Metastatic Rectal Adenocarcinoma Research Articles

Cancer therapy related cardiac dysfunction as a result of Panitumumab

Panitumumab is a human immunoglobulin monoclonal antibody designed to target the epidermal growth factor receptor (EGFR) which is used in the treatment of metastatic colorectal cancer alone or in combination with chemotherapy. In this report, we present a case of new onset heart failure with reduced ejection fraction in a patient following panitumumab therapy. A 73-year-old gentleman with metastatic rectal adenocarcinoma presented to his local hospital with increased shortness of breath, two months after his first and only dose of panitumumab. A transthoracic echocardiogram demonstrated dilated left ventricle with global hypokinesis and an estimated left ventricular ejection fraction of 25%. Our patient underwent a comprehensive diagnostic assessment at his presentation, including ECG, transthoracic echocardiogram, cardiac magnetic resonance, computed tomography coronary angiography (CTCA), invasive coronary angiogram and 18F-FDG PET-CT. These investigations revealed no evidence of ischemic events or inflammatory processes that could account for the severe left ventricular dysfunction. To our knowledge, this is the first reported case of heart failure with reduced ejection fraction linked to panitumumab with subsequent deep phenotyping. The current guidelines do not recommend specific cardiovascular monitoring protocols for patients receiving anti-EGFR monoclonal antibodies. Until more data are available, it would be prudent to implement the same cardiovascular surveillance measures outlined for individuals receiving osimertinib, which is an EGFR tyrosine kinase inhibitor.

S2592 A Rare Case of Metastatic Rectal Adenocarcinoma Associated With Imperforate Anus

S2592 A Rare Case of Metastatic Rectal Adenocarcinoma Associated With Imperforate Anus

Pan-cancer landscape of CD274 (PD-L1) rearrangements in 283,050 patient samples, its correlation with PD-L1 protein expression, and immunotherapy response

BackgroundImmune checkpoint inhibitors (ICIs) benefit patients with multiple cancer types, however, additional predictive biomarkers of response are needed. CD274 (programmed cell death ligand-1, PD-L1) gene rearrangements are positively associated with...

Tumour-to-tumour metastasis: metastatic rectal adenocarcinoma within adenocarcinoma of the lung, and a review of the literature

Background: Tumour-to-tumour metastasis (TTM) is a rare but well-recognised phenomenon. When presented with a case of synchronous colon and pulmonary adenocarcinoma in the lung, one must consider the differential diagnosis of TTM and exclude a tumour with divergent phenotype because of difference in clinical management. Aims: Herein, we present a rare case of TTM, in which a rectal adenocarcinoma has metastasised to a pulmonary adenocarcinoma. We illustrate how morphologic, immunohistochemical, and molecular analyses can help in the pathological diagnosis of TTM. Methods: A case of TTM with a review of the literature is presented. Results and conclusions: A 67-year-old male with a history of metastatic rectal adenocarcinoma to the liver has been in regular follow-up since 2012. Post-operative colonoscopy was normal and a computer tomography scan in 2015 revealed a 0.6 cm subpleural nodule in the left upper lobe of the lung. For the next 3 years, the nodule only showed mild interval enlargement, until a follow-up CT scan in 2019 revealed sudden increase in size to 1.5 cm. Suspicious of lung metastasis, the nodule was resected and histopathological analysis unexpectedly revealed a malignant tumour composed of a pulmonary and metastatic rectal adenocarcinoma. IHC for Napsin A, TTF-1, and CK7 was positive in the pulmonary adenocarcinoma, while CK20 and CDX-2 were positive in the metastatic rectal adenocarcinoma. KRAS mutation was identified in the pulmonary but not in the metastatic carcinoma. The latter was wild-type for KRAS and had TP53 mutation similar to the original rectal tumour. A review of the literature identified some 165 cases, of which only one previous case of colon adenocarcinoma metastasizing to lung adenocarcinoma has been reported. Diagnosis of TTM requires histomorphologic assessment and is aided by immunohistochemical and molecular analysis. Awareness of TTM is important because of the significant difference in clinical management.

