INTERACTIVE CASE STUDY of a patient with mCRC treated long-term with various modalities
MUDr. Stanislav John, Ph.D., Clinic of Oncology and Radiotherapy, Faculty of Medicine, Charles University and University Hospital Hradec Králové
We present the case of a patient with metastatic colorectal cancer (mCRC) who underwent chemoradiotherapy, surgery, and biochemotherapy sequentially.
History 2011
The patient is a 58-year-old man at the time of diagnosis, ECOG 0, weight 90 kg, height 182 cm.
RA: Father died at the age of 60 from CRC, mother was treated for ovarian tumor, died from another cause at 76. Otherwise no family history of cancer.
OA: The patient has been treated for high blood pressure since 2009 (takes ramipril and hydrochlorothiazide in combination). He underwent appendectomy in 1969. Lifelong non-smoker, consumes alcohol in the amount of 2-3 beers per day. Milk allergy.
Diagnostics and treatment
April 2011
Examined for constipation, blood in stool and weight loss of 11 kg over 3 months.
Colonoscopy: rectal tumor size 12-15 cm. Biopsy: poorly differentiated adenocarcinoma.
MRI, chest CT: cT3 cN2 cMx (1 suspected liver metastasis detected on MRI, not described on CT).
Underwent neoadjuvant chemoradiotherapy (CHRT): pelvic radiation therapy using BOX technique at a dose of 45 Gy/25 fractions with a boost of 5.4 Gy/3 fractions, concomitant chemotherapy (CHT) with 5-fluorouracil (5-FU) from May to July 2011.
Targeted liver ultrasound post-treatment: no metastatic process.
August 2011
Surgical intervention: low anterior resection with ileostomy (intraoperative US without liver metastases, postoperative anastomotic dehiscence); ypT3 ypN0(mol+) M0, mucinous moderately differentiated adenocarcinoma, R0, Pn0, L0.
Genetic alterations examination: wt-KRAS, wt-NRAS, wt-BRAF, MMR-proficient, others not determined.
Postoperative chest CT: 2 liver metastases.
Induction biochemotherapy initiated – combination of bevacizumab + mFOLFOX6, 6 cycles from August 2011 to February 2012.
PET/CT: 1 discrete liver lesion – surgery not indicated (patient refused, exhausted from treatment).
April 2012
Ileostomy reversed.
Chest CT: progression of original 2 liver lesions.
December 2012
Non-anatomical resection of S7 liver: 2 lesions of moderately differentiated adenocarcinoma.
Followed by postoperative chemotherapy: mFOLFOX6, 6 cycles (no measurable lesion for biological treatment; complicated by post-treatment peripheral neuropathy of lower limbs).
February 2014
PET/CT: 2 liver metastases detected again in the right lobe.
March 2014
Right-sided hemihepatectomy: 1 lesion of moderately differentiated mucinous adenocarcinoma.
Patient followed up until 12/2017.
December 2017
Progression of mediastinal lymphadenopathy (bronchoscopically confirmed metastasis of moderately differentiated adenocarcinoma from the intestine).
Undergone palliative radiotherapy of the mediastinum and pulmonary hilum AP/PA at a dose of 20 Gy in 5 fractions.
Follow the continuation of the case study in the video.
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