Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy:A case report and literature review
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摘要
Standard chemoradiotherapy(CRT) for local advanced rectal cancer(LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT.
Standard chemoradiotherapy(CRT) for local advanced rectal cancer(LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT.
Standard chemoradiotherapy(CRT) for local advanced rectal cancer(LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT.
引文
1 Sauer R,Liersch T,Merkel S,Fietkau R,Hohenberger W,Hess C,Becker H,Raab HR,Villanueva MT,Witzigmann H,Wittekind C,Beissbarth T,R?del C.Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years.J Clin Oncol 2012;30:1926-1933[PMID:22529255 DOI:10.1200/JCO.2011.40.1836]
2 Roh MS,Colangelo LH,O’Connell MJ,Yothers G,Deutsch M,Allegra CJ,Kahlenberg MS,Baez-Diaz L,Ursiny CS,Petrelli NJ,Wolmark N.Preoperative multimodality therapy improves diseasefree survival in patients with carcinoma of the rectum:NSABPR-03.J Clin Oncol 2009;27:5124-5130[PMID:19770376 DOI:10.1200/JCO.2009.22.0467]
3 De CaluwéL,Van Nieuwenhove Y,Ceelen WP.Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer.Cochrane Database Syst Rev 2013;(2):CD006041[PMID:23450565 DOI:10.1002/14651858.CD006041.pub3]
4 Tomono A,Yamashita K,Kanemitsu K,Sumi Y,Yamamoto M,Kanaji S,Imanishi T,Nakamura T,Suzuki S,Tanaka K,Kakeji Y.Prognostic significance of pathological response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer.Int J Clin Oncol 2016;21:344-349[PMID:26338272 DOI:10.1007/sl0147-015-0900-x]
5 Sobin LH,Gospodarowicz MK,Wittekind C.TNM classification of malignant tumours,7th edn.Wiley-Blackwell,Oxford.2009
6 Bentzen SM.Preventing or reducing late side effects of radiation therapy:radiobiology meets molecular pathology.Nat Rev Cancer2006;6:702-713[PMID:16929324 DOI:10.1038/nrc1950]
7 Watters D.Molecular mechanisms of ionizing radiation-induced apoptosis.Immunol Cell Biol 1999;77:263-271[PMID:10361259DOI:10.1046/j.1440-1711.1999.00824.x]
8 Xiao M,Whitnall MH.Pharmacological countermeasures for the acute radiation syndrome.Curr Mol Pharmacol 2009;2:122-133[PMID:20021452]
9 Kvols LK.Radiation sensitizers:a selective review of molecules targeting DNA and non-DNA targets.J Nucl Med 2005;46 Suppl 1:187S-190S[PMID:15653668]
10 Grann A,Minsky BD,Cohen AM,Saltz L,Guillem JG,Paty PB,Kelsen DP,Kemeny N,Ilson D,Bass-Loeb J.Preliminary results of preoperative 5-fluorouracil,low-dose leucovorin,and concurrent radiation therapy for clinically resectable T3 rectal cancer.Dis Colon Rectum 1997;40:515-522[PMID:9152176]
11 Williams G,Yan BM.Endoscopic ultrasonographic features of subacute radiation proctitis.J Ultrasound Med 2010;29:1495-1498[PMID:20876905]
12 Do NL,Nagle D,Poylin VY.Radiation proctitis:current strategies in management.Gastroenterol Res Pract 2011[PMID:22144997DOI:10.1155/2011/917941]
13 Baglan KL,Frazier RC,Yan D,Huang RR,Martinez AA,Robertson JM.The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer.Int J Radiat Oncol Biol Phys 2002;52:176-183[PMID:11777636]
14 Minsky BD,Conti JA,Huang Y,Knopf K.Relationship of acute gastrointestinal toxicity and the volume of irradiated small bowel in patients receiving combined modality therapy for rectal cancer.JClin Oncol 1995;13:1409-1416[PMID:7751886]
15 Clarke RE,Tenorio LM,Hussey JR,Toklu AS,Cone DL,Hinojosa JG,Desai SP,Dominguez Parra L,Rodrigues SD,Long RJ,Walker MB.Hyperbaric oxygen treatment of chronic refractory radiation proctitis:a randomized and controlled double-blind crossover trial with long-term follow-up.Int J Radiat Oncol Biol Phys 2008;72:134-143[PMID:18342453 DOI:10.1016/j.ijrobp.2007.12.048]
16 Grivennikov SI,Greten FR,Karin M.Immunity,inflammation,and cancer.Cell 2010;140:883-899[PMID:20303878 DOI:10.1016/j.cell.2010.01.025]
