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Squamous-Cell Carcinoma of the Rectum: A Rare but Curable Tumor

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Diseases of the Colon & Rectum

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.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Caio S. R. Nahas M.D., Romane Joseph M.D., Martin R. Weiser M.D., Jose G. Guillem M.D., Phillip B. Paty M.D., W. Douglas Wong M.D. & Larissa K. Temple M.D.

  2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Jinru Shia M.D., David S. Klimstra M.D. & Laura H. Tang M.D.

  3. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Deborah Schrag M.D.

  4. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Deborah Schrag M.D.

  5. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Bruce D. Minsky M.D.

Authors
  1. Caio S. R. Nahas M.D.
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  2. Jinru Shia M.D.
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  3. Romane Joseph M.D.
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  4. Deborah Schrag M.D.
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  5. Bruce D. Minsky M.D.
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  6. Martin R. Weiser M.D.
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  7. Jose G. Guillem M.D.
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  8. Phillip B. Paty M.D.
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  9. David S. Klimstra M.D.
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  10. Laura H. Tang M.D.
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  11. W. Douglas Wong M.D.
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  12. Larissa K. Temple M.D.
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Corresponding author

Correspondence to Larissa K. Temple M.D..

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Nahas, C.S.R., Shia, J., Joseph, R. et al. Squamous-Cell Carcinoma of the Rectum: A Rare but Curable Tumor. Dis Colon Rectum 50, 1393–1400 (2007). https://doi.org/10.1007/s10350-007-0256-z

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  • DOI: https://doi.org/10.1007/s10350-007-0256-z

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