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Complete Response of Isolated Para-aortic Lymph Node Recurrence from Rectosigmoid Cancer Treated by Chemoradiation Therapy with Capecitabine/Oxaliplatin plus Bevacizumab: A Case Report.

Miyazawa T, Ebe K, Koide N, Fujita N - Case Rep Oncol (2012)

Bottom Line: Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy.Hence, this case was interpreted as a complete response.No recurrence was noted 6 months after the complete response.

View Article: PubMed Central - PubMed

Affiliation: Departments of Surgery and Joetsu General Hospital, Joetsu, Japan.

ABSTRACT
Para-aortic lymph node recurrence is a rare type of metastasis from colorectal cancer, and no treatment has yet been established. Here, we report on a case of isolated para-aortic lymph node metastasis from rectosigmoid cancer that showed complete response to chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab. A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Para-aortic lymph node recurrence occurred in 2011. She underwent radiation therapy (50 Gy) and 8 courses of capecitabine/oxaliplatin plus bevacizumab. Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy. Hence, this case was interpreted as a complete response. No recurrence was noted 6 months after the complete response. Chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab is likely to be effective in treating patients with para-aortic lymph node recurrence.

No MeSH data available.


Related in: MedlinePlus

Imaging before chemoradiation therapy. Abdominal CT scan showed para-aortic lymph node swelling (a, b). FDG-PET indicated FDG accumulations at the right side of the abdominal aorta (c).
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Figure 1: Imaging before chemoradiation therapy. Abdominal CT scan showed para-aortic lymph node swelling (a, b). FDG-PET indicated FDG accumulations at the right side of the abdominal aorta (c).

Mentions: A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Pathological examination showed a moderately differentiated adenocarcinoma perforating the visceral peritoneum, with metastatic involvement in 3 of 12 lymph nodes removed (T4 N1). She underwent 5 cycles of oral tegafur/uracil plus leucovorin therapy as postoperative adjuvant chemotherapy. In 2011, an abdominal computed tomography (CT) scan showed swollen para-aortic lymph nodes (fig. 1a, b). Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET)/CT fusion imaging indicated FDG accumulations at the right side of the abdominal aorta (fig. 1c). Thus, the patient was diagnosed with PALR from rectosigmoid cancer. In May 2011, we started para-aortic radiation of 50 Gy in 25 fractions and XELOX plus bevacizumab [oxaliplatin (130 mg/m2) and bevacizumab (7.5 mg/kg) on day 1 plus capecitabine (1,000 mg/m2) twice on days 1–14, every 3 weeks]. After the third course of chemotherapy, the patient experienced G3 neutropenia, and the subsequent chemotherapy doses were reduced: capecitabine was reduced by 1 dose level and oxaliplatin was reduced to 100 mg/m2. Meanwhile, no dose modification of bevacizumab was performed.


Complete Response of Isolated Para-aortic Lymph Node Recurrence from Rectosigmoid Cancer Treated by Chemoradiation Therapy with Capecitabine/Oxaliplatin plus Bevacizumab: A Case Report.

Miyazawa T, Ebe K, Koide N, Fujita N - Case Rep Oncol (2012)

Imaging before chemoradiation therapy. Abdominal CT scan showed para-aortic lymph node swelling (a, b). FDG-PET indicated FDG accumulations at the right side of the abdominal aorta (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3369241&req=5

Figure 1: Imaging before chemoradiation therapy. Abdominal CT scan showed para-aortic lymph node swelling (a, b). FDG-PET indicated FDG accumulations at the right side of the abdominal aorta (c).
Mentions: A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Pathological examination showed a moderately differentiated adenocarcinoma perforating the visceral peritoneum, with metastatic involvement in 3 of 12 lymph nodes removed (T4 N1). She underwent 5 cycles of oral tegafur/uracil plus leucovorin therapy as postoperative adjuvant chemotherapy. In 2011, an abdominal computed tomography (CT) scan showed swollen para-aortic lymph nodes (fig. 1a, b). Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET)/CT fusion imaging indicated FDG accumulations at the right side of the abdominal aorta (fig. 1c). Thus, the patient was diagnosed with PALR from rectosigmoid cancer. In May 2011, we started para-aortic radiation of 50 Gy in 25 fractions and XELOX plus bevacizumab [oxaliplatin (130 mg/m2) and bevacizumab (7.5 mg/kg) on day 1 plus capecitabine (1,000 mg/m2) twice on days 1–14, every 3 weeks]. After the third course of chemotherapy, the patient experienced G3 neutropenia, and the subsequent chemotherapy doses were reduced: capecitabine was reduced by 1 dose level and oxaliplatin was reduced to 100 mg/m2. Meanwhile, no dose modification of bevacizumab was performed.

Bottom Line: Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy.Hence, this case was interpreted as a complete response.No recurrence was noted 6 months after the complete response.

View Article: PubMed Central - PubMed

Affiliation: Departments of Surgery and Joetsu General Hospital, Joetsu, Japan.

ABSTRACT
Para-aortic lymph node recurrence is a rare type of metastasis from colorectal cancer, and no treatment has yet been established. Here, we report on a case of isolated para-aortic lymph node metastasis from rectosigmoid cancer that showed complete response to chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab. A 58-year-old woman underwent high anterior resection for rectosigmoid cancer in 2009. Para-aortic lymph node recurrence occurred in 2011. She underwent radiation therapy (50 Gy) and 8 courses of capecitabine/oxaliplatin plus bevacizumab. Abdominal computed tomography and positron emission tomography with 18-fluorodeoxyglucose did not reveal any para-aortic lymph node recurrence after chemoradiation therapy. Hence, this case was interpreted as a complete response. No recurrence was noted 6 months after the complete response. Chemoradiation therapy with capecitabine/oxaliplatin plus bevacizumab is likely to be effective in treating patients with para-aortic lymph node recurrence.

No MeSH data available.


Related in: MedlinePlus