Long-term safety and effectiveness of canakinumab therapy in patients with cryopyrin-associated periodic syndrome: results from the β-Confident Registry

ObjectiveTo report the long-term safety and effectiveness of canakinumab, a fully human anti-interleukin 1β monoclonal antibody, in patients with cryopyrin-associated periodic syndromes (CAPS), including familial cold autoinflammatory syndrome (FCAS), Muckle-Wells...

Reversible primary adrenal insufficiency related to anti-programmed cell-death 1 protein active immunotherapy: Insight into an unforeseen outcome of a rare immune-related adverse event

The immune checkpoint inhibitors (ICPi) revolutionize the cancer therapeutics, though not being devoid of toxicity. The immune-related primary adrenal insufficiency (PAI) is a rare, yet potentially life-threatening, adverse event, posing diagnostic and therapeutic challenges. We report the first case of reversible PAI related to nivolumab (programmed cell-death 1 protein inhibitor) in a 42-year-old male with metastatic rectal adenocarcinoma. PAI manifested as profound fatigue, disorientation, hypotension, hyperpigmentation of palmar creases, and hyponatremia without hyperkalemia 16 weeks after initiation of nivolumab. Due to impending adrenal crisis, intravenous stress doses of hydrocortisone and hydration with normal saline were initiated. When the state of patient was stabilized, PAI was confirmed through 250 μg Synacthen test 24 h after temporary cessation of hydrocortisone. Hydrocortisone was fixed at maintenance dose, while mineralocorticoid substitution was not required. PAI was ascribed to nivolumab based on history, physical examination, and laboratory work-up with emphasis on positivity of anti-21-hydroxylase antibodies and exclusion of other causes of PAI by normal imaging of adrenal glands on computed tomography (CT). Reevaluation of adrenal function during follow up demonstrated complete recovery. A review of literature concerning the immune-related PAI indicated that the complete recovery of adrenal function, the normal CT imaging, and the positivity of anti-21-hydroxylase antibodies observed in our patient are exceptional findings of immune-related PAI. Finally, heightened suspicion of immune-related PAI in case of hyponatremia without hyperkalemia and constant vigilance for diagnosis of rare, but real, reversibility of immune-related PAI are of paramount importance.

The Coexistence of RAS and BRAF Mutations in Metastatic Colorectal Cancer: A Case Report and Systematic Literature Review

The coexistence of RAS and BRAF mutations is extremely rare, occurring in approximately 0.05% of patients with metastatic colorectal cancer (mCRC). Starting from a case presentation, this review aims to examine the prevalence, clinical, histopathological and molecular features of tumors with concomitant mutations. Case report and systematic review. We performed a systematic literature search in PubMed and EMBASE using the following MeSH terms: "coexistence" OR "concomitant" AND "RAS" AND "BRAF" AND "colorectal cancer" from the inception of the databases onwards. We present the case of a 53-year-old man diagnosed with metastatic rectal adenocarcinoma with both a KRAS and a BRAF mutation. The review included eleven papers reporting on a total of 30 mCRC cases with concomitant RAS and BRAF mutations. The male/female ratio was 11/5. The average age was 58.5 years. The tumor was located in nine cases on the right colon and in two cases in the left colon. 43.3% of subjects had liver metastases, and 6.6% had lung metastases. Next-generation sequencing (NGS) was used in 36.6% of cases and polymerase chain reaction (PCR) in 16.6% of cases. KRAS mutations were present in 83.3% of patients and NRAS mutations in 16.6% of patients. Survival could be assessed in 10 patients and the median was 21.1 months (about 30% lower than the survival in the general mCRC population). The results of this systematic review suggest the need to design a cohort study (either prospective or retrospective) to better characterize the patients with concomitant RAS and BRAF mutations and to establish the optimal treatment for this rare situation.

