Capecitabine-Induced Ileitis during Neoadjuvant Pelvic Radio-Chemotherapy for Locally Advanced Rectal Cancer: A Case Report with Literature Review

Author:

Brignoli Andrea12ORCID,Ferrara Eleonora1,Zannetti Micol1ORCID,Loi Gianfranco3,Forti Laura4,Socci Carlo5,Carriero Alessandro26,Gennari Alessandra24,Krengli Marco78,Franco Pierfrancesco12ORCID

Affiliation:

1. Division of Radiation Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy

2. Department of Translational Medicine, University of the Eastern Piedmont, 28100 Novara, Italy

3. Department of Medical Physics, University Hospital “Maggiore della Carità”, 28100 Novara, Italy

4. Division of Medical Oncology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy

5. Division of Surgery, Hospital ‘S.S. Trinita’, 28021 Borgomanero, Italy

6. Division of Radiology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy

7. Radiation Oncology, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy

8. Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padua, Italy

Abstract

We report on a clinical case of capecitabine-induced acute ileitis in a patient treated with pre-operative concurrent chemoradiation with capecitabine for locally advanced rectal cancer and provide a comprehensive literature review. This a rare, but life-threatening, clinical situation, that clinicians should be aware of. Severe persistent diarrhea is the most frequent clinical feature and computed tomography is a valid tool for diagnosis. Conservative management includes capecitabine withdrawal, antidiarrheal therapy and endovenous hydration, together with dietary modifications and broad-spectrum antibiotics. Pelvic irradiation represents an adjunctive risk factor, which may increase the likelihood of occurrence of terminal ileitis. Early recognition and prompt intervention are crucial for successful clinical management.

Publisher

MDPI AG

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