Locoregional and multiple distant metastases after chemoradiation therapy following endoscopic resection for rectal cancer with deep submucosal invasion

A 61-year-old man underwent endoscopic mucosal resection for a 12-mm flat neoplasm in the lower rectum at another hospital. Histopathology of the resected specimen indicated well- to moderately differentiated adenocarcinoma with deep submucosal invasion and lymphatic and venous involvement. Although the tumor was completely removed by endoscopic resection, the possibility of lymph node metastasis could not be ignored. Therefore, additional surgery with lymph node dissection was recommended, but the patient refused and visited our hospital. He instead underwent chemoradiotherapy as an alternative therapy(i.v. drip infusion of 5-fluorouracil [250mg/m2 per day] for 5 daysx5 weeks+1.8Gy/day of irradiation for 5 daysx5 weeks). However, lung and locoregional metastases were detected approximately 2 years after completion of chemoradiotherapy. He is now undergoing systemic combination chemotherapy with capecitabine, oxaliplatin, and bevacizumab once a month.