A case report of advanced mucinous adenocarcinoma of the transverse colon with peritoneal dissemination effectively treated by multidisciplinary approach with a focus on FOLFOX4 therapy combined with panitumumab

: A 63-year-old woman with chief complaints of abdominal distention and vomiting was brought to our hospital in May, 2010. Her radiological examination revealed that she was suffering from perforative peritonitis. The patient underwent emergency open laparotomy. Perioperatively, we made a diagnosis of unresectable transverse colon cancer accompanied with tough peritoneal dissemination, and therefore performed intraperitoneal irrigation drainage, transverse loop colostomy and biopsy of omental dissemination. A pathological examination of omental dissemination demonstrated mucinous adenocarcinoma with the wild-type Kras gene, and the cytology of ascites was negative. FOLFOX4 combined with panitumumab therapy was initiated 1 month after the operation. Seventeen courses of this chemotherapy regimen were performed, although adverse events including grade 3 neutropenia and grade 2 skin symptoms were noted. Consequently, serum CEA levels decreased to 5. 5 ng/mL, although the size of the primary lesion of transverse colon cancer was unchanged on abdominal computed tomography(CT). Chemotherapy has been continued without marked side effects, although 1 year has passed since we started medical treatment for this difficult case. We found that a multidisciplinary approach with a focus on FOLFOX4 therapy combined with panitumumab is useful for patients with highly advanced mucinous adenocarcinoma of the colon that develops into peritoneal dissemination.