Curative surgery enabled by radiotherapy in rectal cancer: A case report.

Abstract

Neoadjuvant chemo-radiotherapy is the standard of care for patients with locally advanced rectal cancer. However, certain patients are ineligible for chemotherapy due to clinical contraindications such as active infections. Although neoadjuvant therapy remains the preferred approach, guidelines are limited for patients who cannot receive combined treatment. The present report describes a case in which radiotherapy alone, initiated with palliative intent, enabled complete surgical resection. A 46-year-old male patient presented with fever and proctalgia. Imaging revealed a large rectal mass associated with an ischiorectal abscess. Biopsy confirmed T4bN1 rectal adenocarcinoma. Chemotherapy was contraindicated due to ongoing infection; therefore, a diverting colostomy was performed. Short-course radiotherapy led to marked tumor regression. Subsequent pelvic exenteration achieved complete tumor removal. Postoperative wound dehiscence was managed successfully with vacuum-assisted closure therapy. No recurrence was observed on follow-up. The current case illustrates that radiotherapy alone may serve as a bridge to curative surgery in patients unfit for chemo-radiotherapy. The use of 3D reconstruction markedly improved preoperative planning and facilitated precise surgical resection. Additionally, perineal closure with Vicryl mesh and omental interposition minimized postoperative complications. In conclusion, in selected patients with contraindications to total neoadjuvant therapy, radiotherapy alone may be a feasible alternative to enable radical resection. Advanced surgical planning with 3D modeling can enhance outcomes in complex pelvic surgery.