Metastatic rectal cancer to papillary thyroid carcinoma: a case report and review of literature

BackgroundTumor-to-tumor metastasis is a rare event. Rectal cancer to primary thyroid neoplasm metastasis is extremely rare. Herein, we reported a case of metastatic rectal adenocarcinoma to a papillary thyroid carcinoma. The incidence and clinicopathological characteristics of metastatic colorectal cancer to a thyroid gland neoplasm were described, and the pertinent literature was reviewed.Case presentationA 34-year-old female patient had curative treatment of initial rectal adenocarcinoma in 2012, and was found to have lung metastases by follow-up CT scan 3 years later. In 2018, she was found to have thyroid metastasis by imaging due to left neck pain and hoarseness. A fine-needle aspiration biopsy (FNAB) result suggested suspicious papillary thyroid carcinoma (PTC). The patient underwent a total thyroidectomy and bilateral cervical lymph nodes dissection. The histopathology of thyroidectomy specimen revealed a rectal adenocarcinoma metastatic to the thyroid concomitant with the papillary carcinoma in metastatic adenocarcinoma. The patient received levothyroxine supplementation therapy and palliative chemotherapy with irinotecan and anti-angiogenesis for the metastatic rectal adenocarcinoma. After 1 year of thyroidectomy, no newly developed lesion evidence of recurrent PTC was observed. The patient remains still alive.ConclusionThe possibility of metastases should be considered in patients with a history of rectal cancer and with a thyroid lesion, particularly in those with ageing, hereditary nonpolyposis colorectal cancer (HNPCC) or long-term survival. The diagnosis should be histologically confirmed for the presence of both primary thyroid lesions and secondary thyroid neoplasms. Thyroidectomy may be a feasible treatment for symptomatic thyroid metastasis or thyroid cancer. we need to gain more available evidence from large or multi-center clinical data to help clinicians to diagnose rectal cancer to thyroid neoplasm metastases and evaluate treatment.

Scrotal Lesions of Metastatic Rectal Adenocarcinoma: Case Report and Literature Review

Secondary scrotal tumors originating from viscera are rare and indicate a poor prognosis. We report a patient who underwent abdominoperineal resection due to his rectal cancer. Tumor recurrence at the surgical site led to prostate involvement. About 1 month after the prostatectomy, scrotal skin metastasis presented as bilateral papulonodular lesions. Finally, brain metastasis occurred and caused his death. Also, several ways by which malignancies can metastasize to scrotum have been discussed.
 © 2019 Tehran University of Medical Sciences. All rights reserved.
 Acta Med Iran 2019;57(4):262-266.

1675 A Rare Case of Rectal Adenocarcinoma With Isolated, Asynchronous Metastasis to the Temporal Bone

INTRODUCTION: Metastatic disease only to the bone without other organ involvement in colorectal cancer patients is extremely rare. Isolated, asynchronous metastasis to the temporal bone, without involvement of the liver or lung is an even further deviation from the traditional presentation. We present the case of a 56-year-old lady with a history of rectal cancer in remission presenting with hearing loss, facial swelling, and facial droop. CASE DESCRIPTION/METHODS: The patient presented with a stage 3C rectal cancer pT3N2bM0 and received adjuvant chemotherapy based on her pathology. The disease was in complete remission, without evidence of any CT, PET, or endoscopic findings of disease recurrence. Three years after her initial diagnosis, the patient began to develop swelling, with associated myalgia and hearing loss on the ipsilateral side. CT and MRI imaging revealed a mass in the right temporal bone, eroding into the bony architecture with peri-orbital and temporal swelling, with inflammatory changes of the right mandibular process. A subsequent biopsy of the cranial mass was consistent with metastatic rectal adenocarcinoma. Repeat imaging had not shown any evidence of abdominal or chest disease. DISCUSSION: More than 90% of colorectal carcinomas are adenocarcinomas originating from epithelial cells of the colorectal mucosa. Approximately 10% of all colorectal carcinomas are mucinous carcinomas. The metastatic pattern of colorectal carcinomas is well known. In a study using more than 49,000 patients with colorectal cancer, it was found that the most common sites of metastasis involved the thoracic organs, the liver, the nervous system, and the peritoneum. Literature review reveals an overall incidence of 5–11% of bony metastasis. This figure includes both isolated skeletal metastases and those with coinciding liver and lung spread. Isolated skeletal metastases are even more infrequently seen, occurring at an estimated frequency of 1–2%. Asynchronous and isolated metastasis to the temporal bone is rare. Assi R, Mukherji D, Haydar A, Saroufim M, Temraz S, Shamseddine A. Metastatic colorectal cancer presenting with bone marrow metastasis: a case series and review of literature. J Gastrointest Oncol. 2016;7(2):284–297.

