Medical Radiology and Radiation Safety. 2017. Vol. 62. No. 2. P. 71-78

DOI: 10.12737/article_58f0b957500454.54839072

Successful Treatment of Recurrence of Rectal Cancer with Invasion of the Sacrum (Case Report)

Е.R. Musaev, S.I. Tkachev, D.V. Kuzmichev, A.V. Polynovskiy, A.O. Rasulov, V.F. Tsaryk, N.A. Kochura, E.A. Sushentcov, U.E. Suraeva

N.N.Blokhin Russian Cancer Research Center, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

E.R. Musaev - Dr. Sci. Med., Head of the Department of Vertebral Oncology; S.I. Tkachev - Dr. Sci. Med., Leading Researcher; D.V. Kuzmichev - PhD in Medicine, Senior Researcher; A.V. Polynovskiy - PhD in Medicine, Research Associate; A.O. Rasulov - Dr. Sci. Med., Head of the Department of Coloproctology; V.F. Tsaryuk - Dr. Sci. Med., Leading Research; N.A. Kochura - Doctor, Department of Anesthesiolody; E.А. Sushentcov - PhD in Medicine, Senior Researcher; J.E. Suraeva - PhD student

Abstract

Purpose: Recurrence of rectal cancer located in presacral area and having invasion in the bone structure, are the most difficult in clinical practice to diagnosis and treatment. The purpose of our observation is a demonstration of modern possibilities of preoperative chemoradiotherapy followed by high-tech surgery in treatment of the patient with recurrent rectal cancer with sacral invasion in a multidisciplinary clinic.

Material and methods: Article describes the case of successful treatment of patient with recurrent rectal cancer with sacral invasion, previously operated at another clinic without prior neoadjuvant therapy. At N.N.Blochin Russian Cancer Research Center patient was performed preoperative chemoradiotherapy 40 Gy in 4 Gy fractions with capecitabine 3500 mg/day per os on radiation days to achieve maximum tumor regression. In 8 weeks after the end of combined treatment, a control examination, according to which positive dynamics in the form of reducing the size of the tumor was identified. Taking into account the recurrent tumor with sacral invasion, the absence of distant metastases and severe concomitant comorbidity, the patient underwent high-tech surgery with recurrent tumor removal and high sacral resection (level S1) with plastic replacement of the defect with recto-abdominal flap. According to pathological examination of postoperative material in recurrent tumor was reached tumor regression grade II (Dworak).

At the time of publication of the article the patient after 43 months since the operation is observed without signs of recurrence and progression of disease, return to full social life without motor restrictions.

Conclusion: This case demonstrates the importance of preoperative chemoradiotherapy in patients with recurrent rectal cancer previously have not treated with neoadjuvant treatment. Sacral resections (including a high resection at the S1 level) with a recurrent tumor removal significantly increases the overall survival and life quality. If R0 resection can be achieved, it is possible to expect a better long-term result.

This type of operation is associated with a high number of intra - and postoperative complications and, therefore, must be performed in highly specialized centers by a multidisciplinary surgical team using modern possibilities of anesthesia and intensive care support.

Key words: recurrence, rectal cancer, invasion of the sacrum, resection of the sacrum, radiotherapy, preoperative chemoradiotherapy

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For citation: Musaev ER, Tkachev SI, Kuzmichev DV, Polynovskiy AV, Rasulov AO, Tsaryk VF, Kochura NA, Sushentcov EA, Suraeva UE. Successful Treatment of Recurrence of Rectal Cancer with Invasion of the Sacrum (Case Report). Medical Radiology and Radiation Safety. 2017;62(2):71-8. Russian. DOI: 10.12737/article_58f0b957500454.54839072

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