A 59-year-old male patient with
rectal cancer 2 cm in diameter (T2) at the peritoneal reflection with suspicious left lateral node
metastasis was treated with 400 mg of preoperative oral
uracil and tegaful (UFT) for 5 weeks, 5 days a week in combination with concomitant
radiotherapy of 45 Gy per 25 fractions for 5 weeks. After resting for another 5 weeks, colon fiberscopy, barium enema, and computed tomography revealed a trace of the primary
tumor and a 40% shrinkage of the lateral
metastasis. The serum CEA level decreased to the normal range during treatment. The adverse effects were
nausea, bloody stool and elevation of
transaminase, all at grade 1. Low anterior resection with a left hemi-lateral
lymphadenectomy was performed through a suprapubic, one hand-size incision without laparoscopy. The preoperative treatment did not affect any operative procedures, and no postoperative complications occurred. The surgical specimen showed that the
rectal tumor had been remarkably shrunk by the preoperative treatment, to the level of a superficial type
tumor. Histological analysis indicated moderately differentiated
adenocarcinoma cells that were present at only 2 mm in diameter in the mucosal layer, 6 mm in the submucosal layer, and 1 mm or less in the muscular layer with
scar formation. No
metastasis was detected in the 16 lymph nodes dissected, but an organizing
tumor thrombus, which had preoperatively been diagnosed as lateral node
metastasis, was detected. These results suggest that preoperative oral UFT plus concomitant
radiotherapy may be a feasible, tolerable and effective treatment for patients with
rectal cancer.