Metastatic urachal adenocarcinoma successfully treated with surgery and chemotherapy

Abstract

Urachal cancers are rare bladder cancers and almost always adenocarcinomas. Surgical resection is the only standard treatment, and no effective chemotherapeutic regimen has been established. We herein report a case of urachal cancer that recurred 2 years after tumor resection and partial cystectomy. The patient was successfully treated with surgery and modified FOLFOX6 (mFOLFOX6) chemotherapy. A 60-year-old female patient diagnosed with urachal cancer underwent tumor resection and partial cystectomy at another hospital. The initial clinical and pathological stage was unclear. Two years later, an intrapelvic mass that had invaded the uterus and right ovary and multiple lung metastases were detected on follow-up computed tomography. The intrapelvic tumor, entire uterus, vault of the vagina, and right ovary were completely excised at another different hospital. The patient was referred to our department for further management of multiple lung metastases. A combined chemotherapeutic regimen with mFOLFOX6 (85 mg/m² oxaliplatin and 200 mg/m² leucovorin administered as 2-h infusions on day 1, followed by a 400 mg/m² 5-fluorouracil bolus and 46-h infusion of 2400 mg/m² over days 1 and 2) was administered every 2 weeks as one cycle. After six cycles of treatment, CT revealed that the lung metastases had completely disappeared. In total, the patient underwent 19 cycles of the regimen. At the time of this report, the patient has been free from recurrence for 34 months. The successful treatment observed in the present case sheds light on a possible curative treatment for this disease using a multimodal treatment strategy, particularly surgical excision of intrapelvic tumors and the administration of mFOLFOX for distant metastases.