1694 Endoscopic Ultrasonography With Fine-Needle Aspiration in the Diagnosis of Metastatic Rectal Adenocarcinoma in Left Atrium

INTRODUCTION: Endoscopic ultrasonography(EUS) of the mediastinum with the use of fine needle aspiration(FNA) or biopsy can be used to characterize lesions that are within or adjacent to the esophageal wall, posterior and inferior mediastinum with minimal risk to the patient. EUS is an underutilized tool for identifying mediastinal masses and can help guide clinical decision making in patients with concerning lesions found on non-invasive imaging modalities. CASE DESCRIPTION/METHODS: A 71-year-old male with history of adenocarcinoma of the rectum with metastases to the liver and lung was treated with surgical resection and adjuvant chemotherapy. Patient responded well and was under regular surveillance when a new irregularly shaped abnormal soft tissue density measuring approximately 5.4 × 3.0 cm adjacent to the aorta and esophagus appearing to invade into the left atrium (Figure 1a) was found on a CT scan and confirmed on PET imaging. These findings favored rectal metastatic disease over thrombus but could not definitively rule out a new carcinoma. For that reason, an endoscopic ultrasonography was performed to determine the nature of the mass. A curvilinear array echoendoscope was used to visualize a 36 × 30 mm exophytic lesion within the left atrium which extended into the posterior mediastinum (Figure 2). Using Doppler to identify a vessel-free path, a 25-gauge needle was passed under ultrasound guidance through the esophagus and directly into the mass with the use of an endoscopic fine needle biopsy (FNB) device for three passes. Histopathological examination confirmed adenocarcinoma (Figure 3) and immunophenotype was compatible with colorectal primary which ruled out a pulmonary adenocarcinoma. DISCUSSION: The patient was determined to not be a surgical candidate due to the location of the mass and high risk nature of the surgery. The multidisciplinary team’s consensus was to repeat chemo-adjuvant therapy since he had responded so well previously. He received treatment and had follow up imaging six months after EUS diagnosis which showed decrease in size (Figure 1b) and activity of the mass. He is planned to have have stereotactic body radiation therapy to further decrease the size of the atrial mass. This case demonstrated how EUS with the use of FNA is a helpful tool in the prompt evaluation and confirmation of a mediastinal mass which allowed all physician’s involved in the care of the patient to develop and implement a treatment plan quickly. Watch the video: http://bit.ly/2Giu99S.

Abstract LB-293: A Phase II trial of TRC102 (methoxyamine HCl) in combination with temozolomide in patients with relapsed metastatic colorectal carcinoma

