PV QA 1 - Poster Viewing Q&A 1
SU_1_2006 - Clinical Outcomes of Rectal Squamous Cell Carcinomas Treated With Chemoradiotherapy With or Without Surgery: A Rare Cancer Network Study.
Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3
Berardino De Bari
Université de Bourgogne - Franche Comté: Employee: Employee
Clinical Outcomes of Rectal Squamous Cell Carcinomas Treated With Chemoradiotherapy With or Without Surgery: A Rare Cancer Network Study.
B. De Bari1, D. Aloi2, C. Lemanski3, C. L. Hallemeier4, E. Touboul5, S. Qi6, D. Christie7, H. Vees8, K. Shulman9, B. M. Atasoy10, I. Sefik11, O. Micke12, S. Servagi Vernat13, and K. Khanfir14; 1Centre Hospitalier Régional Universitaire "Jean Minjoz", Université de Bourgogne - Franche Comté, Besancon, France, 2Centre Hospitalier Régional Universitaire "Jean Minjoz", Université de Bourgogne - Franche Comté, Besançon, France, 3Institut du Cancer de Montpellier, Montpellier, France, 4Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 5Tenon Hospital (AP-HP), Paris, France, 6State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 7School of Medicine and Public Health, University of Newcastle, Newcastle, Australia, 8Hirslanden, Männedorf, Switzerland, 9Division of Oncology, Rambam Health Care Campus, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, 10Marmara University School of Medicine, Marmara, Turkey, 11Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey, 12Department of Radiation Oncology,Franziskus Hospital, Bielefeld, Germany, 13Institut Jean-Godinot, Reims, France, 14Centre Hospitalier du Valais Romand (CHVR), Sion, Switzerland
Purpose/Objective(s): Rectal Squamous Cell Carcinoma (R-SCC) is a rare disease. The therapeutic approach is not well established. We report the clinical results of a large, multicentric study promoted by the Rare Cancer Network.
Materials/Methods: This study included 77 adult non-metastatic R-SCC patients treated in 13 American and European Institutions (M/F = 54/23). Median age was 59 years (range: 25 - 87). Curative Radiotherapy (RT) was delivered in 72 patients, usually with concomitant CT (n = 62) as radical (n = 47), neoadjuvant (n = 17) or postoperative treatment (n = 8). Pelvic RT volume always encompassed internal iliac and presacral nodes, + external nodes (n = 17) or + external and inguinal nodes (n = 39), up to a median total dose of 45 Gy (range: 30 – 65 Gy, 1.8 – 3 Gy/fraction). A boost was delivered in 40 patients, with external beam radiotherapy (n = 36), up to a median total dose of 18 Gy (range: 5.4 – 30.6 Gy), or with brachytherapy (n = 4) up to a total dose of 25-33.4 Gy. Surgery was delivered in 30 patients, as LAR (n = 9), APR (n = 14) or Trans-Anal Resection (n = 5).
Results: Median follow-up was 59.6 months (Range, 3.1 – 268). Five-year overall survival, cancer specific survival, local control (at the anal level), loco-regional control (at the anal and/or the pelvic nodes level), metastases-free survival and disease-free survival were 83% + 7% (95% Confidence Interval), 85% + 7%, 85% + 7%, 83% + 7%, 82% + 7% and 76% + 10%, respectively. Better 5-year LRR rates were reported in patients receiving exclusive chemoradiotherapy compared to those who received combined surgery and chemoradiotherapy (88% vs 71%, Log-rank p-value 0.03). Noteworthy, no differences were seen in terms of distribution of stages amongst these 2 therapeutic approaches. At univariate analysis, T stage (T1-2 vs T3-4), N status (N0 vs N+), and Stage (I-II vs IIIA-B) did not statistically influence the 5-year loco-regional control rate. Patients with a IIIB stage presented a statistically lower 5-year loco-regional control rate (66% vs 85%, log-rank p-value = 0.003). Salvage APR was realized in only 2/47 patients who received exclusive chemoradiotherapy. Toxicity data were available for all the patients: 51/77 patients presented a G1-4 acute toxicity (66%), while late G1-4 toxicity was reported in 32/77 patients (41%). Acute and late toxicity scores were available for 57 (74%) and 64 (83%) patients, respectively. The rates of grade >3 acute and late toxicity were 14% and 12%, respectively.
Conclusion: Chemoradiotherapy seems to be the treatment of choice for R-SCC, as it allows good clinical outcomes and sphincter saving procedures, with acceptable severe toxicity rates. Stage IIIB patients present lower loco-regional control rates and are probably the best candidates to multidisciplinary approaches.
Author Disclosure: B. De Bari: None. D. Aloi: None. C. Lemanski: None. C.L. Hallemeier: Research Grant; Mayo Clinic. S. Qi: None. I. Sefik: None. S. Servagi Vernat: None.