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Management Strategies for Squamous Cell Carcinoma of the Rectum: Is There a Role for Surgery?
Paolo Goffredo
Surgery, University of Iowa, Iowa City, IA
Introduction: Squamous cell carcinoma of the rectum (RSCC) is a rare malignancy that accounts for approximately 0.01–0.025% of all colorectal cancers. As a result, published data regarding its management are mainly limited to small single institutional series. Our aim was to analyze the disease-specific survival (DSS) according to different treatment modalities for AJCC stage I, II, and III RSCCs in order to determine the optimal management strategy.
Methods: We identified 1038 patients with stage I, II, and III RSCCs from the Surveillance, Epidemiology, and End Results (SEER) database treated between 1998 and 2013. Management strategies were categorized as radiation or local excision alone, radiation with local excision, and radiation with radical resection. These modalities accounted for ~85% of patients in the cohort. Stratified survival analyses were adjusted by gender, age, and race. Data were examined using simple summary statistics, chi-square and student’s-T tests, Kaplan-Meier analysis, and Cox proportional hazards regression.
Results: The majority of patients were white (85%) and female (65%). Mean age at diagnosis was 62±14 years. The 5-year DSS was 80% for stage I (530 pts), 61% for stage II (262 pts), and 61% for stage III (246 pts, p<0.001). In univariate analysis for patients with stage I and II disease, no difference was observed in the 5-year DSS among management strategies (p=0.94 and 0.29, respectively). However, for stage III disease, the combination of radiation and radical resection was associated with worse outcomes compared to radiation ± local excision (p=0.017) (Table 1). After adjustment for available demographic confounders, the addition of local excision or radical resection to radiation was not associated with improved survival across all stages.
Conclusions: Our data suggest that for stage I disease either radiation or local excision only may represent an adequate oncologic treatment. The addition of local excision or radical surgery to radiation for stage II and III disease was not associated with a survival benefit. Therefore, a treatment approach primarily based on radiation should be considered the optimal management strategy for squamous cell carcinomas of the rectum.
TABLE:
Five year disease-specific survival by AJCC stage and Management Strategy
| Management Strategy | 5 year disease-specific survival by AJCC stage, % | | I (n = 441) | II (n = 217) | III (n = 221) | | Local excision | 81 (n=65) | n/a | n/a | | Radiation | 83 (n=255) | 64 (n=142) | 65 (n=153) | | Radiation with local excision | 84 (n=121) | 75 (n=21) | 86 (n=18) | | Radiation with radical resection | n/a | 58 (54) | 48 (n=50) | | p-value | 0.940 | 0.290 | 0.017 |
Percentages have been rounded and they might not sum up to 100
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