Song Erin J, Jacobs Corbin D, Palta Manisha, Willett Christopher G, Wu Yuan, Czito Brian G
Duke School of Medicine, Durham, NC, USA.
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, USA.
J Gastrointest Oncol. 2020 Apr;11(2):242-249. doi: 10.21037/jgo.2018.11.02.
Colorectal cancer is the third most common cancer in the United States and associated with significant morbidity and mortality. Within colorectal cancer histologies, squamous cell carcinomas (SCC) are rare compared to adenocarcinomas, with only about 200 cases reported to date. Because rectal SCC is rarely encountered, there is a lack of literature and clinical consensus surrounding its optimal treatment approach. Staging and management of SCC can be partly analogous to both rectal adenocarcinoma and anal canal SCC, which leads to a dilemma in how to best approach these patients. As large randomized prospective trials are unrealistic in the setting of this rare malignancy, this study evaluates an institutional experience and reviews the existing literature to help guide future management approaches.
This retrospective study compared various treatment regimens for rectal SCC patients treated at Duke University Medical Center from January 1, 1980 through December 31, 2016. Patients ≥18 years old with histologically confirmed, nonmetastatic rectal SCC were included. Due to small sample size, all statistical analyses were descriptive. For our systematic review, a comprehensive search of PubMed from 1933 to March 2018 was performed, with selected articles referenced to ensure all relevant publications were included. A qualitative analysis was performed to examine patient diagnoses, treatments, and disease- and treatment-related outcomes.
Eight patients were included. Three patients underwent initial, curative attempt surgery and two of these patients required colostomy. With follow-up ranging from 7.1 to 31.5 months, one patient was alive with no evidence of disease while two developed local/regional recurrences. Five patients received definitive chemoradiation. Of these, three patients developed local/regional and/or metastatic recurrence. Two patients achieved complete response on imaging and currently remain disease-free (follow-up of 31.5 and 33.6 months).
Although the review of our institutional experience is limited by small numbers, our analysis suggests that definitive chemoradiation therapy is the preferred treatment approach to rectal SCC based on improved disease-related outcomes, sphincter preservation and morbidity profiles. This conclusion is supported by a systematic literature review.
结直肠癌是美国第三大常见癌症，与显著的发病率和死亡率相关。在结直肠癌组织学类型中，与腺癌相比，鳞状细胞癌（SCC）较为罕见，迄今为止报道的病例仅有约200例。由于直肠SCC很少见，围绕其最佳治疗方法缺乏文献资料和临床共识。SCC的分期和管理在一定程度上与直肠腺癌和肛管SCC相似，这导致在如何最佳治疗这些患者方面陷入两难境地。鉴于在这种罕见恶性肿瘤情况下进行大型随机前瞻性试验不现实，本研究评估了一项机构经验并回顾现有文献，以帮助指导未来的管理方法。
这项回顾性研究比较了1980年1月1日至2016年12月31日在杜克大学医学中心接受治疗的直肠SCC患者的各种治疗方案。纳入年龄≥18岁、组织学确诊的非转移性直肠SCC患者。由于样本量小，所有统计分析均为描述性分析。对于我们的系统评价，对1933年至2018年3月的PubMed进行了全面检索，并参考所选文章以确保纳入所有相关出版物。进行定性分析以检查患者的诊断、治疗以及与疾病和治疗相关的结果。
共纳入8例患者。3例患者接受了初次根治性手术尝试，其中2例患者需要结肠造口术。随访时间为7.1至31.5个月，1例患者存活且无疾病证据，2例出现局部/区域复发。5例患者接受了确定性放化疗。其中，3例患者出现局部/区域和/或远处复发。2例患者影像学检查达到完全缓解，目前仍无疾病（随访时间分别为31.5和33.6个月）。
尽管对我们机构经验的回顾因数量有限而受到限制，但我们的分析表明，基于改善的疾病相关结果、括约肌保留和发病率情况，确定性放化疗是直肠SCC的首选治疗方法。这一结论得到了系统文献综述的支持。
