Lack of diagnostic potential of Dickkopf-1 in colon and rectum cancers

The Wnt/b-catenin signalling pathway plays crucial roles in development and its aberrant activation is an initial and crucial event in the majority of colon cancers. The Dickkopf-1 (Dkk-1) gene encodes an extracellular Wnt inhibitor that blocks the formation of signalling receptor complexes at the plasma membrane. Here, we report the serum levels of Dkk1 in colorectal cancer patients without any therapy. The levels were determined by enzyme-linked immunosorbent assay (ELISA) in 135 colon and 160 rectum cancer patients, as well as 90 healthy subjects. Data analyses were performed using SPSS software (SPSS 16, Chicago, IL). There were no significant differences among the groups for Dkk-1 (p=0.363). In conclusion, the present study did not confirm that serum Dkk-1 levels could have any diagnostic potential in colon and rectum cancers.

Chemoradiation-induced changes in serum CEA and plasma TIMP-1 in patients with locally advanced rectal cancer

BACKGROUND

Preoperative biomarkers serum CEA and plasma TIMP-1 have been shown to have prognostic and predictive value in patients with colorectal cancer. The aim of the present study was to evaluate the possible impact of chemoradiotherapy (CRT) on preoperative biomarker levels in patients with rectal cancer.

PATIENTS AND METHODS

Thirty-three patients with rectal cancer were prospectively included. The patients received CRT for 6-8 weeks. Blood samples were collected before CRT (pre-CRT) and preoperatively (post-CRT).

RESULTS

Median CEA was 3.5 (range 0.6-36.1) μg/l and 2.4 (range 0.0-10.2) μg/l (p=0.002) and median plasma TIMP-1 was 132.1 (range 77.8-342.7) μg/l and 140.0 (range 82.6-440.9) μg/l (p=0.04) in the pre- and post-CRT measurements, respectively.

CONCLUSION

CRT induced a significant decrease in serum CEA and increase in plasma TIMP-1 levels. Therefore, the preoperative biomarker levels may be affected by treatments received before blood sample collection. Translation of results of preoperative biomarkers needs to take such facts into consideration.

[Evaluation of bevacizumab combined with irinotecan-based regimen as the first-line treatment for patients with metastatic colorectal cancer]

OBJECTIVE

To assess the efficacy and safety of bevacizumab plus irinotecan-based regimen for the first line treatment in metastatic colorectal cancer (mCRC) patients, and to investigate the correlation between serum tumor markers including CEA and CA19-9 and response as well as prognosis.

METHODS

From May 2007 to July 2008, 67 previously untreated mCRC patients received treatment of IFL (n = 25), IFL plus Bevacizumab (n = 20) or FOLFIRI (n = 22). The treatment continued until disease progression or unacceptable toxicity. The data were retrospectively analyzed.

RESULTS

All patients were evaluable for response, survival and toxicity analysis. The objective response rate of IFL, IFL plus Bevacizumab or FOLFIRI regimen groups was 16.0% (4/25), 35.0% (7/20) and 18.2% (4/22), respectively (χ(2) = 6.026, P = 0.049). The median progression-free survival (PFS) of IFL plus bevacizumab group was 7.5 months, significantly improved as compared with 3.7 months in the IFL group and 4 months in FOLFIRI group (χ(2) = 11.97, P = 0.003). Of all 67 cases, the one-year survival rate was 47.0%, two-year survival rate was 27.0%, and the median overall survival (OS) was 13.0 months, with no significant difference among the three treatment groups (χ(2) = 3.42, P = 0.18). The serum CEA and CA19-9 levels were decreased after treatment, but with no significant difference among the three groups (P > 0.05). The common toxicity profiles of IFL and FOLFIRI regimens were diarrhea and neutropenia, while the toxicity related to bevacizumab was consistent with that documented in previous literature, such as hypertension, hemorrhage, cardiac toxicity and delayed wound healing.

