TOTAL NEOADJUVANT THERAPY FOR RECTAL CANCER TREATMENT IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Case Presentation Female, 54 years old, diagnosed with Systemic Lupus Erythematosus (SLE), regularly using Hydroxychloroquine, without previous surgeries or a family history of colorectal cancer. The patient has been experiencing episodes of hematochezia for 3 months and underwent a colonoscopy, which revealed a vegetative lesion 10 cm from the anal margin, measuring approximately 5 cm in length. Pathology: well-differentiated adenocarcinoma. The patient underwent magnetic resonance imaging (MRI), which showed a polypoid expansile formation located 10 cm from the anal margin, with the distal margin 7.5 cm above the anorectal ring. The epicenter and most of the lesion were below the peritoneal reflection. It involved 25% of the circumference and infiltrated 2 mm beyond the muscularis propria. The lesion affected the mesorectal fascia. No suspicious lymph nodes or evidence of extramural venous invasion were found. cT3bN0M0. Total Neoadjuvant Therapy (TNT) was opted for. The patient experienced episodes of diarrhea, requiring hospitalization and a temporary interruption of Capecitabine and Oxaliplatin (CAPOX) for 5 weeks. After this, a restaging was performed, including a sigmoidoscopy and MRI, suggesting a complete response, although the previous lesion could not be assessed by rectal examination. After 26 weeks of neoadjuvant therapy, the patient underwent a rectosigmoidectomy with total mesorectal excision (TME) and low colorectal anastomosis with loop ileostomy, encountering technical difficulties due to extensive fibrosis. Pathology: no residual neoplasia.

Discussion SLE is associated with a slight overall increase in cancer risk compared to the general population. Gastrointestinal toxicity due to chemotherapy is a frequent complication, and it was more intense due to the underlying disease. The surgical procedure was technically challenging due to severe fibrosis, as the surgery was delayed due to the temporary interruption of CAPOX, and there was also an increase in scar tissue resulting from the SLE. Studies indicate exacerbation of fibrosis and greater technical difficulty during TME in patients with collagen diseases who undergo neoadjuvant radiotherapy, often leading to higher postoperative complications. This finding may suggest a relative contraindication for TNT in this patient group.

Comments A better understanding of the pathophysiology and underlying elements of this risk will lead to more efficient and individualized treatments.

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Artikel online veröffentlicht:
25. April 2025