A long-term survival case of rectal cancer with virchow's lymph node metastasis by multimodality therapy

A 57-year-old man was diagnosed as having advanced rectal cancer that was suspected for a prostatic gland invasion. CPT-11 plus UFT/LV-based chemoradiotherapy (CRT) was administered. A total radiation dose was 50.4 Gy. After completion of CRT, rectal tumor has shrunken, but Virchow's lymph node metastasis was found on PET CT scan. Therefore, the main rectal tumor was resected first, and chemotherapy was then planned. After an abdominoperineal resection, mFOLF-0X6 was started. We have stopped mFOLFOX6 after 9 courses because of grade 3 peripheral neuropathy. FOLFIRI was administered thereafter for 27 courses until the confirmation of the shrinkage of the Virchow's lymph node. With a request from the patient, the chemotherapy was stopped for 7 months. Virchow's lymph node has re-grown. We restarted chemotherapy with FOLFOX+bevacizumab regimen. Although the re-grown Virchow's lymph node was unresectable, a tumor in the rectum was resected for a control of local symptom. We, then, introduced a sequential systemic chemotherapy. After that, we could continue the treatment for 38 months without spoiling the QOL. The patient is alive and come to see us as an outpatient.