Abstract Background: The base excisional repair (BER) pathway plays an important role in the development of resistance to alkylating agents. TRC102 (methoxyamine HCL) inhibits BER by binding apurinic/apyrimidinic sites, which increases temozolomide (TMZ)-induced DNA strand breaks and apoptosis. We conducted a multihistology phase I/II trial of TRC102 in combination with TMZ in patients (pts) with refractory solid tumors (NCT01851369); here we report the clinical activity of this combination in the phase II refractory colorectal carcinoma (CRC) cohort. The phase I portion of the study demonstrated anemia to be the major dose limiting toxicity of this combination; the recommended phase II doses (RP2D) for the combination were: 125 mg TRC 102 + 150 mg/m2 TMZ (PO, D1-5 of 28-day cycles). The expanded phase II trial utilized a 3-arm Simon 2-stage design based on objective responses documented during the phase I portion of the study (CRC, NSCLC, and granulosa cell ovarian cancer). Methods: Phase II pts were treated at the RP2D, except that pts with BSA < 1.6 m2 received 100 mg of TRC102. Eligibility for the CRC cohort included pts with recurrent, metastatic, histologically confirmed colorectal adenocarcinoma after ≥ 2 lines of therapy, adequate organ function, and an ECOG performance status (PS) ≤ 1. Overall response rate (ORR) was defined as a partial response (PR) or a complete response (CR), per RECIST 1.1 criteria. Results: During the phase I trial, one pt with KRAS mutant CRC experienced a sustained PR of 21 cycles (maximum 70% decrease by RECIST). This pt decided to stop treatment due to travel constraints, but at 17 months off treatment had not progressed. Based on this response, 16 pts were enrolled in the CRC cohort of the phase II trial (3 rectal, 13 colon), all heavily pretreated (median: 6 lines of prior therapy, range: 3-14). Median pt age was 64 years (range: 46-80 years); all had an ECOG PS of 1. Median time on study was 2 cycles (range: 1 to 5 cycles) including 5 pts who came off study for early clinical progression. ORR for this cohort was 6% (1 PR). Nine pts had KRAS mutant disease, including the partial responder, who also was the only pt (of the 10 tested by tumor IHC) with MGMT-negative disease. Grade 3 and 4 protocol treatment-related toxicities included thrombocytopenia (2 pts), hemolysis (1 pt), and diarrhea (1 pt). No pts discontinued the protocol because of toxicity and only 1 pt required dose reduction (thrombocytopenia). Conclusions: Despite a promising phase I result from a pt with CRC, a phase II study of combined TRC102 and TMZ treatment in patients with metastatic colon or rectal adenocarcinoma displayed an ORR of 6%. Assessing tumor MGMT status may help identify pts who could benefit from this combination and pharmacodynamic studies are underway to assess drug activity in responding and non-responding patients. Supported in part by NCI Contract HHSN261200800001E. Citation Format: Geraldine OSullivan Coyne, Cecilia Monge Bonilla, Jennifer Zlott, Naoko Takebe, Robert Meehan, Lamin Juwara, Richard Piekarz, Laurence Rubinstein, Deborah F. Wilsker, Robert J. Kinders, Ralph E. Parchment, Shahanawaz Jiwani, Shivaani Kumar, James H. Doroshow, Alice P. Chen. A Phase II trial of TRC102 (methoxyamine HCl) in combination with temozolomide in patients with relapsed metastatic colorectal carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-293.

Long Term Maintenance Therapy with VEGF Inhibitor with Remission of the Disease for Seven Years in Patient with Metastatic Rectal Cancer

We report a case of a 65-year-old female with metastatic rectal adenocarcinoma which was on maintenance therapy with bevacizumab from September 2007 to September 2014. For seven years she was in remission. At that time except for the hoarseness that developed after three years of maintenance therapy with bevacizumab, no additional changes were noted. Bevacizumab is a monoclonal antibody, a VEGF inhibitor. Neutralizing the biological activity of VEGF regresses the vascularisation of tumours, normalises remaining tumour vasculature, and inhibits the formation of new tumour vasculature, thereby inhibiting tumour growth. The use of maintenance therapy with bevacizumab in patients with metastatic colorectal cancer is widely accepted, but the duration of maintenance is not yet defined. The side effects of bevacizumab as maintenance therapy remains to be answered. The individual treatment approach is the best way of treating the patient, and in the lack of definite data of the biology of the individual metastatic carcinoma, the multidisciplinary approach and the experienced specialists are essential..

Tectal region papillary neuroglial tumour: a case report

Papillary glioneuronal tumor (PGNT) is a rare central nervous system neoplasm. Of reported cases, the vast majority are located in the frontal and temporal lobes. We present the case of a 39-year-old male who presented with a one day history of gait disturbance following chemotherapy treatment for metastatic rectal adenocarcinoma. Following MRI of the head showed a tectal mass. Following an occipital interhemispheric craniotomy for tumor resection, final pathology was diagnostic of a papillary neuroglial tumor, WHO grade I. To the best or out knowledge this is the only report of it arising from the tectal plate.

