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Metachronous metastases from rectum adenocarcinoma in cervical lymph nodes after preoperative neoadjuvant chemoradiotherapy.

Authors: Y. Barsukov, V. Aliev, D. Kuzmichev, G. Lazarev, A. Atroshchenko.

Background:  cases of metastatic damage of cervical lymph nodes from rectal adenocarcinoma are rare. According to the literature the frequency does not exceed 0.1%.  For the primary tumor, these metastases are considered as distant.

Patient and methods:  a 63 years old woman underwent neoadjuvant treatment for rectal adenocarcinoma T3N2M0 (radiation therapy 5 Gy for 5 days, chemotherapy: Xeloda -1,5 gr/m2 each  days of the radiation therapy and inrarectal exposition of polymer composite mixture with metronidazole - 18gr. in  3rd, 5th days of  the radiation therapy). Three weeks later after noadjuvant therapy CT, colonoscopy and ultra sound diagnostic  control showed a good effect from the tumor (reduction of the length, volume of the tumor and there were no evidence for distance metastasis). The patient was operated on in the volume of rectal resection.  There were no adjuvant treatment after surgery. Four years later, during planning  control examination was reviled the metastatic damage of the left side neck lymph nodes (hystolgycally and immunohistochemically – metastasis of the rectal adenocarcinoma).

Results: Fascial-fat surgery resection of left side groups  lymph nodes was performed, and «XELOX» regimen of  chemotherapy was appointed.

Conclusion: the program of neoadjuvant chemoradiotherapy helps to achieve a good local control after surgery and  help to  minimize the number of local recurrences, but the issue of management of the distant metastases remains relevant.


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