Case Report
Copyright ©2013 Baishideng. All rights reserved.
World J Clin Cases. May 16, 2013; 1(2): 87-91
Published online May 16, 2013. doi: 10.12998/wjcc.v1.i2.87
Synchronous rectal and esophageal cancer treated with chemotherapy followed by two-stage resection
Setsuo Utsunomiya, Keisuke Uehara, Takuya Kurimoto, Ken Hirose, Masahide Fukaya, Yu Takahashi, Yoshiro Taguchi, Keita Itatsu, Masato Nagino
Setsuo Utsunomiya, Takuya Kurimoto, Department of Gastrointestinal Oncology, Nagoya Kyoritsu Hospital, Nakagawa-ku, Nagoya 454-0933, Japan
Keisuke Uehara, Masahide Fukaya, Yu Takahashi, Yoshiro Taguchi, Keita Itatsu, Masato Nagino, Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya 466-8550, Japan
Ken Hirose, Department of Gastroenterology, Nagoya Kyoritsu Hospital, Nakagawa-ku, Nagoya 454-0933, Japan
Author contributions: Uehara K and Utsunomiya S designed the report; Utsunomiya S and Taguchi Y were attending doctors for the patients; Uehara K, Fukaya M, Takahashi Y and Itatsu K performed surgical operation; Kurimoto T and Hirose K were performed image diagnosis; Nagino M and Uehara K organized the report; and Utsunomiya S wrote paper.
Correspondence to: Keisuke Uehara, MD, PhD, Division of Surgical Oncology, Department of Surgery, Nagoya Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. kuehara@med.nagoya-u.ac.jp
Telephone: +81-52-7442222 Fax: +81-52-7442230
Received: February 10, 2013
Revised: April 3, 2013
Accepted: April 10, 2013
Published online: May 16, 2013
Processing time: 94 Days and 18.7 Hours
Abstract

We report a case of 61-year-old male who had synchronous advanced rectal cancer involving the urinary bladder massively associated with multiple liver metastases, and esophageal cancer successfully treated by neoadjuvant chemotherapy followed by two-stage resection. Although complete resection of each of the lesions was considered possible by performing anterior pelvic exenteration, liver resection, and esophagectomy, it might be impossible for the patient to endure the stress of all of these operative procedures at once. Therefore, we planned to perform staged treatment with prioritizing consideration. First, we instituted chemotherapy with the FOLFOX (oxaliplatin + fluorouracil + leucovorin) plus cetuximab regimen, which could adequately control both rectal and esophageal cancer. After 6 cycles of chemotherapy, high anterior resection combined with cystoprostatectomy and lateral segmentectomy plus partial hepatectomy was performed followed by staged esophagectomy with three-field lymph node dissection. It was possible to use oxaliplatin and cetuximab safely as neoadjuvant therapy not only for advanced rectal cancer but for esophageal cancer, and it was effective.

Keywords: Rectal cancer; Esophageal cancer; Neoadjuvant chemotherapy; Cetuximab; Oxaliplatin

Core tip: In case with synchronous multiple cancers, it is sometimes difficult to identify the origin especially when liver and/or pulmonary lesions have a possibility of metastases, or to decide on a course or priority of the treatment. FOLFOX + cetuximab (Cet) therapy could provide a favorable control of not only rectal origin accompanied by liver metastases but also esophageal cancer, which made possible to undergo two-stage curative resection. FOLFOX + Cet regimen might be a useful option for such refractory rectal and esophageal cancer.