CONCLUSION

The addition of bevacizumab to irinotecan-based regimen significantly improves the response rate and PFS in first-line treatment for patients with mCRC and its toxicity is well tolerated.

Circulating C-reactive protein concentrations and risks of colon and rectal cancer: a nested case-control study within the European Prospective Investigation into Cancer and Nutrition

The authors investigated associations between serum C-reactive protein (CRP) concentrations and colon and rectal cancer risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (1992-2003) among 1,096 incident cases and 1,096 controls selected using risk-set sampling and matched on study center, age, sex, time of blood collection, fasting status, menopausal status, menstrual cycle phase, and hormone replacement therapy. In conditional logistic regression with adjustment for education, smoking, nutritional factors, body mass index, and waist circumference, CRP showed a significant nonlinear association with colon cancer risk but not rectal cancer risk. Multivariable-adjusted relative risks for CRP concentrations of > or = 3.0 mg/L versus <1.0 mg/L were 1.36 (95% confidence interval (CI): 1.00, 1.85; P-trend = 0.01) for colon cancer and 1.02 (95% CI: 0.67, 1.57; P-trend = 0.65) for rectal cancer. Colon cancer risk was significantly increased in men (relative risk = 1.74, 95% CI: 1.11, 2.73; P-trend = 0.01) but not in women (relative risk = 1.06, 95% CI: 0.67, 1.68; P-trend = 0.13). Additional adjustment for C-peptide, glycated hemoglobin, and high density lipoprotein cholesterol did not attenuate these results. These data provide evidence that elevated CRP concentrations are related to a higher risk of colon cancer but not rectal cancer, predominantly among men and independently of obesity, insulin resistance, and dyslipidemia.

[Prognostic analysis of 77 cases of rectal cancer with synchronous liver metastases]

OBJECTIVE

To explore the prognostic factors for rectal cancer patients with synchronous liver metastases.

METHODS

Data from a total of 77 cases of rectal cancer with synchronous liver metastases treated in our center from January 2002 to December 2008 were collected and reviewed. The total survival rate was analyzed by Kaplan-Meier method. Log-rank test and Cox regression model with SPSS 17.0 software were used to analyze 13 factors including clinicopathological factors and treatment choices.

RESULTS

The median survival time of the 77 cases was 12 months. The 1-, 2-, 3- and 5-year survival rates were 47.7%, 28.0%, 13.1%, and 1.5%, respectively. Univariate analysis with Kaplan-Meier method revealed that the differentiation of the primary tumor, T-stage, N status, the distribution, number and size of liver metastases, extrahepatic disease, serum CEA level at diagnosis and treatment modality were prognostic factors (P < 0.05). Multivariate analysis showed that the differentiation of the primary tumor (P = 0.007), T-stage (P = 0.027), the size of liver metastases (P = 0.003), serum CEA value at diagnosis (P = 0.000) were independent prognostic factors for rectal cancer patients with synchronous liver metastases.

CONCLUSION

The factors affecting the prognosis for rectal cancer patients with synchronous liver metastases are the differentiation of the primary tumor, T-stage, N status, the distribution, number and size of liver metastases, extrahepatic disease, serum CEA level at diagnosis and treatment modality. The differentiation of the primary tumor, T-stage, the size of liver metastases, and serum CEA value at diagnosis are independent prognostic factors.

Plasma soluble VEGFR-1 is a potential dual biomarker of response and toxicity for bevacizumab with chemoradiation in locally advanced rectal cancer

