A 63-year-old woman with chief complaints of abdominal distention and
vomiting was brought to our hospital in May, 2010. Her radiological examination revealed that she was suffering from perforative
peritonitis. The patient underwent emergency open
laparotomy. Perioperatively, we made a diagnosis of unresectable transverse colon
cancer accompanied with tough peritoneal dissemination, and therefore performed intraperitoneal irrigation drainage, transverse loop
colostomy and biopsy of omental dissemination. A pathological examination of omental dissemination demonstrated
mucinous adenocarcinoma with the wild-type Kras gene, and the cytology of
ascites was negative. FOLFOX4 combined with
panitumumab therapy was initiated 1 month after the operation. Seventeen courses of this
chemotherapy regimen were performed, although adverse events including grade 3
neutropenia and grade 2 skin symptoms were noted. Consequently, serum CEA levels decreased to 5. 5 ng/mL, although the size of the primary lesion of transverse colon
cancer was unchanged on abdominal computed tomography(CT).
Chemotherapy has been continued without marked side effects, although 1 year has passed since we started medical treatment for this difficult case. We found that a multidisciplinary approach with a focus on FOLFOX4
therapy combined with
panitumumab is useful for patients with highly advanced
mucinous adenocarcinoma of the colon that develops into peritoneal dissemination.