IV Incontro di Aggiornamento Scientifico del Dipartimento Oncologico

Ospedale Sacro Cuore – Don Calabria (Negrar)

8-5-2014

Strategie terapeutiche

nel carcinoma del colon-retto:

Caso clinico n.4

De Bari Berardino, MD Radiation Oncologist

CHUV - Lausanne

-  Male, 47 years old

-  Schizophrenia since 1982 (he is hospitalized in a specialized center)

-  Mild psycosis

-  gastroesophageal reflux disease + chronic esophagitis (hyatal hernia)

-  Strabismus

-  TBC (recent diagnosis, treated by antibiotics)

The clinical case

Low  Risk...    

The clinical case

The clinical case

Symptomes -  Asthenia

-  Weight loss (-6kg)

-  Mild anemia

-  Low back pain

Several colonoscopy

The clinical case

Colonoscopy (24-10-2013)

The clinical case

Biopsy (10-2013)

The clinical case

Colonoscopy (2013)

The clinical case

Biopsy (11-2013)

The clinical case

Colonoscopy (01-2014)

The clinical case

Pathology (01-2014)

The clinical case

MRI (02-2014)

The clinical case

MRI (02-2014)

The clinical case

MRI (02-2014)

The clinical case

MRI (02-2014)

The clinical case

MRI (02-2014 nodal status)

The clinical case

Who is right??

Low  Risk...    

The clinical case

The clinical case

Controversies

-  NEOADJUVANT TREATMENT….YES VS NOT!

-  IF YES…..LONG COURSE VS SHORT COURSE?

Low  Risk...    

The clinical case

Preoperative RT

Low  Risk...    

The clinical case

Preoperative RT

The clinical case

MRI (04-2014 restaging)

02-2014

The clinical case

MRI (04-2014 restaging)

Low  Risk...    

The clinical case

Surgery: Anterior Resection

-  Pathology - Rectal Adenocarcinoma G2 - TRG (Mandard regression Score): 3/5 - TME quality: complete excision; - CRM (marge de résection circonférentielle) :

Anterior : +ve on 0.1 cm Posterior and lateral margins: -ve ( >1cm)

-  Nodal status: 0/29 positive nodes

ypT2 ypN0 (0/29) Pn0 L0 V0 G2 R1

Low  Risk...    

The clinical case

Low  Risk...    

The clinical case

Multidisciplinary meeting

-  Postoperative irradiation?

-  Postoperative CT?

-  Both?

Low  Risk...    

The clinical case

Low  Risk...    

The clinical case

Local recurrence rates according to treatment arm. Preoperative radiotherapy prevents local recurrences in patients with (a) wide circumferential margin (p <

0.0001) and in patients with (b) narrow circumferential margin (p = 0.02). No beneficial effect was observed in patients with (c) margin involvement (p = 0.08).

Low  Risk...    

The clinical case

Multidisciplinary meeting

-  Postoperative irradiation?

-  Postoperative CT?

-  Both?

Finally, an indication of postoperative irradiation on the

R1 site has been given…we are right???

IV Incontro di Aggiornamento Scientifico del Dipartimento Oncologico

Ospedale Sacro Cuore – Don Calabria (Negrar)

8-5-2014

Strategie terapeutiche nel carcinoma del colon-retto:

Caso clinico n.4

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