We explored plasma and urinary concentrations of two members of the vascular endothelial growth factor (VEGF) family and their receptors as potential response and toxicity biomarkers of bevacizumab with neoadjuvant chemoradiation in patients with localized rectal cancer. The concentrations of VEGF, placental growth factor (PlGF), soluble VEGF receptor 1 (sVEGFR-1), and sVEGFR-2 were measured in plasma and urine at baseline and during treatment. Pretreatment values and changes over time were analyzed as potential biomarkers of pathological response to treatment as well as for acute toxicity in patients with locally advanced rectal cancer treated prospectively in 2002-2008 with neoadjuvant bevacizumab, 5-fluorouracil, radiation therapy, and surgery in a phase I/II trial. Of all biomarkers, pretreatment plasma sVEGFR-1-an endogenous blocker of VEGF and PlGF, and a factor linked with "vascular normalization"-was associated with both primary tumor regression and the development of adverse events after neoadjuvant bevacizumab and chemoradiation. Based on the findings in this exploratory study, we propose that plasma sVEGFR-1 should be further studied as a potential biomarker to stratify patients in future studies of bevacizumab and/or cytotoxics in the neoadjuvant setting.

Effects of preoperative immunochemoradiotherapy and chemoradiotherapy on immune responses in patients with rectal adenocarcinoma

BACKGROUND

We previously reported that preoperative chemoradiotherapy (CRT) combined with intraoperative electron irradiation for cT3/T4 adenocarcinoma of the rectum reduced the local recurrence, with significant improvement of survival. Radiotherapy has been reported to reduce immune function. We examined the effects of PSK, a protein-bound polysaccharide, concomitant with preoperative CRT on immune responses.

PATIENTS AND METHODS

Thirty patients with cT3/T4 adenocarcinoma of the rectum were randomly assigned to 2 weeks' irradiation and 4 weeks' S-1 administration before surgery (control group), or the same CRT with simultaneous 4 weeks' PSK administration (PSK group). Both systemic and local immune responses were evaluated.

RESULTS

Significant increase of natural killer cell count in the peripheral blood and cytotoxic T-cell counts in the peri-tumoral and normal mucosa, and a significant decrease of serum immunosuppressive acidic protein level were observed in the PSK group.

CONCLUSION

Combined use of PSK with preoperative CRT may improve immune function.

[Effect of laparoscopic-assisted resection of rectal carcinoma on C-reactive protein and humoral immunity]

OBJECTIVE

To investigate the effect of laparoscopic-assisted resection of rectal carcinoma on perioperative levels of C-reactive protein (CRP), immunoglobulins(Ig) and complements.

METHODS

Fifty-four patients with rectal carcinoma were divided into laparoscopic group (n=26) and open operation group(n=28) according to the patients' will. C-reactive protein (CRP), IgG, IgA, IgM, C(3), C(4) and CH(50) of peripheral blood were assayed preoperatively and on the 1st, 2nd, 3rd and 7th day postoperatively.

RESULTS

Compared with the preoperative period, the CRP levels in both groups were significantly increased on the 1st, 2nd, and 3rd day(P<0.01) and peaked on the 2nd day postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than those in the open operation group(P<0.01). After operation, the immunoglobulin levels were significantly decreased in both groups(P<0.01), and there were no significant differences in IgG and IgM. The levels of C(3), C(4) and CH(50) were significantly decreased after operation in both groups(P<0.05) and returned to the preoperative levels during postoperative 48-72 hours in laparoscopic group.

CONCLUSION

Laparoscopic-assisted resection of rectal carcinoma results in less wound, lower levels of stress response, and less effect on immune function compared to open surgery, which recovers the immune function of patients more rapidly after operation.

[A case report of complete response to RPMI regimen for multiple lymph node metastases following rectal cancer surgery]

A 78-year old man underwent low anterior resection for Stage IIIb rectal cancer(Ra). After surgery, he underwent the Roswell Park Memorial Institute(RPMI)regimen for 6 months followed by oral UFT for 8 months. Since liver metastasis(S6)recurred 2 years and 2 months after surgery, he underwent S6 subsegmentectomy. Four years and 4 months later, he developed multiple lymph node metastases(the Virchow, paraaortic, and intrapelvic lymph nodes), for which FOLFIRI therapy was started, but converted to the RPMI regimen because of strong gastrointestinal side effects. After 3 courses of this regimen, tumor markers returned to normal, and imaging studies showed that the metastases had disappeared. This was interpreted as a complete response(CR). The patient has maintained the complete response for 1 year and 4 months since the start of the RPMI regimen.

