P2-33-2 - Successful Multimodal Treatment of Multiple Metastatic Rectal Cancer in an Elderly Patient with Chronic Renal Failure

Abstract

A 75-year-old man, having history of angina pectoris and chronic renal failure (CKD stage4), was admitted due to melena. Colonoscopy revealed advanced rectal cancer and Miles operation was performed (pApN1M0, stageIIIa). Postoperative adjuvant chemotherapy using S-1 was introduced but was canceled because of nausea and general malaise. One year after the surgery, he revealed to have multiple lung and liver metastases detected by follow-up CT. Considering severe renal failure, he started 75% dose of FOLFOX6 therapy and a total of 13 courses had completed without severe adverse events. The status of lung lesions was PR (almost disappeared except for one lesion), but two liver lesions remained NC status. Subsequently, he underwent laparoscopic partial liver resection 21 months after the initial surgery. Despite of continuation of 75% dose FOLFOX6 therapy postoperatively, the remnant lung lesion became PD 33 months after the initial surgery, and he underwent radiation therapy (50Gy/25Fr). Soon after the radiation therapy, relapse of multiple lung metastases occurred. Since FOLFOX therapy was canceled due to peripheral neuropathy, he started half dose of oral uracil-tegafur and leucovorin therapy, maintaining the SD tumor status for 19 months, but finally discontinued the therapy due to drug eruption. Instead, bevacizumab and irinotecan therapy was administered every 3 weeks and SD status was maintained for additional 21 months until now. The patient is currently 80 years of age, 5 years after the initial surgery, and has maintained excellent performance status with good disease control.Standardization of chemotherapy or other therapeutic modalities has not been established for the treatment of recurrent colorectal cancer in elderly patients with chronic renal failure. We discussed efficacy of multidisciplinary treatment for such high risk colorectal cancer patients with the review of the literature.