A case of chemotherapy for unresectable sigmoid colon cancer with severe cardiac dysfunction

Abstract

Abstract Background In the treatment of advanced cancer patients with severe cardiac dysfunction, there is a risk that the side effects of the chemotherapy may lead to a serious situation, and it is necessary to carefully judge the indications. There were only a few reported cases of chemotherapy for such patients. Here we report our experience with a patient who had continued chemotherapy for more than a year and a half for advanced sigmoid colon cancer with severe cardiac dysfunction. Case presentation A 73-year-old man came to our hospital because positive fecal occult blood was pointed out in a medical examination in March 2017. He had been diagnosed dilated cardiomyopathy at the age of sixty, and his LVEF was about 25% by the recent echocardiogram. A colonoscopy was performed in May, sigmoid colon cancer was found, and further CT examination was revealed multiple liver metastases. We determined that surgery was not a possible treatment option for him, and we decided to perform chemotherapy. In June we introduced to the patient S-1 plus oxaliplatin combination therapy. We changed to S-1 plus irinotecan combination therapy because of becoming PD from November in the same year. After that SD was maintained for a while, but it became PD by December 2018, and we changed to FTD/TPI as the third line chemotherapy from January 2019. Discussion Median survival of BSC follow-up for unresectable advanced recurrent colorectal cancer was reported to be 6 to 8 months. This case has survived more than a year and a half after starting chemotherapy, suggesting that chemotherapy should be performed as much as possible even for cancer patients with severe cardiac dysfunction. However, there are few such case reports, and it is necessary to accumulate and study more cases from now on.