[Concurrent chemoradiation experience of the local relapse of rectal cancer patients]

We have reported the concurrent chemoradiation experience of local relapse of rectal cancer patients. From October 2004 to January 2007 we have treated consecutive 10 patients with radiation and the concurrent chemotherapy by CPT-11+S-1. Of 10 lesions, 5(50%)had a complete response, 2(20%)a partial response, 3(30%)a stable disease, yielding an overall response rate of 70%. Three year survival and relapse free survival was 64% and 22 months, respectively. Four patients live without cancers, 3 patients died with cancers and 2 patients live with cancers. Three patients had acute complication(more than Grade 2)including 3 appetite losses. The concurrent chemoradiation is feasible for out-patients and seems to offer good results for the local relapse of rectal cancer patients.

[A case of simultaneous double cancers with multiple liver metastases responding to S-1+CPT-11]

The patient was a 70-year-old male with advanced cancers of stomach and rectum and multiple metastatic hepatic tumors. No resectability was detected. The origin of metastatic hepatic tumors was unknown, so the combination of S- / 1 and CPT-11 as a treatment regimen was selected. S-1, 80 mg m(2), was administered on 14 consecutive days followed / by a 14-day rest period, and CPT-11, 100 mg/m(2), was administered on day 1 and day 15. One cycle was defined as 4 weeks, and cycles were repeated. CR was achieved as long as metastatic hepatic tumors after completion of 5 cycles. When we encounter a case of simultaneous double cancers with metastatic sites which has no respectability, generally speaking, it is difficult to determine the strategy for chemotherapy. This case suggests that the combination of S-1 and CPT-11 may be an effective regimen for the treatment of simultaneous advanced cancers of stomach and rectum with multiple hepatic metastases.

[Pharmacokinetic monitoring of 5-fluorouracil may improve the clinical benefit with an individualized regimen-a case report]

Serum levels of 5-fluorouracil(5-FU)were measured in a patient receiving pharmacokinetic modulation chemotherapy( PMC), with 5-FU, as well as a combination of oxaliplatin and infusional 5-FU plus leucovorin(FOLFOX). A 77- year-old man presented with unresectable multiple hepatic metastases after abdominoperineal resection of rectal / carcinoma, and was successfully treated by PMC. The patient initially received infusional 5-FU at 750 mg/m(2) once a week, and showed a partial response. Serum 5-FU levels were higher at night, and the peak concentration of 5-FU was / 398 ng/mL. After 13 months of PMC, second-line chemotherapy with FOLFOX was initiated because new liver metastases had appeared. After 4 cycles of FOLFOX4, progression was observed, and the concentration profile of 5-FU / was measured. The area under the concentration vs. time curve(AUC ngxh/mL)was smaller with FOLFOX4 than with PMC, so the FOLFOX6 regimen was tried instead. The AUC increased and disease progression was suppressed. This case shows that individual adjustment of the dose and regimen based on pharmacokinetic monitoring can increase the clinical benefit of fluorouracil.

[A CR case of colorectal cancer given 39 courses of FOLFOX]

We report a CR case of advanced rectal cancer successfully treated with 39 courses of mFOLFOX6. The patient was a 29-year-old female with Stage IV rectal cancer. At first she was given IFL together with radiotherapy. It took effect for three months, and the therapeutic effect was PR, but interstitial pneumonia developed. Therefore, we shifted to mFOLFOX6, and she was treated with 39 courses. Grade 1 appeared several times for peripheral neuropathy, but recovered immediately. If we could control peripheral neuropathy with FOLFOX, it was thought that long-term survival could / be expected.

