Erschienen in:
01.09.2007
Squamous-Cell Carcinoma of the Rectum: A Rare but Curable Tumor
verfasst von:
Caio S. R. Nahas, M.D., Jinru Shia, M.D., Romane Joseph, M.D., Deborah Schrag, M.D., Bruce D. Minsky, M.D., Martin R. Weiser, M.D., Jose G. Guillem, M.D., Phillip B. Paty, M.D., David S. Klimstra, M.D., Laura H. Tang, M.D., W. Douglas Wong, M.D., Larissa K. Temple, M.D.
Erschienen in:
Diseases of the Colon & Rectum
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Ausgabe 9/2007
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Purpose
This study was designed to evaluate one institution’s experience with treatment outcomes for rectal squamous-cell carcinoma.
Methods
Using our prospective Colorectal Database, we identified patients diagnosed with rectal squamous-cell carcinoma at our institution between 1983 and 2005. Pathology was rereviewed, tumor immunophenotype was compared to control cases of anal squamous-cell carcinoma and rectal adenocarcinoma, treatment modalities and outcomes were analyzed.
Results
Twelve patients were identified (10 females median age, 58 years). Median distal extent of tumors was 7 (range, 5–8) cm from the anal verge. Treatment included chemotherapy only (n = 1), chemoradiation only (n = 2), induction chemotherapy followed by chemoradiation and surgery (n = 2), chemoradiation followed by surgery (n = 5), and surgery followed by chemoradiation (n = 2). The chemotherapy regimen was 5-fluorouracil-based. Radiotherapy total dose was 50.4 Gy (1.8 Gy/day, daily × 5) external iliac and inguinal nodes were not included in the radiation field. Complete clinical responders to chemoradiation (n = 2) received no further treatment. All seven partial responders underwent surgery; six had complete pathologic response; nodal status in two of six was unknown because they had local excision. Immunophenotypical analysis showed similar keratin expression profile between rectal squamous-cell carcinoma (n = 5) and rectal adenocarcinoma (n = 5), which is different from anal squamous-cell carcinoma (n = 10). All patients were alive without evidence of disease at follow-up (median follow-up, 2.6 (range, 0.5–16) years).
Conclusions
Our data suggest that most patients treated with upfront chemoradiation therapy followed by surgery did well. Sphincter-preserving surgery is usually feasible. Clinical judgment of tumor response after chemoradiation is not completely reliable. Immunohistochemistry suggests a common cellular origin for rectal squamous-cell carcinoma and rectal adenocarcinoma, which is different from anal squamous-cell carcinoma.