[A Case in Which FOLFOXIRI Was Useful as Preoperative Chemotherapy for Locally Advanced Rectal Cancer with Difficulty in Securing CRM].

ABSTRACT

The patient is a 65-year-old woman. Colonoscopy performed for close examination of constipation and lower abdominal pain revealed a circumferential type 3 lesion in the rectum Ra. A CT scan showed invasion of the primary lesion into the extramural and sacral front and multiple metastases in the mesorectal lymph nodes but no distant metastasis. Staging laparoscopy was performed. As the mesorectum around the primary lesion was tightly adherent, it was difficult to R0 resection; hence, only construction of colostomy was performed. We have introduced chemotherapy(FOLFOXIRI plus bevacizumab therapy), and 4 courses were administered. Post-treatment CT scan showed that the peri-invasiveness of the primary tumor had disappeared and the enlarged lymph nodes had shrunk. Furthermore, SUVmax of PET-CT for main lesion was decreased, dramatically. On day 109 after the initial surgery, laparoscopic low anterior resection was performed. Although the left hypogastric nerve was resected, other areas could be dissected and R0 resection could be performed. FOLFOXIRI therapy has shown good early-tumor shrinkage and depth of response and may be useful for patients with locally advanced rectal cancer who have difficulty securing circumferential resection margin(CRM).