PMC8289441_01
Enhanced abdominal CT and gene status of the patient before chemotherapy. (A) Enhanced abdominal CT showed multiple lesions in the liver. (B) Enhanced abdominal CT demonstrated the enlargement of liver portal lymph nodes, retroperitoneal lymph nodes and a primary rectal lesion. The red circles represent the target lesion. (C) Next-generation sequencing (NGS) results of the primary rectal cancer tissue samples. (D) Family tumor history of the patient. Male 1 was died of lymphoma, male 2 was died of liver cancer, male 3 was diagnosed with esophageal squamous cell carcinoma, female 1 was diagnosed with thyroid diffuse large B-cell lymphoma, male 5 was diagnosed with rectal cancer, the case was diagnosed with rectal cancer.
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Enhanced abdominal computed tomography (CT) showed multiple lesions in the liver that were suspected as metastases (Figure 1A). We also found the enlargement of the liver portal and retroperitoneal lymph nodes (Figure 1B). We also detected no UGT1A1*6/UGT1A1*28/DPYD mutations and investigated family tumor history of the patient (Figure 1C and D).
Enhanced abdominal CT and tumor markers (CEA) revealed rapid response to XELOXIRI plus bevacizumab. (A) Enhanced abdominal CT showed significant regression of tumor size of liver metastasis and primary rectal lesion. The red arrows represent the target lesion. (B) Enhanced abdominal CT showed the sizes of the liver portal and retroperitoneal lymph nodes were stable. The red circles represent the target lesion. (C) Two and Four cycles after the beginning of therapy, tumor markers (CEA) returned to normal.
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Two and four cycles after the beginning of therapy, enhanced abdominal CT showed significant tumor regression of liver metastasis and primary rectal lesions (Figure 2A). The sizes of the liver portal and retroperitoneal lymph nodes were stable (Figure 2B) and tumor markers (CEA) returned to normal (Figure 2C).
PET-CT and Colonoscopy images revealed rapid response to XELOXIRI plus bevacizumab. (A) a, b, c PET-CT revealed the size of liver metastasis continued to shrink and d, e and f denote the rectal lesion with SUV of 2.1 after six cycles of XELOXIRI plus bevacizumab. (B) Colonoscopy images before starting chemotherapy and colonoscopy images after eight cycles of XELOXIRI plus bevacizumab. (C) Enhanced abdominal CT showed the tumor continued to shrink after eight cycles of XELOXIRI plus bevacizumab. The red circles and arrows represent the target lesion.
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After six cycles of treatment, positron emission tomography-computed tomography (PET-CT) showed that the tumor had continued to shrink with a maximum standard uptake value (SUV) of 8.1 for the liver metastasis and 2.1 for the rectal lesion (Figure 3A). Colonoscopy showed thickening of the rectal mucosa with a slightly rough surface about 8 cm from the anal margin and the remaining mucosa was smooth (Figure 3B). Enhanced abdominal CT showed the size of the liver metastasis continued to shrink (Figure 3C).
Medical imaging examination and biopsy during the follow-up period. (A) Biopsy showed the absence of neoplastic cells in all examined specimens after right hemihepatectomy, partial liver IV resection. (B) Liver MRI during the follow-up period. (C) Enhanced abdominal CT during the follow-up period. (D) Colonoscopy during the follow-up period. (E) Colonoscopy biopsy during the follow-up period. (F) Rectal MRI during the follow-up period. (G) Timeline of the young-aged rectal cancer patient.
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Pathology showed the absence of neoplastic cells in all of the examined specimens (Figure 4A). CT every 3-6 months (Figure 4C). Colonoscopy and rectal or liver magnetic resonance imaging (MRI) were also performed every six months (Figure 4B and D-F). The patient remained free of disease and the duration of OS (from time of diagnosis to present) was more than three years (Figure 4G).