Prophylactic intestinal resection following carbon-ion radiotherapy for locally recurrent rectal cancer: a case report.

Abstract

Treatment of locally recurrent rectal cancer (LRRC) after surgery is often complex and challenging. A 52-year-old man received emergency surgery (Hartmann's procedure) for bowel perforation caused by a huge sigmoid colon cancer, followed by treatment for concurrent advanced lower rectal cancer with neoadjuvant chemoradiotherapy and abdominoperineal resection. A solitary lung metastasis emerged afterwards, and was surgically removed. However, the patient developed LRRC in front of the sacrum. As surgical resection for the local recurrence was considered too invasive, carbon-ion radiotherapy (CIRT) was performed as radical local therapy. Because the surrounding intestine was highly adherent to the tumor and there was a high risk of developing an ulcer, the intestine was prophylactically resected. The patient has remained relapse-free for 2 years and 6 months since the most recent surgery. CIRT for LRRC appears to represent a useful therapeutic option in combination with prophylactic intestinal resection.