17 Wei-Xing Z,Craig BT.Necrotic death as a cell fate.Genes Dev2006;20:1-15[DOI:10.1101/gad.1376506]
18 Di Staso M,Bonfili P,Gravina GL,Di Genesio Pagliuca M,Franzese P,Buonopane S,Osti MF,Valeriani M,Festuccia C,Enrici RM,Tombolini V.Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer.BJU Int 2010;106:1458-1462[PMID:20518760 DOI:10.1111/j.1464-410X.2010.09418.x]
19 Coia LR,Myerson RJ,Tepper JE.Late effects of radiation therapy on the gastrointestinal tract.Int J Radiat Oncol Biol Phys 1995;31:1213-1236[PMID:7713784 DOI:10.1016/0360-3016(94)00419-L]
20 Khan A,Suhaibani YA,Sharief AA.Rectal cancer perforation:a rare complication of neoadjuvant radiotherapy for rectal cancer.Int J Oncol 2009;7:1-5
21 Medina-Arana V,Martínez-Riera A,Delgado-Plasencia L,Rodríguez-González D,Bravo-Gutiérrez A,álvarez-Argüelles H,Alarcó-Hernández A,Salido-Ruiz E,Fernández-Peralta AM,González-Aguilera JJ.Clinicopathological analysis of factors related to colorectal tumor perforation:influence of angiogenesis.Medicine(Baltimore)2015;94:e703[PMID:25881846 DOI:10.1097/md.0000000000000703]
22 Lee J,Chen F,Steel M,Keck J,Mackay J.Perforated rectal cancer associated with neoadjuvant radiotherapy:report of four cases.Dis Colon Rectum 2006;49:1629-1632[PMID:17039387 DOI:10.1007/s10350-006-0687-y]
23 El Gendy K.Rectal perforation after neoadjuvant chemoradiotherapy for low-lying rectal cancer.BMJ Case Rep 2015[PMID:25564637 DOI:10.1136/bcr-2014-207105]
24 Takada S,Hoshino Y,Ito H,Masugi Y,Terauchi T,Endo K,Kimata M,Furukawa J,Shinozaki H,Kobayashi K,Ogata Y.Extensive bowel necrosis related to bevacizumab in metastatic rectal cancer patient:a case report and review of literature.Jpn JClin Oncol 2015;45:286-290[PMID:25489005 DOI:10.1093/jjco/hyu206]
25 Samantha LK,Allison FL,Patrick GJ,Pedro ADB,Michael BA.Bowel perforation associated with robust response to BRAF/MEK inhibitor therapy for BRAF-mutant melanoma:a case report.Melanoma Management 2015;2:115-120[DOI:10.2217/mmt.15.10]
26 Borzomati D,Nappo G,Valeri S,Vincenzi B,Ripetti V,Coppola R.Infusion of bevacizumab increases the risk of intestinal perforation:results on a series of 143 patients consecutively treated.Updates Surg 2013;65:121-124[PMID:23532741 DOI:10.1007/s13304-013-0207-2]
2 Roh MS,Colangelo LH,O’Connell MJ,Yothers G,Deutsch M,Allegra CJ,Kahlenberg MS,Baez-Diaz L,Ursiny CS,Petrelli NJ,Wolmark N.Preoperative multimodality therapy improves diseasefree survival in patients with carcinoma of the rectum:NSABPR-03.J Clin Oncol 2009;27:5124-5130[PMID:19770376 DOI:10.1200/JCO.2009.22.0467]
3 De CaluwéL,Van Nieuwenhove Y,Ceelen WP.Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer.Cochrane Database Syst Rev 2013;(2):CD006041[PMID:23450565 DOI:10.1002/14651858.CD006041.pub3]
4 Tomono A,Yamashita K,Kanemitsu K,Sumi Y,Yamamoto M,Kanaji S,Imanishi T,Nakamura T,Suzuki S,Tanaka K,Kakeji Y.Prognostic significance of pathological response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer.Int J Clin Oncol 2016;21:344-349[PMID:26338272 DOI:10.1007/sl0147-015-0900-x]
5 Sobin LH,Gospodarowicz MK,Wittekind C.TNM classification of malignant tumours,7th edn.Wiley-Blackwell,Oxford.2009
6 Bentzen SM.Preventing or reducing late side effects of radiation therapy:radiobiology meets molecular pathology.Nat Rev Cancer2006;6:702-713[PMID:16929324 DOI:10.1038/nrc1950]
7 Watters D.Molecular mechanisms of ionizing radiation-induced apoptosis.Immunol Cell Biol 1999;77:263-271[PMID:10361259DOI:10.1046/j.1440-1711.1999.00824.x]
8 Xiao M,Whitnall MH.Pharmacological countermeasures for the acute radiation syndrome.Curr Mol Pharmacol 2009;2:122-133[PMID:20021452]
9 Kvols LK.Radiation sensitizers:a selective review of molecules targeting DNA and non-DNA targets.J Nucl Med 2005;46 Suppl 1:187S-190S[PMID:15653668]