[Modified FOLFOX6 treatment for obstructive jaundice caused by hepatic lymph-node metastasis from liver metastases of rectal cancer--a case report]

Chemotherapy is potentially hazardous for patients with liver dysfunction. Although FOLFOX regimen is one of the standard chemotherapies for nonresectable liver metastases of colorectal cancer, the safety of this regimen has not been established yet in patients with obstructive jaundice associated with multiple liver metastases. We report a case of nonresectable liver metastases of rectal cancer treated by modified FOLFOX6 regimen after percutaneous transhepatic biliary drainage for obstructive jaundice, which was caused by hepatic lymph-node metastasis. Five days after giving a birth, a 32-year-old woman underwent Hartmann's procedure for perforation of rectal cancer associated with multiple liver metastases. She was admitted again to receive chemotherapy 35 days after surgery, but the level of total bilirubin was elevated (3.9 mg/dL). Since the total bilirubin level was not rapidly decreased after PTBD, the modified FOLFOX6 regimen was started with a 70% dose. After an introduction of mFOLFOX6 treatment, a biliary-stenting was successfully performed, and the mFOLFOX6 continued with a full dose starting from the 5th cycle. Although the therapeutic efficacy after an additional 8-cycle was classified as stable disease (SD), she did not show any sign of adverse effects except for grade 1 neurotoxicity.

[A case of metastatic lung and liver tumors from rectal cancer treated with oral UFT and CPT-11 by hepatic arterial infusion followed by FOLFOX and FOLFIRI]

The patient was a 62-year-old male who underwent a high anterior resection for rectal cancer with multiple liver metastases in June 2004. After the operation, 66 courses of weekly hepatic arterial infusion(HAI)therapy of 5-FU/Leucovorin( LV)were performed. Thereafter 14 courses of FOLFOX 4, 5 courses of FOLFIRI and 5 courses of FOLFOX 4 therapy were also sequentially performed. As a result of the CT examination, which revealed a new metastatic lesion in the liver and lung metastases, combination chemotherapy consisting of UFT and HAI of low-dose CPT-11 was administered in July 2007. After 1 cycle of this therapy, metastatic liver and lung tumors showed a reduction rate of 8.5% and 27.0%, respectively, without any adverse events. The elevated serum CEA (2,055 ng/mL)and CA19-9 (924 U/mL) levels decreased to 623 ng/mL and 332U /mL, respectively, after 1 cycle of the treatment. The combination of oral UFT and HAI of CPT-11 may therefore be a useful treatment for patients after FOLFOX and FOLFIRI therapy.

[Hepatic artery infusion chemotherapy to three liver metastasis cases in which systemic chemotherapy was impossible or ineffective]

Recently, standard therapies for either gastric cancer or colorectal cancer have been established through the development of multidrug systemic chemotherapy and the appearance of molecular targeting drugs. For example, either FOLFIRI or FOLFOX therapy is normally chosen for the treatment of unresectable liver metastasis from colorectal cancer. On the other hand, hepatic artery infusion (HAI) chemotherapy is generally used as only a second-line therapy. There are, however, some cases in which systemic chemotherapy is not indicated due to age and/or the risk of side effects. We herein report three cases that were treated by HAI after initially performing systemic chemotherapy in order to treat liver metastasis from either gastric cancer or colorectal cancer.

[Epiphora in a patient receiving FOLFOX therapy]

A 75-year-old patient with colorectal cancer was treated by FOLFOX4 therapy. When the total dose of 5-fluorouracil reached 21,200 mg and the total dose of oxaliplatin reached 880 mg after about 100 days of treatment, epiphora developed. Because the pharmacist discovered it soon, he could consult with an ophthalmologist, and the man was diagnosed with subconjunctival hemorrhage. Thereafter, the symptom improved with ofloxacin eye drops. Attention must be paid to the visual side effect in case an anticancer agent is used and when aggressive involvement of the pharmacist in medical team treatment is expected.

[Expression of human pituitary tumor transforming gene 1 in colorectal cancer detected with real-time fluorescent quantitative PCR and its clinical significance]

BACKGROUND & OBJECTIVE

Although human pituitary tumor transforming gene 1 (hPTTG1) is overexpressed in malignant tumors such as colorectal cancer, its correlation to clinicopathologic parameters and its value in diagnosis and prognosis prediction of colorectal cancer are still not clear. We investigated the expression of hPTTG1 in colorectal cancer tissues, and elucidated its correlation to some clinicopathologic parameters of colorectal cancer.

