Rectal cancer with inguinal lymph nodes metastasis treated by multidisciplinary team

Abstract

This case report described the process of a rectal cancer patient managed by multidisciplinary team (MDT). The patient was diagnosed as rectal cancer with inguinal lymph nodes metastasis (cT4bN1M1) after initial MDT evaluation. The patient received concurrent XELOX chemotherapy plus local radiotherapy to primary tumor and groin drainage area. The primary lesion was re-evaluated in fifteen weeks post radiation. It was shrinked dramatically and that clinical complete remission (cCR) can not be ruled out. However, a single liver metastatic lesion was newly detected. After further MDT discussion, radiofrequency ablation (RFA) for the liver metastasis was recommended and delivered to the patient. Multiple methods including tumor biomarkers, hepatic MRI and PET-CT showed no evidence of disease in the patient after RFA. The patient is in routine follow-up now. For these rectal cancer patients which achieved cCR in primary lesion after neo-adjuvant chemoradiotherapy, the following decision of radical resection or wait and watch strategy is worthy of further consideration. Key words: Rectal neoplasms; Multidisciplinary team; Neoadjuvant radiochemotherapy; Clinical complete response; Watch and wait