Matthaiou Christiana MD, MSc Specialist Registrar in...

ESMO Preceptorship Programme

Stage IV Rectal Cancer with CR

Matthaiou Christiana MD, MSc

Specialist Registrar in Medical Oncology

Cyprus Oncology Center

Colorectal Cancer– Barcelona– 25/26 November 2016

ESMO PRECEPTORSHIP PROGRAM

Case report(1)� 70 yo woman

� Weakness, fatigue, one episode of

rectal bleeding

� 5/2011:CT abdomen-pelvis:

multiple liver metastases

� 5/2011:liver biopsy:

adenocarcinoma grade II,GI tract

origin

� 6/2011:colonoscopy:

fungating tumour present on the

proximal rectum 10cm distance

from the anal verge

� 6/2011:CT chest (-) STAGE IV

ADENOCARCINOMA OF

RECTUM

ESMO PRECEPTORSHIP PROGRAM

Case report(2)

� PMH:TAH-BSO

� FAMILY HISTORY:

� Father 70 yo with lung cancer

� Two sisters(51yo and 38yo) with breast cancer

� 6/2011: CEA 93,2 ng/ml CA 19.9=510U/ml

� K-ras: wild type

ESMO PRECEPTORSHIP PROGRAM

Initial management

� 8xFolfiri+Cetuximab biweekly

� 10/2011:CT restaging: PR >50%decrease

� 10/2011:CEA:5ng/ml,

CA 19-9:25.8 U/ml

� 11/2011:

right hepatectomy and metastasectomy from the segment III of the liver

ESMO PRECEPTORSHIP PROGRAM

The next steps after hepatectomy…

� Postoperative CT: 7xFolfiri+Cetuximab biweekly

� 4/2012: CT restaging (-)

� 4/2012: MRI pelvis: cT4aN0 (stage IIB), CRM(-)

� Neoadjuvant RT: 500cGYX5

� 05/2012: low anterior resection: pT3N0 gr II

� Adjuvant CT: 4xMdG

� 10/2012: obstruction of ureter: no recurrence�ureteral stent

ESMO PRECEPTORSHIP PROGRAM

Recurrence

� 7/2015:liver recurrence

segment I near the IVC

� CEA:5,8 ng/ml

� CA 19-9:25,2 U/ml

� GI meeting:

no possibilities for topical

treatment

� 12x Folfiri+Cetuximab

ESMO PRECEPTORSHIP PROGRAM

Complete Response� Follow up restaging:

� 2/2016 CT: CR

� 5/2016 CT: CR

� 11/2016 CT: CR

� Questions:� Do we need further imaging?

� Is there micrometastatic disease?

� Which is the role of maintenance therapy?

� What is the best chemotherapy-regimen for a new recurrence?

Thanks for your attention