METHODS

The expression of hPTTG1 in 60 specimens of colorectal cancer and corresponding noncancerous tissues were examined with real-time fluorescent quantitative polymerase chain reaction, and its correlation to seven clinicopathologic parameters were analyzed.

RESULTS

The mRNA level of hPTTG1 was significantly higher in colorectal cancer tissues than in corresponding noncancerous tissues (0.42+/-0.07 vs. 0.03+/-0.01, P<0.001), significantly higher in colorectal cancer tissues with serum CEA level of > 5 ng/mL than in those with CEA of < 5 ng/mL (22.79+/-7.42 vs. 9.34+/-2.61, P<0.001), significantly higher in colorectal cancer tissues with diameter of > or = 3.5 cm than in those with diameter of < 3.5 cm (15.80+/-8.80 vs. 10.91+/-5.22, P<0.05), significantly lower in Dukes'A, B tumors than in Dukes' C, D tumors (9.03+/-0.35 and 9.58+/-2.93 vs. 15.88+/-8.09 and 25.69+/-7.67, P<0.001), and significantly higher in colorectal cancer tissues with lymph node metastasis (17.63+/-8.47), liver metastasis (31.07+/-4.10) and other organ metastasis (22.78+/-6.39) than in those without metastasis (11.15+/-6.65) (P<0.001). hPTTG1 expression had no relationship with patients' age, sex and histological type (P>0.05).

CONCLUSIONS

hPTTG1 is overexpressed in colorectal cancer. It is closely related to the progression of colorectal cancer, and may be helpful for prognosis prediction of colorectal cancer.

[A case of long-term disease free survival after three surgical resections for local recurrence and lung metastases from rectal cancer]

Six years ago, a 67-year-old-man underwent Mile's operation for rectal cancer. He complained of lower back pain in 1999, and was diagnosed with local recurrence from rectal cancer. The tumor invaded to the bladder, prostate, internal obturator muscle, and the piriform muscle. We performed a total pelvic resection and systemic chemotherapy with low-dose 5-fluorouracil/cisplatin. Since lung metastases were pointed in 2001, he received chemotherapy consisted of irinotecan and 5'-DFUR for 1 year, and a partial resection for lung metastasis was performed in 2002. After a partial resection for subsequent lung metastasis occurred in 2003, he has survived more than 5 years. A surgical resection is an effective treatment for a localized recurrence from colorectal cancer.

[A case of increased resectability with preoperative chemotherapy FOLFOX4 for unresectable rectal cancer]

The patient was a 57-year-old man. The chief complaints were bleeding upon defecation and decreased body weight. He came to our department in May 2006 because the bleeding had been observed since summer 2005 and he had lost 7 kg in one year. A tumor was palpable on the rectum, approximately 5 cm proximal to the anal verge. Abdominal CT revealed a large tumor within the pelvis and enlarged paraaortic lymph nodes. CEA was 14.0 ng/mL. The patient underwent surgery in June 2006, but the tumor was firmly fixed anterior to the sacrum. We judged it unresectable and performed double-barrel descending colostomy. FOLFOX4 chemotherapy commenced following the surgery, and the tumor marker level normalized following three cycles. Abdominal CT following five cycles showed that the size of the tumor had reduced significantly. Later, the patient developed grade 2 nausea and decreased appetite as adverse events, and the chemotherapy was discontinued at his request. We considered resection possible and performed rectal resection in November 2006. The patient underwent radiotherapy following surgery and is currently receiving S-1. FOLFOX4 may be an effective preoperative chemotherapy for unresectable primary rectal cancer.

Daily low-dose/continuous capecitabine combined with neo-adjuvant irradiation reduces VEGF and PDGF-BB levels in rectal carcinoma patients

Metronomic low-dose chemotherapy regimen was found to have an antiangiogenic effect in tumors. However, its effect on levels of circulating pro-angiogenic and anti-angiogenic factors is not fully explored.

