Successful treatment of an unresectable rectal carcinoma with combined radio-chemo-immunotherapy resulting in complete remission

Abstract

We administered multidisciplinary treatment to a 37-year-old man with poorly differentiated adenocarcinoma of the rectum which exhibited a fistula between the rectum and the urinary bladder; the tumor was considered unresectable because of extensive local spread at initial evaluation, including a laparotomy. The patient received radiotherapy, consisting of a total dose of 50 Gy, given as fractions of 2 Gy per day 4 days a week. Concurrently with the radiation, the patient also received twice daily a tegafur [1-(2-tetrahydrofuryl)-5-fluorouracil] suppository (750 mg) and 5-fluorouracil ointment (2.5 g) applied to the perianal involved skin lesion. In addition, 5 KE of OK-432 was injected into the tumor nine times during the course of radiation. Because the tumor responded well to this radio-chemo-immunotherapy, the patient was discharged, and was treated only with tegafur suppositories for almost 3 years on an outpatient basis (total dose of tegafur, approximately 1500 g). As a result of the combined therapy, the tumor completely disappeared, while only the recto-urinary fistula remained. The patient has survived without recurrence for 50 months after his initial presentation, and his levels of carcinoembryonic antigen and immunosuppressive acidic protein have decreased from pretreatment values of 85 ng/ml and 1220 μg/ml, respectively, to 0.8 ng/ml and 459 μg/ml, respectively. Although this is only one case, it shows that appropriate multidisciplinary treatment may achieve excellent results even in patients with unresectable poorly differentiated adenocarcinomas of the rectum.