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Multimodal approach for metastatic colorectal cancer – a clinical model: Case report

Tsvetelina Paycheva,Kostadin Angelov,Vasil Pavlov,Svilen Maslyankov.

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Background: Colorectal cancer is a socially significant disease because of its high morbidity and mortality rates. It requires integrated work of many medical specialist in order to achieve better treatment results and better quality of life to those patients. The presented case illustrates our clinical model for multidisciplinary approach.
Case summary: The presented case is about 74 years old patient with metastatic colorectal cancer. He underwent resection of the sigmoid colon. Later on was discovered a single metastatic lesion in the left lung and lower left lobectomy was performed. Couple of mounts later he was readmitted to Surgery Clinic with abdominal pain and discomfort due to new liver lesion. He underwent liver resection and started first line chemotherapy on FOLFOX-6 scheme. On next clinical reevaluation it appeared to be ineffective. The disease disseminated in liver, visceral peritoneum, spinal and pelvic bones. Second line chemotherapy with FOLFIRI scheme couldn’t stop further progression and palliative radiotherapy was scheduled in order to manage the pain syndrome. Afterwards he underwent spinal surgery, because of pathologic fracture of L5 and started third line Capecitabine as monotherapy.
Conclusions: Multidisciplinary approach is the only relevant treatment option for patients with metastatic colorectal cancer. This case demonstrates the advantages in terms of overall survival and progression free survival, in the context of late diagnosis and comorbid terrain. It also raises questions to the findings in patients with progression and chemo-resistance in colorectal tumors, published by leading world cancer centers.

Key words: CRC, colorectal cancer, sigmoid cancer, multimodal approach, Chemotherapy, FOLFOX-6, FOLFIRI, Capecitabine, Metastasis, PET/CT, Radiotherapy, progression

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