MATERIALS AND METHODS

The levels of both VEGF and PDGF-BB were measured in three time points, in the serum of 32 rectal carcinoma patients receiving daily reduced-dose/continuous capecitabine in combination with preoperative pelvic irradiation.

RESULTS

We found a significant decrease in VEGF and PDGF-BB serum levels during the combination treatment (p < 0.0001), followed by an increase in the successive rest-period (p < 0.0001). In addition, substantial changes in platelets counts were observed during treatment in correlation with the changes of VEGF and PDGF-BB serum levels.

DISCUSSION

These results suggest that combined chemo-irradiation affect levels of pro-angiogenic factors during treatment, and may reflect an anti-angiogenic window induced during this treatment. The potential implications of this inducible phenomenon, including a possible clinical benefit from the administration of long lasting metronomic chemotherapy immediately following combined chemo-irradiation, would warrant further investigation.

[5-FU/LV therapy for a rectal cancer patient undergoing continuous hemodialysis with multiple hepatic metastases--a case report]

Chemotherapy for advanced or recurrent colorectal cancer is standardized as oxaliplatin/5-FU/LV therapy (FOLFOX)and irinotecan/5-FU/LV therapy(FOLFIRI). It is difficult to introduce cancer chemotherapy to hemodialysis patients, and limited chemotherapeutics are available. The case was a 57-year-old man who was undergoing continuous hemodialysis when rectal cancer was found with multiple hepatic metastases. After rectum elevation and anterior resection, we treated him with 5-FU/LV therapy. After three courses the number of hepatic metastatic foci decreased, and the ascites disappeared. Levels of carcinoembryonic antigen(CEA)decreased from 837 ng/mL to 29 ng/mL; carbohydrate antigen 19-9(CA19-9)decreased from 79.6 U/mL to 14.2 U/mL, and cancer-related antigen 72-4 (CA72-4)was reduced from 33.3 U/mL to 7.4 U/mL. Partial remission was achieved following the chemotherapy. We used 5-FU/LV therapy according to the Roswell Park Memorial Institute method. Our patient was able to undergo treatment safely without serious adverse drug response, except that he exhibited diarrhea and hand-foot syndrome of grade 2.

Radiotherapy for rectal cancer is associated with reduced serum testosterone and increased FSH and LH

PURPOSE

It is known that scattered radiation to the testes during pelvic radiotherapy can affect fertility, but there is little knowledge on its effects on male sex hormones. The aim of this study was to determine whether radiotherapy for rectal cancer affects testosterone production.

METHODS AND MATERIALS

All male patients who had received adjuvant radiotherapy for rectal cancer from 1993 to 2003 were identified from the Norwegian Rectal Cancer Registry. Patients treated with surgery alone were randomly selected from the same registry as control subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and sex hormone binding globulin (SHBG) were analyzed, and free testosterone was calculated (N = 290). Information about the radiotherapy treatment was collected from the patient hospital charts.

RESULTS

Serum FSH was 3 times higher in the radiotherapy group than in the control group (median, 18.8 vs. 6.3 IU/L, p <0.001), and serum LH was 1.7 times higher (median, 7.5 vs. 4.5 IU/l, p <0.001). In the radiotherapy group, 27% of patients had testosterone levels below the reference range (8-35 nmol/L), compared with 10% of the nonirradiated patients (p <0.001). Irradiated patients had lower serum testosterone (mean, 11.1 vs. 13.4 nmol/L, p <0.001) and lower calculated free testosterone (mean, 214 vs. 235 pmol/L, p <0.05) than control subjects. Total testosterone, calculated free testosterone, and gonadotropins were related to the distance from the bony pelvic structures to the caudal field edge.

CONCLUSIONS

Increased serum levels of gonadotropins and subnormal serum levels of testosterone indicate that curative radiotherapy for rectal cancer can result in permanent testicular dysfunction.