贝伐珠单抗联合FOLFIRI方案治疗晚期直肠癌并发直肠阴道瘘1例报告及文献复习

Treatment of advanced rectal cancer with rectovaginal fistula through bevacizumab combined with FOLFIRI regimen:A case report and literature review

目的:探讨贝伐珠单抗联合化疗治疗已形成直肠阴道瘘直肠癌患者的疗效,为该病的治疗提供参考依据。方法:收集1例采用贝伐珠单抗联合FOLFIRI方案治疗的晚期直肠癌伴直肠阴道瘘患者的临床资料,分析其诊治特点和过程,并对相关文献进行总结。结果:患者,女性,64岁,于吉林省人民医院行经腹直肠癌手术(Dioxon手术),术后病理为中分化直肠腺癌,阴道后壁侵犯及区域淋巴结转移(pT4bN2M0,ⅢC期,DukesC);免疫组织化学检测,MSH2(+)、MLH1(+)、PMS2(+)、MSH6(+)、S-100(-)和BRAFV600E(-),提示错配修复蛋白功能正常(pMMR);该患者发生N-和K-ras基因突变,术后4周辅助化疗前盆腔核磁成像(MRI)显示术后直肠阴道瘘,延期化疗,术后5个月疾病继续进展,被迫行姑息性一线、二线化疗,但疾病持续进展,三线采用贝伐珠单抗联合FOLFIRI方案治疗,未加重直肠阴道瘘,且促进了瘘道愈合,并显著提高了患者的生活质量。结论:针对肿瘤进展导致直肠阴道瘘且无法从西妥昔单抗治疗中受益的直肠癌患者,采用贝伐珠单抗联合化疗进行针对病因的治疗是一种可行的方案。

Objective:To investigate the efficacy of bevacizumab combined with chemotherapy in the treatment of the rectal cancer patients with rectovaginal fistula,and to provide the reference basis for the treatment of the disease.Methods:The clinical data of one patient with advanced rectal cancer with rectovaginal fistula treated with bevacizumab combined with FOLFIRI were collected,and the characteristics and process of diagnosis and treatment were analyzed;the relevant literatures were summarized at the same time.Results:A 64-year-old female patient received transabdominal rectal cancer surgery(Dixon surgery)in People’s Hospital of Jilin Province,and the postoperative pathological results showed moderately differentiated rectal adenocarcinoma,invasion of posterior wall of vagina and regional lymph node metastasis(pT4bN2M0,StageⅢC,Dukes C);the immunohistochemistry results showed MHS2(+),MLH1(+),PMS2(+),MSH6(+),S-100(-),and BRAFV600E(-),indicating proficiency of mismatch repair(pMMR);the patient had N-and K-RAS gene mutations.The pelvic MRI results at 4 weeks after surgery revealed the postoperative rectovaginal fistula before pre-adjuvant chemotherapy.The chemotherapy was postponed,and the disease continued to progress 5 months after surgery,and the palliative first-line and second-line chemotherapy were perfermed under compulsion.However,the disease continued to progress,and the third-line chemotherapy of bevalizumab combined with FOLFIRI regimen was performed and did not aggravate the rectovaginal fistula,and promoted the fistula healing,while significantly improved the quality of life of the patient.Conclusion:Bevacizumab combined with chemotherapy is a feasible treatment option for the rectal cancer patients with rectovaginal fistula caused by the tumor progression and will not benefit from the cetuximab therapy.