Strategie terapeutiche
nel carcinoma del
colon-retto:
Caso clinico n.4
De Bari Berardino, MD
Radiation Oncologist
CHUV - Lausanne
IV Incontro di Aggiornamento Scientifico
del Dipartimento Oncologico
Ospedale Sacro Cuore – Don Calabria (Negrar)
8-5-2014
The clinical case
-  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
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??
The clinical case
Low Risk... The clinical case
Controversies
-  NEOADJUVANT TREATMENT….YES VS NOT!
-  IF YES…..LONG COURSE VS SHORT COURSE?
The clinical case
Preoperative RT
Low Risk... The clinical case
Preoperative RT
Low Risk... The clinical case
MRI (04-2014 restaging)
02-2014
The clinical case
MRI (04-2014 restaging)
The clinical case
Surgery: Anterior Resection
Low Risk... -  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
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
Low Risk... 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).
The clinical case
Multidisciplinary meeting
Low Risk... -  Postoperative irradiation?
-  Postoperative CT?
-  Both?
Finally, an indication of postoperative irradiation on the
R1 site has been given…we are right???
Strategie terapeutiche nel
carcinoma del colon-retto:
Caso clinico n.4
GRAZIE PER
L’ATTENZIONE
IV Incontro di Aggiornamento Scientifico
del Dipartimento Oncologico
Ospedale Sacro Cuore – Don Calabria (Negrar)
8-5-2014