10 Grann A,Minsky BD,Cohen AM,Saltz L,Guillem JG,Paty PB,Kelsen DP,Kemeny N,Ilson D,Bass-Loeb J.Preliminary results of preoperative 5-fluorouracil,low-dose leucovorin,and concurrent radiation therapy for clinically resectable T3 rectal cancer.Dis Colon Rectum 1997;40:515-522[PMID:9152176]
11 Williams G,Yan BM.Endoscopic ultrasonographic features of subacute radiation proctitis.J Ultrasound Med 2010;29:1495-1498[PMID:20876905]
12 Do NL,Nagle D,Poylin VY.Radiation proctitis:current strategies in management.Gastroenterol Res Pract 2011[PMID:22144997DOI:10.1155/2011/917941]
13 Baglan KL,Frazier RC,Yan D,Huang RR,Martinez AA,Robertson JM.The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer.Int J Radiat Oncol Biol Phys 2002;52:176-183[PMID:11777636]
14 Minsky BD,Conti JA,Huang Y,Knopf K.Relationship of acute gastrointestinal toxicity and the volume of irradiated small bowel in patients receiving combined modality therapy for rectal cancer.JClin Oncol 1995;13:1409-1416[PMID:7751886]
15 Clarke RE,Tenorio LM,Hussey JR,Toklu AS,Cone DL,Hinojosa JG,Desai SP,Dominguez Parra L,Rodrigues SD,Long RJ,Walker MB.Hyperbaric oxygen treatment of chronic refractory radiation proctitis:a randomized and controlled double-blind crossover trial with long-term follow-up.Int J Radiat Oncol Biol Phys 2008;72:134-143[PMID:18342453 DOI:10.1016/j.ijrobp.2007.12.048]
16 Grivennikov SI,Greten FR,Karin M.Immunity,inflammation,and cancer.Cell 2010;140:883-899[PMID:20303878 DOI:10.1016/j.cell.2010.01.025]
17 Wei-Xing Z,Craig BT.Necrotic death as a cell fate.Genes Dev2006;20:1-15[DOI:10.1101/gad.1376506]
18 Di Staso M,Bonfili P,Gravina GL,Di Genesio Pagliuca M,Franzese P,Buonopane S,Osti MF,Valeriani M,Festuccia C,Enrici RM,Tombolini V.Late morbidity and oncological outcome after radical hypofractionated radiotherapy in men with prostate cancer.BJU Int 2010;106:1458-1462[PMID:20518760 DOI:10.1111/j.1464-410X.2010.09418.x]
19 Coia LR,Myerson RJ,Tepper JE.Late effects of radiation therapy on the gastrointestinal tract.Int J Radiat Oncol Biol Phys 1995;31:1213-1236[PMID:7713784 DOI:10.1016/0360-3016(94)00419-L]
20 Khan A,Suhaibani YA,Sharief AA.Rectal cancer perforation:a rare complication of neoadjuvant radiotherapy for rectal cancer.Int J Oncol 2009;7:1-5
21 Medina-Arana V,Martínez-Riera A,Delgado-Plasencia L,Rodríguez-González D,Bravo-Gutiérrez A,álvarez-Argüelles H,Alarcó-Hernández A,Salido-Ruiz E,Fernández-Peralta AM,González-Aguilera JJ.Clinicopathological analysis of factors related to colorectal tumor perforation:influence of angiogenesis.Medicine(Baltimore)2015;94:e703[PMID:25881846 DOI:10.1097/md.0000000000000703]
22 Lee J,Chen F,Steel M,Keck J,Mackay J.Perforated rectal cancer associated with neoadjuvant radiotherapy:report of four cases.Dis Colon Rectum 2006;49:1629-1632[PMID:17039387 DOI:10.1007/s10350-006-0687-y]
23 El Gendy K.Rectal perforation after neoadjuvant chemoradiotherapy for low-lying rectal cancer.BMJ Case Rep 2015[PMID:25564637 DOI:10.1136/bcr-2014-207105]
24 Takada S,Hoshino Y,Ito H,Masugi Y,Terauchi T,Endo K,Kimata M,Furukawa J,Shinozaki H,Kobayashi K,Ogata Y.Extensive bowel necrosis related to bevacizumab in metastatic rectal cancer patient:a case report and review of literature.Jpn JClin Oncol 2015;45:286-290[PMID:25489005 DOI:10.1093/jjco/hyu206]
25 Samantha LK,Allison FL,Patrick GJ,Pedro ADB,Michael BA.Bowel perforation associated with robust response to BRAF/MEK inhibitor therapy for BRAF-mutant melanoma:a case report.Melanoma Management 2015;2:115-120[DOI:10.2217/mmt.15.10]
26 Borzomati D,Nappo G,Valeri S,Vincenzi B,Ripetti V,Coppola R.Infusion of bevacizumab increases the risk of intestinal perforation:results on a series of 143 patients consecutively treated.Updates Surg 2013;65:121-124[PMID:23532741 DOI:10.1007/s13304-013-0207-2]