Survival Outcomes After Surgical Management of the Primary Tumor With and Without Radiotherapy for Metastatic Rectal Adenocarcinoma: A National Cancer Database (NCDB) Analysis

BackgroundWith advances in systemic therapies, the role of primary tumor resection may be of increased importance in patients with metastatic rectal cancer. The role of combining pelvic radiotherapy with surgical resection in the metastatic setting is unknown. We utilized the National Cancer Database to examine outcomes in patients with metastatic rectal adenocarcinoma with primary tumor resection with and without pelvic radiotherapy. Materials and MethodsWe queried the National Cancer Database from 2004 to 2014 for patients with stage IV rectal adenocarcinoma receiving chemotherapy. We identified 4051 patients in that group that had primary tumor resection. Patients were then stratified by receipt of pelvic radiotherapy (yes = 1882; no = 2169) Univariable and multivariable analyses identified characteristics predictive of overall survival. Propensity-adjusted Cox proportional hazard ratios for survival were used to account for indication bias. ResultsThe median patient age was 63 years (range, 18-90 years) with a median follow-up of 32.3 months (range, 3.02-151.29 months). There were proportionately more patients with T3/T4 disease or N1 disease in the surgery plus radiotherapy arm. The median survival was 46.3 months versus 35.3 months in favor of addition of radiotherapy (P < .001). The 2- and 5-year overall survival was 68.4% and 24.8% for surgical resection alone compared with 77.2% and 39.6% for surgery + radiotherapy. On propensity-adjusted multivariable analysis, radiotherapy was associated with a statistically significant reduction in risk of death (hazard ratio, 0.722; 95% confidence interval, 0.0665-0.784). ConclusionThis analysis indicates that in patients with metastatic rectal adenocarcinoma receiving chemotherapy, pelvic radiotherapy in addition to primary tumor resection may be of significant benefit.

Pelvic radiotherapy in combination with radical resection of the primary tumor improves survival in patients with metastatic rectal adenocarcinoma: A national cancer database analysis (NCDB).

714 Background: With recent advances in systemic therapies and increased survival of patients with metastatic rectal cancer, the role of primary tumor resection may be of increased importance and is often debated. However, the role of combining radiotherapy to surgical resection in the metastatic setting is unknown. Accordingly, we utilized the NCDB to quantify survival in metastatic rectal adenocarcinoma patients with primary tumor resection with and without pelvic radiotherapy. Methods: Of the 15,643 Stage IV rectal adenocarcinoma patients receiving chemotherapy from 2004 to 2014, 4051 patients had primary tumor resection with sufficient follow up for analysis. Patients were stratified by receipt of pelvic radiotherapy (n = 1882) or no pelvic radiotherapy (n = 2169). Univariable/multivariable analyses and propensity-adjusted Cox proportional hazard ratios for survival were performed. Results: Median age was 63 years (18-90) with median follow up of 32.3 months (3.02-151.29). There were more patients with T3/T4 disease (69.6% vs 46.5%) or N1 disease (41.5% vs 27.3%) in the surgery plus radiotherapy arm. Metastatic burden was confined to one organ in 40.5% of patients and was equally distributed between radiotherapy and non-radiotherapy groups (OR 0.92; 95%CI 0.81-1.04). Median survival was 46.3 months vs. 35.3 months in favor of adding radiotherapy (p &lt; 0.001). The 2, 5 and 10-year overall survival were 68.4%, 24.8%, and 9.5% for surgical resection alone compared to 77.2%, 39.6%, and 22.3% for surgery + radiotherapy. On multivariable analysis radiotherapy was associated with a statistically significant reduction in the risk of death (HR 0.718; 95% CI 0.661-0.780). This benefit was upheld on propensity matched analysis (HR 0.722; 95% CI 0.0665-0.784). Conclusions: Our study indicates that adding radiotherapy to surgical management of the primary tumor in patients receiving systemic chemotherapy for metastatic rectal adenocarcinoma improves survival. Prospective investigation of the management of the rectal primary tumor with chemotherapy, pelvic radiotherapy, and surgical resection is warranted.

