Synchronous Metastatic Rectal Cancer Completely Resected After Multidisciplinary Planning and Treatment: A Case Report

Colorectal cancer is a common and significant public health concern. The liver is the most common site of metastasis, and colorectal cancer liver metastases (CRLM) may affect up to 60% of patients at some time during the course of their disease. Approximately 25% of patients are found to have synchronous CRLM at the time of diagnosis, and these patients have a worse prognosis than those who develop metastases later in their disease course. In the absence of extrahepatic disease, resection of CRLM with negative margins along with chemotherapy can lead to a 5-year overall survival rate of up to 60%. This report presents the case of a 48-year-old man diagnosed with rectal cancer and synchronous liver metastases that a multidisciplinary tumor board initially deemed to be unresectable because of large size and insufficient future liver remnant. The patient underwent FOLFOX chemotherapy with bevacizumab and experienced conversion to resectable hepatic disease. After neoadjuvant short-course radiation treatment to the rectum, the patient underwent combined low anterior resection of the rectum and a right hepatectomy and was rendered disease-free. The management of the patient’s clinical course with correlation to the NCCN Clinical Practice Guidelines in Oncology for Rectal Cancer is presented in this report, including discussion of the role of chemotherapy in the conversion of CRLM to resectable status, the role of surgical metastasectomy, and postoperative surveillance of patients with colorectal cancer.

Target Audience

This activity has been designated to meet the educational needs of physicians, nurses, and pharmacists involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Discuss the NCCN Clinical Practice Guidelines in Oncology for Rectal Cancer recommendations for the management of potentially resectable synchronous metastatic disease
  • Describe the role of chemotherapy with bevacizumab in the conversion of colorectal cancer liver metastasis (CRLM) to resectable status
Additional information
Supporters: 

Supported by educational grants from sanofi-aventis U.S. and Regeneron Pharmaceuticals; Bayer HealthCare Pharmaceuticals Inc.; Genentech, USA; and Lilly USA, LLC.

Course summary
Available credit: 
  • 1.25 Participation
  • 1.25 Nurse
  • 1.25 Pharmacist
  • 1.25 Physician
Course opens: 
10/04/2013
Course expires: 
08/31/2014
Cost:
$0.00

Hans F. Schoellhammer, MD
Division of Surgical Oncology, Department of Surgery
City of Hope Comprehensive Cancer Center
Duarte, California

Gagandeep Singh, MD, FACS
Division of Surgical Oncology, Department of Surgery
City of Hope Comprehensive Cancer Center
Duarte, California

Lucille Leong, MD
Department of Medical Oncology and Therapeutics Research
City of Hope Comprehensive Cancer Center
Duarte, California

Available Credit

  • 1.25 Participation
  • 1.25 Nurse
  • 1.25 Pharmacist
  • 1.25 Physician

Accreditation Period

Course opens: 
10/04/2013
Course expires: 
08/31/2014

Price

Cost:
$0.00
Please login or register to take this course.

Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing