PMC10352850_01
Colonoscopy images before neoadjuvant therapy.
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F1
Colonoscopy revealed a cauliflower-like neoplasm in the lower part of the intestine, with necrosis and hemorrhage on the surface, hard and poorly mobile, and the lower margin adjacent to the anal dentate line, invading most of the perimeter of the intestinal lumen (Figure 1).
(A) CT image before neoadjuvant therapy. (B) CT image after three cycles of short course radiotherapy + XELOX + camrelizumab.
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F2
No distant organ metastasis was observed on computed tomography (CT) (Figure 2), and the lesion was preoperatively classified as stage T4bN1bM0 IIIC according to the Chinese CSCO guidelines for colorectal cancer.
(A) MRI image before neoadjuvant therapy. (B) MRI image after three cycles of short course radiotherapy + XELOX + camrelizumab. (C) MRI image at the end of neoadjuvant therapy.
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F3
Magnetic resonance imaging (MRI) showed: The lower margin of the tumor was about 1.9 cm from the anal margin, the tumor invaded the left anal levator muscle, and the left internal iliac artery lymph node was enlarged; CRM (circumferential resection) (+), EMVI (extra-mural vascular invasion) (-) (Figure 3). Review after three cycles suggested that the lesions were significantly smaller and the left internal iliac vessel parietal lymph nodes were smaller than before the treatment (Figure 3). N1a, CRM (-), EMVI (NA), and the primary tumor MR TRG grading (standard) was about grade 1 (grade 1: completely low-signal fibrotic component, no residual isosignal tumor tissue) (Figure 3), rectal finger examination is about 7 cm into the finger, no mass is found, half circle of tumor scar can be found at about 3 cm-4 cm from the anus. laparoscopic ultra-low rectal anterior resection + lateral lymph node dissection + temporary ileostomy was performed with robotic assistance. No intraperitoneal dissemination or distant metastasis was observed.
(A) Lung image after three cycles of short course radiotherapy + XELOX + camrelizumab. (B) Lung image one month after discontinuation of camrelizumab.
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F4
However, multiple patchy shadows were observed in both lungs (Figure 4). Most multiple patchy shadows on the lungs disappeared (Figure 4).