PMC3037991_01
Colonoscopy. A type 2 tumor in 2/3 circumferential extension over the rectosigmoid. Biopsy revealed moderately differentiated adenocarcinoma.
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F1
CEA (224.3 ng/ml, normal range <5 ng/ml) and CA19-9 (444 U/ml, normal range <37 U/ml) as tumor markers were high. Colonoscopy revealed a type 2 lesion (2/3 of the circumference) in the rectosigmoid area (fig. 1).
Abdominal contrast-enhanced CT. a At initial examination, multiple metastatic lesions were observed throughout the liver. b At the end of 6 courses of BV + mFOLFOX6 therapy, the tumor had almost disappeared (complete remission). c At the end of 6 courses of BV + Cape therapy, complete remission was maintained without an increase in tumor size.
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F2
Abdominal CT showed multiple metastatic lesions in the liver (fig. 2a). The results of abdominal CT showed partial response (fig. 2b). Abdominal CT also showed the continuation of partial response (fig. 2c).
Treatment course and changes in tumor markers. The CEA and CA19-9 levels increased before surgery but decreased to values below the normal range after 11 courses of BV + mFOLFOX6 therapy. This therapy was changed to BV + Cape therapy. At present, after 6 courses of BV + Cape therapy, the tumor markers are within the normal range. 2008/12: before surgery (at initial consultation); 2009/01: after surgery (before initiation of chemotherapy); 2009/04: after 6 courses of BV + mFOLFOX6 therapy; 2009/07: after 11 courses of BV + mFOLFOX6 therapy; 2010/01: after 6 courses of BV + Cape therapy.
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F3
Postoperative chemotherapy for the metastatic lesions of the liver, therapy with BV and mFOLFOX6 was initiated in January 2009 (chemotherapy consisted of an intravenous injection of oxaliplatin 85 mg/m2 with isovorin 200 mg/m2 over 2 h followed by 5-fluorouracil (5-FU) 400 mg/m2 bolus and 2,400 mg/m2 continuous infusion over 48 h with BV 5 mg/m2, which was repeated every 2 weeks) (fig. 3).