Synchronous rectal and esophageal cancer treated with chemotherapy followed by two-stage resection

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.