Metastatic rectal adenocarcinoma in the maxillary bone: A case report

Introduction: Colorectal cancer patients presenting with isolated bone metastases are exceedingly rare. Case Report: A 72-year-old male patient appeared with a painless gross swelling in the anterior maxillary gingiva, nearly a year after anterior rectal resection for cancer. The patient was submitted to lesion excision and nasolabial flap reconstruction. Histology revealed an intestinal type adenocarcinoma. The patient underwent radiotherapy. The disease spread and our patient lost his battle with cancer. Conclusion: Rectal tumor metastasis to maxillary bone is exceedingly rare and a high index of suspicion must be maintained in order to timely diagnose and treat it. Intraoral reconstruction with a nasolabial flap is a simple and fast procedure with good cosmetic and functional results.

A Rare Case of Bevacizumab and Radiation-Induced Ischemic Bowel Injury

Ischemic colitis is a poorly documented side effect of the combination of palliative radiation and targeted therapy with Bevacizumab, a recombinant and humanized monoclonal antibody against the vascular endothelial growth factor receptor.1 We present a case of acute onset of ischemic colitis in a patient with prior pelvic irradiation undergoing treatment of metastatic rectal adenocarcinoma with Bevacizumab. A 68 y/o male with microsatellite stable, KRAS-mutated Stage IVB Rectal Adenocarcinoma status post 3 months of fluorouracil, oxaliplatin, folinic acid, abdominal perineal resection with ileo-colonic anastomosis with end colostomy, and palliative radiation to pelvis and spine presented with abdominal pain and bright red blood in his ostomy bag. Hemoglobin was 5.6 g/dL on admission, with appropriate response after transfusion. Recent endoscopy showed monlial esophagitis and non-bleeding erosive gastropathy. Colonoscopy 1 year prior showed multiple benign polyps. He underwent colonoscopy via colostomy, which was remarkable for both a continuous area of non-bleeding ulcerated mucosa and a segmental area of severely friable mucosa within the distal colon, neither with stigmata of recent bleeding. Histopathology demonstrated severely active colitis with ulceration. Colorectal surgery recommended no acute surgical intervention given his poor prognosis. Conventional therapy for treatment of metastatic colorectal cancer includes a fluoropyrimidine-based therapy with or without the use of targeted therapy and/or palliative radiation. Bevacizumab inhibits tumor neovascularization, which has proven beneficial when treating solid tumors by restricting tumor growth and metastatic ability.1 Radiation amplifies this effect by free radical formation, which promotes cell death. Results of a retrospective study looking at 33 patients undergoing therapy with Bevacizumab and prior radiation showed a 9% incidence of severe bowel complications, including acute ischemic colitis and bowel perforation.2 Ischemic colitis, a rare and minimally reported risk of therapy with Bevacizumab and radiation, should be considered in patients presenting with sudden onset of abdominal pain and hematochezia.1487_A Figure 1. Previously normal appearing descending colon1487_B Figure 2. Friability with absence of bleeding in distal colon1487_C Figure 3. Ulceration of distal colon

Individualized multimodal treatment strategy for metastatic rectal adenocarcinoma: Case report.

Metastatic rectal cancer requires a multidisciplinary and individualized approach.The authors describe a case report of a 48-year-old man with recurrence of rectal adenocarcinoma that underwent multimodal treatment, which included chemotherapy with biologic agents, cytoreduction surgery with hyperthermic intraperitoneal chemotherapy, and radiotherapy with improvement in progression-free survival and overall survival.

P-203 - Survival and prognostic factors of non metastatic rectal adenocarcinoma: Analytic multifactor review of 91 cases

P-203 - Survival and prognostic factors of non metastatic rectal adenocarcinoma: Analytic multifactor review of 91 cases