grade 2 nausea and decreased appetite as adverse events, and the chemotherapy was discontinued at his request. We considered resection possible and performed rectal resection in November 2006. The patient underwent radiotherapy following surgery and is currently receiving S-1. FOLFOX4 may be an effective preoperative chemotherapy for unresectable primary rectal cancer.