Management and Survivorship Considerations in Early-Onset Rectal Cancer

Area of Science:

• Oncology
• Surgical Gastroenterology
• Reproductive Medicine

Background:

• Rectal adenocarcinoma presents unique challenges in premenopausal women, particularly concerning fertility.
• The standard treatment often involves pelvic radiation, which can impair fertility, a significant concern for young patients desiring childbearing.

Purpose of the Study:

• To evaluate the feasibility and outcomes of a radiation-sparing approach in a premenopausal woman with rectal cancer.
• To assess the efficacy of neoadjuvant chemotherapy (FOLFOX) in downstaging the tumor for surgical resection while preserving fertility.

Main Methods:

• A 34-year-old premenopausal female with stage IIIB rectal adenocarcinoma underwent fertility preservation counseling.
• She received neoadjuvant FOLFOX chemotherapy, followed by restaging.
• The patient then underwent low anterior resection with diverting loop ileostomy (DLI).

Main Results:

• Neoadjuvant FOLFOX resulted in a 50% reduction in tumor size.
• Final pathology confirmed ypT2N0M0 disease with negative surgical margins.
• The patient successfully underwent surgical resection without pelvic radiation.

Conclusions:

• A radiation-sparing approach combined with neoadjuvant chemotherapy is a viable option for premenopausal women with rectal cancer who wish to preserve fertility.
• This strategy can achieve tumor downstaging and successful surgical outcomes while mitigating the risks of radiation-induced infertility.