Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment

In the era of personalized medicine, systemic treatment with chemotherapy in combination with targeted drugs, tailored according to RAS and BRAF status, has improved the survival of patients with metastatic colorectal cancer (mCRC), but curative resection of metastases provides the only chance of cu...

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Autores principales:	Natalja Eigeliene, Jatta Saarenheimo, Viktor Wichmann, Pia Österlund, Antti Jekunen
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	chemotherapy liver resection metastatic colorectal cancer radiotherapy targeted agents Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/8c00431f27c04617b299394d704c7826
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spelling	oai:doaj.org-article:8c00431f27c04617b299394d704c78262021-11-18T11:08:46ZMetastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment1662-657510.1159/000519044https://doaj.org/article/8c00431f27c04617b299394d704c78262021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519044https://doaj.org/toc/1662-6575In the era of personalized medicine, systemic treatment with chemotherapy in combination with targeted drugs, tailored according to RAS and BRAF status, has improved the survival of patients with metastatic colorectal cancer (mCRC), but curative resection of metastases provides the only chance of cure. Here, we present a 40-year-old male with rectal adenocarcinoma and multiple bilateral synchronous liver metastases who has achieved long-term remission with multimodal treatment without resection of all metastatic lesions. This case emphasizes the need of repeated multidisciplinary team assessments and change of treatment intent if extraordinary responses are seen. The initial therapy consisted of short-course radiotherapy and surgery of the primary tumor followed by oxaliplatin-based combination chemotherapy and panitumumab with disease control intent. A complete radiologic response in >20 liver metastases in segments II–VIII was obtained. A biopsy-verified relapse of 3 liver metastases occurred at 9 months of treatment pause. Subsequently, major liver resection of 8 lesions was performed (4 with adenocarcinoma and 4 with cicatrix showing the challenge of disappearing lesions), followed by 6 months of adjuvant-like therapy. No relapse in MRI, PET, or CT has been noted since liver resection 6 years ago. Comprehensive genomic profiling of the primary tumor and liver metastases had similar driver mutations representing a low level of gene alteration and low diversity, possibly explaining the exceptional treatment response.Natalja EigelieneJatta SaarenheimoViktor WichmannPia ÖsterlundAntti JekunenKarger Publishersarticlechemotherapyliver resectionmetastatic colorectal cancerradiotherapytargeted agentsNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCase Reports in Oncology, Vol 14, Iss 3, Pp 1475-1482 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chemotherapy liver resection metastatic colorectal cancer radiotherapy targeted agents Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	chemotherapy liver resection metastatic colorectal cancer radiotherapy targeted agents Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Natalja Eigeliene Jatta Saarenheimo Viktor Wichmann Pia Österlund Antti Jekunen Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment
description	In the era of personalized medicine, systemic treatment with chemotherapy in combination with targeted drugs, tailored according to RAS and BRAF status, has improved the survival of patients with metastatic colorectal cancer (mCRC), but curative resection of metastases provides the only chance of cure. Here, we present a 40-year-old male with rectal adenocarcinoma and multiple bilateral synchronous liver metastases who has achieved long-term remission with multimodal treatment without resection of all metastatic lesions. This case emphasizes the need of repeated multidisciplinary team assessments and change of treatment intent if extraordinary responses are seen. The initial therapy consisted of short-course radiotherapy and surgery of the primary tumor followed by oxaliplatin-based combination chemotherapy and panitumumab with disease control intent. A complete radiologic response in >20 liver metastases in segments II–VIII was obtained. A biopsy-verified relapse of 3 liver metastases occurred at 9 months of treatment pause. Subsequently, major liver resection of 8 lesions was performed (4 with adenocarcinoma and 4 with cicatrix showing the challenge of disappearing lesions), followed by 6 months of adjuvant-like therapy. No relapse in MRI, PET, or CT has been noted since liver resection 6 years ago. Comprehensive genomic profiling of the primary tumor and liver metastases had similar driver mutations representing a low level of gene alteration and low diversity, possibly explaining the exceptional treatment response.
format	article
author	Natalja Eigeliene Jatta Saarenheimo Viktor Wichmann Pia Österlund Antti Jekunen
author_facet	Natalja Eigeliene Jatta Saarenheimo Viktor Wichmann Pia Österlund Antti Jekunen
author_sort	Natalja Eigeliene
title	Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment
title_short	Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment
title_full	Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment
title_fullStr	Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment
title_full_unstemmed	Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment
title_sort	metastatic rectal carcinoma with long-term remission due to modern multimodality treatment
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/8c00431f27c04617b299394d704c7826
work_keys_str_mv	AT nataljaeigeliene metastaticrectalcarcinomawithlongtermremissionduetomodernmultimodalitytreatment AT jattasaarenheimo metastaticrectalcarcinomawithlongtermremissionduetomodernmultimodalitytreatment AT viktorwichmann metastaticrectalcarcinomawithlongtermremissionduetomodernmultimodalitytreatment AT piaosterlund metastaticrectalcarcinomawithlongtermremissionduetomodernmultimodalitytreatment AT anttijekunen metastaticrectalcarcinomawithlongtermremissionduetomodernmultimodalitytreatment
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Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment

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