[A Case of Long-Term Survival Achieved by Chemotherapy for Multiple Metastases Occurring 22 Years after Surgery for...

Late recurrence of colorectal cancer, especially more than 5 years after curative resection, is rare, accounting for less than 0.5% of all cases. We report a valuable case of a 72-year-old female who was diagnosed multiple metastases 22 years after undergoing surgery for rectal cancer in her 50s. Initial examination revealed elevated CEA and various metastatic lesions including a right iliopsoas muscle tumor, multiple pulmonary nodules, and widespread multiple lymphadenopathy. Biopsy of the iliopsoas mass confirmed adenocarcinoma, consistent with her previous rectal cancer. Systemic chemotherapy was initiated, starting with FOLFIRI plus panitumumab(Pmab), which achieved a partial response. Due to skin toxicity from Pmab, it was switched to cetuximab(Cmab), and FOLFIRI was continued for 71 courses. Subsequently, the patient experienced disease progression and received second-line FOLFOX plus bevacizumab(Bmab)and third-line FTD/TPI plus Bmab. Furthermore, FOLFIRI plus Pmab was rechallenged. Ultimately, the patient died of the original disease 6 years and 1 month after the initiation of chemotherapy, and 28 years after the initial surgery. The recurrence of colorectal cancer 22 years post-surgery was the longest reported case in Japan. This case demonstrates that long-term survival can be achieved even in unresectable late-onset recurrent rectal cancer through persistent and multidisciplinary chemotherapy.