Intra-arterial chemoembolization with chemotherapy for unresectable locally advanced rectal cancer: a case report and literature review

Preoperative intra-arterial chemoembolization has been successfully applied in many malignant tumors but is rarely reported in patients with locally advanced rectal cancer (LARC). Herein we report a 69-year-old female diagnosed as rectal adenocarcinoma by endoscopic biopsy and the clinical stage was cT4aN2M0, IIIB. After computed tomography (CT) and magnetic resonance imaging (MRI) examinations, the neoplasm was considered unresectable. Then neoadjuvant chemoradiotherapy was recommended to the patient after multidisciplinary treatment. Due to the financial situation and physical condition, the patient only chose chemotherapy for preoperative treatment. During the first time of the mFOLFOX6 regimen, the patient had severe side effects of vomiting, despite tropisetron being routinely given. Then we recommended regional intra-arterial chemoembolization combined with CAPEOX regimen for conversion treatment. After intra-arterial chemoembolization with oxaliplatin and 3 months of chemotherapy with CAPEOX regimen, CT and MRI were performed again to re-evaluate the local condition. Images showed distinct remission in the tumor area, and its surrounding lymph nodes were reduced in number and volume. Also, the tumor had shrunk distinctly with a negative circumferential resection margin (CRM). We concluded that the tumor was converted into a resectable one, and the patient met the conditions for the operation. The fact indicates that it is effective in creating good operative conditions for LARC by adding intra-arterial chemotherapy to the standard treatment.