Prolonged Remission After Radiotherapy in a Patient with BRAF V600E Mutated Colon Cancer with Latero-Aortic Lymph Node Involvement
Canova Charles-Henry*, Troussier Idriss, Guillaume Klausner
Centre Haute Energie (Radiation Therapy Nice), High Energy Center, Clinic Saint George Hall 2-Consultations, France
*Corresponding author: Canova Charles-Henry, Centre Haute Energie (Radiation Therapy Nice), High Energy Center, Clinic Saint George Hall 2-Consultations, France
Received Date: 06 December 2022
Accepted Date: 10 December 2022
Published Date: 13 December 2022
Citation: Canova CH, Troussier I, Klausner G (2022) Prolonged Remission After Radiotherapy in a Patient with BRAF V600E Mutated Colon Cancer with Latero-Aortic Lymph Node Involvement. Ann Case Report. 7: 1082. https://doi.org/10.29011/2574-7754.101082
Introduction
Colorectal cancer is the second Leading cause of cancer mortality in Europe [1].
Among patients with locally advanced disease, 20 to 30% will develop metastatic disease [2]. Management has expanded over time since the advent of immunotherapy for patients with microsatellite instability [3] and some targeted therapies such as anti-BRAF molecules combined with anti-EGFR in case of BRAF V600E mutation [4].
There are few data in the literature on para-aortic oligometastatic lymph node involvement and the prevalence of this isolated involvement is estimated at 1.7% [5].
Case report
51 years old patient with no notable medical history. The patient underwent surgery on 19/01/2018 for a poorly differentiated right colonic adenocarcinoma, MSS, RAS unmutated but with a BRAF V600E mutation, with an initial stage of T4 N2, with a postoperative CT scan that found coelio mesenteric lymphadenopathy of 35 X 25 mm.
Chemotherapy with FOLFOX-Bevacizumab was started, followed by LV5 FU2 maintenance with Bevacizumab from February to October 2018.
Despite a good initial response, progression was noted on PET-CT of november 2018 at the inter-aortic-caval lymph node level (Figure 1).
Figure 1: PET-CT after FOLFOX chemotherapy (November 2018).
A treatment with FOLFIRI bevacizumab was proposed in second line.
A stability of lymphadenopathy was noted on the dosimetric scanner.
Bevacizumab treatment was interrupted 6 weeks before the beginning of the irradiation in order not to increase the risk of bowel toxicity.
Para-aortic radio-chemotherapy was performed with capecitabine at a dose of 45 Gy in 25 fractionations of 1.8 Gy and a simultaneous integrated boost at a dose of 54 Gy was delivered in 25 fractionations of 2.16 Gy (Figure 2).
This irradiation was performed with a VMAT technique on a VERSA HD using 6 MV energy beams.