[A case successfully treated with multidisciplinary treatment against recurrence of lateral lymph node and liver for...

We report a case successfully treated with multidisciplinary treatment against recurrence of lateral lymph node and liver for rectal cancer. The patient was a 61-year-old man with lower rectal cancer (moderately-differentiated tubular adenocarcinoma). Low anterior resection with D2 (prxD2) lymph node dissection was performed. Final findings were pA, pN1, sH0, sP0, cM0, fStage IIIa, and S-1 was given as postoperative adjuvant chemotherapy. Seven months after surgery, recurrence of the right lateral lymph node (283rt) was detected on abdominal CT and PET-CT (SUVmax 23.6). Chemotherapy with FOLFOX4 was performed. However, because of elevated CEA, concurrent chemoradiotherapy with FOLFOX4 and radiation (60 Gy) was performed. Though CEA decreased once after chemoradiotherapy, it rose again in chemotherapy with FOLFOX4. The chemotherapy regimen was changed to FOLFIRI. Then, CEA decreased to the normal level. Eight courses of FOLFIRI and five courses of FOLFIRI plus bevacizumab were performed. Thereafter, chemotherapy with CPT-11 was continuously performed. Twenty months after surgery, no abnormal uptake was detected on PET-CT. Twenty-six months after surgery, radiofrequency ablation was performed for a small hepatic metastasis (2 cm or less in diameter). Thirty-nine months after surgery, no recurrence was detected on abdominal CT and the CEA level was normal.