| Abstract: |
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. © 2007 The American Society of Colon and Rectal Surgeons. |
| Keywords: |
immunohistochemistry; adult; cancer chemotherapy; clinical article; controlled study; human tissue; protein expression; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; squamous cell carcinoma; carcinoma, squamous cell; cisplatin; fluorouracil; united states; cancer patient; cancer radiotherapy; comparative study; radiotherapy, adjuvant; chemotherapy; follow up; methodology; follow-up studies; neoplasm staging; prospective study; prospective studies; multiple cycle treatment; antimetabolites, antineoplastic; radiotherapy; tumor markers, biological; continuous infusion; pathology; data base; feasibility study; experience; clinical evaluation; immunophenotyping; keratins; mitomycin; rectum carcinoma; rectal neoplasms; colectomy; anus sphincter; squamous-cell carcinoma; keratin; human papillomavirus; institutional care; anus carcinoma; rectal neoplasm; anus
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