Rectal Cancer Patient with Complete Response to Neoadjuvant Chemoradiotherapy

ABSTRACT

Personalized medicine for rectal cancer patients includes nonoperative management. This strategy is appropriate for select patients who exhibit a clinical complete response (cCR) to neoadjuvant chemoradiotherapy (nCRT). This study presents the case of a 70-year-old female with locally advanced rectal cancer. She received standard nCRT, consisting of 50.4 Gy pelvic radiotherapy and concurrent 5-fluorouracil chemotherapy. The response to nCRT was evaluated at 11 weeks after nCRT completion. Colonoscopy and computed tomography indicated cCR, but a partial residual tumor was suspected based on magnetic resonance imaging. Low anterior resection was performed with the creation of a protective colostomy. The pathological examination of the surgical specimen revealed only a fibrotic mass, no viable tumor cells. The stoma was maintained for 10 months until reversal after adjuvant chemotherapy ended. The patient remains alive with no evidence of disease 4 years later; however, the utility of this radical major surgery was questionable for this patient. Development of a risk-adapted strategy based on the nCRT response would avoid overtreatment, improving functional outcomes and quality of life while also retaining good oncological outcomes.