ESMO Preceptorship Programme

Transcription

1 ESMO Preceptorship Programme Rectal Cancer Barcelona November 2016 Andreia Braz Pires Radiation Oncology Resident (3rd year) Instituto Português de Oncologia do Porto Francisco Gentil, EPE Low dose re-irradiation and intraoperative radiotherapy Rectal Cancer Relapse

2 Identification: 63 years old, caucasian male Personal History: - Hypertension - Dyslipidemia - Diabetes mellitus type II - Obesity No family history of cancer 2010 May/2010: multiple episodes of rectal bleeding. Colonoscopy : rectumneoplasia (10 cm AV). Biopsy: ADENOCARCINOMA, ct2n0m : CEA 3,89 ng/ml; Ca 19,9 57 u/ml TAP CT : no metastatic disease. Loweranterior rectal resection : ADENOCARCINOMA, pt3n1g2m0r0 - Kras wild-type ECOG 0 AdjuvantChemoradiotherapyuntil : 50.4Gy, 1.8Gy/day + 5-Fu + Adjuvant ChT until : Folfox 4 x 12 cycles

3 : CEA 3,71 ng/ml; Ca 19,9 70,7 u/ml TAP CT : nodular pre sacral densification (21.6mm) F-FDG PET/CT : pre sacral hiperfixation sugestive of locoregional relapse. Pre sacral Biopsy : ADENOCARCINOMA Paliative ChT: Folfiri + Cetuximab x 5 cycles until TAP CT : pre sacral mass persistence (25mm) + right external iliac adenomegalia (10mm). Low volume ascite Citology : inconclusive! : CEA 3,31 ng/ml; Ca 19,9 56,7 u/ml F-FDG PET/CT : LOCOREGIONAL RELAPSE

4 Identification: 65 years old, caucasian male 2012 PreoperativeCRT: 30Gy,2Gy/day+ 5-Fu, until ECOG 1 PTV= GTV+1cm - Rectal Adenocarcinoma RAR pt3n1g2m0r0 - RT/ChT adjuvant ChT adjuvant Presacral relapse PaliativeChT(Folfiri+Cetuximab) weeks : Abdominoperinealresection(APR) + Intraoperative radiotherapy(iort) IORT: pre sacral irradiation with 15Gy, 9 Mev. PA: no evidence of residual tumor. SURVEILLANCE

5 : CEA 3,23 ng/ml; Ca 19,9 19,8 u/ml subj: lefthippainwith3 monthevolution, no othersrelevantsymptoms. MRI : fluidcollectionin sacredspace. Signalchangein leftiliacandipsilateral hemisacro, compatible with metastatic envolvement + Swollen of the left psoas Iliac muscle contiguity involvement(?). Therightiliacboneshows anareaoflowsignal, thatcan havethesamemeaning. F-FDG PET/CT : metabolicactivityin posterior aspectoftheleftiliacwithextensionto psoas iliac muscle, sacroiliacjointandipsilateral sacro. No evidenceofpresacral relapse. Leftilacbiopsy : unspecificinflamatorychanges!

6 F-FDG PET/CT : decreasingmetabolicactivityin leftsacroiliactopography, compared to study. Without evidence of tumor relapse or metastatic disease Alive without cancer evidence SURVEILLANCE - Although the poor prognosis and the challenge treatment of previously irradiated patients with recurrent rectal cancer, several studies have shown that reirradiation and IORT are feasible, safe, and effective in terms of achieving radical resection in selected patients with modern staging and radiotherapy techniques, allowing for increased accuracy and individualised radiotherapy. - In our institution we have a protocol for patients with locorregial relapse and may undergo to a R0 surgery, that consists in preoperative chemoradiotherapy (low dose RT associate with 5-Fu), followed by surgery with IORT.

7 ESMO Preceptorship Programme Andreia Braz Pires Radiation Oncology Resident (3rd year) Instituto Português de Oncologia do Porto Francisco Gentil, EPE Thank you for your attention!