Abstract
BackgroundA colo-duodenal fistula is a very rare complication of colon cancer that presents with not only severe clinical symptoms, but a poor prognosis due to locally advanced cancer. A novel immune checkpoint inhibitor for colon cancer patients provides a high objective response rate. Recently, radiation therapy combined with immune checkpoint inhibitor therapy has been reported to have a synergistic antitumor effect. A case of complete closure of a colo-duodenal fistula in a patient with locally advanced colon cancer after combined pembrolizumab and radiation therapy is reported.Case presentationA 66-year-old man presented with abdominal distention. Abdominal contrast-enhanced computed tomography (CT) showed a 80-mm bulky mass in the right upper quadrant. The tumor created a fistula to the second portion of the duodenum. Upper gastrointestinal endoscopy showed a colo-duodenal fistula. Gastro-jejunal bypass and ileostomy were performed to prevent bowel obstruction, followed by systemic chemotherapy. MSI-high was diagnosed on examination of the biopsy specimen. Treatment was then changed to immunotherapy using pembrolizumab; after six courses, the tumor markers were decreased to within normal ranges, but the main tumor increased. Radiation therapy was then given for local control of the main tumor, after which CT showed that all of the tumor, including the main tumor, lymph node metastases, and the colo-duodenal fistula, had gradually shrunk. Follow-up upper gastrointestinal endoscopy showed that the colo-duodenal fistula had closed completely. PET–CT showed no abnormal uptake in all tumors, and clinical complete response was diagnosed. Now, 21 months after diagnosis, the tumor is well controlled without evidence of regrowth.ConclusionsPembrolizumab combined with radiation therapy has a potentially dramatic therapeutic effect for advanced colon cancer.
Highlights
A colo-duodenal fistula is a very rare complication of colon cancer that presents with severe clinical symptoms, but a poor prognosis due to locally advanced cancer
Pembrolizumab combined with radiation therapy has a potentially dramatic therapeutic effect for advanced colon cancer
Tominaga et al surg case rep (2021) 7:168 a colo-duodenal fistula that presents in patients with locally advanced cancer leads to a poor prognosis [2]
Summary
A colo-duodenal fistula is a very rare complication of colon cancer and has been reported to occur in 0.1% to 0.14% of colon cancer patients [1, 2]. A colo-duodenal fistula often presents with severe clinical symptoms including diarrhea, vomiting, and weight loss [3]. Tominaga et al surg case rep (2021) 7:168 a colo-duodenal fistula that presents in patients with locally advanced cancer leads to a poor prognosis [2]. This report provides the first description of closure of a malignant colo-duodenal fistula in a patient with locally advanced transverse colon cancer who obtained cCR after combined pembrolizumab and radiation therapy. Case presentation A 66-year-old man with general fatigue and abdominal distention came to our hospital His vital signs were stable, but physical examination showed tenderness of the right upper abdomen. Upper gastrointestinal endoscopy showed a colo-duodenal fistula at the second portion of the duodenum (Fig. 2a). 21 months after the first diagnosis, the tumor is well controlled without evidence of reg rowth
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