A case of locally recurrent rectal cancer resected in combination with preoperative carbon ion radiotherapy

Although surgical resection is viewed as the most effective therapy for locally recurrent rectal cancer (LRRC), surgical stress and sacral nerve damage accompanied by high sacral resection often yield a dismal result. Despite efficacy similar to that of surgery, indications for carbon ion radiotherapy (C-ion RT) are limited by gastrointestinal toxicity. We report a case of LRRC resected combined with preoperative C-ion RT. A 62-year-old man undergoing low anterior resection for rectal adenocarcinoma with D2 lymphadenectomy in November 2003 was diagnosed pathologically with moderately differentiated adenocarcinoma, SS, NO, Stage II, R0, operative curability A. Admitted for sacral pain in February 2008, he was diagnosed by endoscopic biopsy as having recurrent rectal cancer. Imaging analysis showed recurrent sites at the anastomosis and sacral bones 2 to 4. Because sacral bone metastasis could not be resected, C-ion RT (73.6 Gray equivalent) was started for both lesions in April 2008. After the completion of C-ion RT, the man underwent abdominoperineal resection combined with sacral (S5), coccygeal, and partial resection of the small intestine. Histologically, resected specimens showed no residual caner cells, i.e., grade 3 based on the Japanese radiation therapy criteria He was discharged on postoperative day 46 without severe complications and remains alive with no sign of recurrence in the 13 months since surgery.