Purpose: Metastatic rectal cancer (mRC) is a highly lethal and complex disease that demands a multidisciplinary treatment approach. However, the clinical effectiveness of radiotherapy (RT) for de novo mRC remains controversial and uncertain. Methods: This retrospective cohort study examined medical records from Kaohsiung Chang Gung Memorial Hospital for patients with histologically confirmed de novo mRC diagnosed between January 2015 and December 2020. All patients received standard systemic therapy and radical surgery when feasible. The primary outcome, overall survival (OS), was assessed using the Kaplan-Meier method. Multivariable analysis was performed using a Cox regression model. Results: Among 271 patients included in the analysis, 117 received RT and 154 did not. The median OS was significantly longer in the RT group compared with the non-RT group (27.8 months vs. 21.9 months; P=0.046). Multivariate analysis identified several independent predictors of OS: age ≥65 years (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.26–2.27; P=0.001), primary tumor resection (HR, 2.62; 95% CI, 1.90–3.61; P<0.001), M1b or M1c disease (HR, 1.97; 95% CI, 1.44–2.69; P<0.001), and receipt of RT (HR, 1.41; 95% CI, 1.02–1.94; P=0.036). Conclusion RT significantly improves OS in patients with mRC, underscoring its role in treatment strategies. These findings support its inclusion in therapeutic protocols and highlight the need for larger, multicenter trials to confirm and extend these results.

A perforated sigmoid colon cancer within an inguinal hernia is extremely rare. This unexpected finding is usually discovered during surgery and causes an unavoidable septic evolution. Here, we describe the case of an 84-year-old man who presented with fever, abdominal distension, and a painful, enlarged, left scrotum. A CT showed a left, incarcerated, inguinal hernia containing a perforated sigmoid adenocarcinoma (which was confirmed by histopathology). The possibility of an irreducible inguinal hernia in association with perforated sigmoid colon cancer should be considered in the array of diagnoses. A pre-operative CT scan would be helpful in facilitating an accurate diagnosis.
Adenocarcinoma/complications/*radiography/surgery ; Aged, 80 and over ; Colon, Sigmoid/radiography/surgery ; Diagnosis, Differential ; Fatal Outcome ; Fever/etiology ; Hernia, Inguinal/complications/*radiography/surgery ; Humans ; Intestinal Perforation/complications/*radiography/surgery ; Male ; Pain/etiology ; Shock, Septic/complications ; Sigmoid Neoplasms/complications/*radiography/surgery ; Tomography, X-Ray Computed

INTRODUCTIONWe report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).

CLINICAL PICTUREThis 52-year-old man presented with acute loss of consciousness with normal brain computed tomography (CT). He was treated as non-ST-elevation AMI complicated with pulmonary oedema based on findings of chest radiograph (bilateral pulmonary oedema), electrocardiogram (marked ST-T changes in leads V3 to V6), and cardiac enzymes [elevated creatinine kinase (CK) and CK-MB]. However, coronary angiogram and serial cardiac enzymes were inconclusive. Anisocoria developed after admission and a repeat brain CT was evident for large left cerebral infarct.

TREATMENTDecompressive craniectomy was carried out.

OUTCOMEMortality.

CONCLUSIONSThe diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain CT. It can be mistaken for cardiogenic pulmonary oedema secondary to AMI.

Cerebral Infarction ; physiopathology ; Coma ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; Pulmonary Edema ; diagnosis ; physiopathology ; Radiography, Thoracic ; Taiwan