Gastrointestinal Cancer

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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

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.

Berardino De Bari

Disclosure:
Employment
Université de Bourgogne - Franche Comté: Employee: Employee

Biography:
Berardino DE BARI, M.D., is Assistant Professor and Radiation Oncologist in the Department of Radiation Oncology at the University Hospital of Besançon (France) and he is also Assistant Professor at the University Hospital of Lausanne (Switzerland). Since 2008, he is ESTRO Fellow and since 2014 is teacher of the ESTRO School. He focuses his scientific and clinical interest in the treatment of gastrointestinal and genitourinary cancers. From an educational point of view, he is teacher in the multidisciplinary ESTRO course of prostate cancer and of Evidence Based Radiotherapy. He is member of the ESTRO core of the FALCON program (Fellowship in Anatomic delineation and CONtouring). He is one of the co-authors of the ESTRO guidelines on prostate cancer contouring, recently published in the Green Journal. He is member of the EMUC (European Multidisciplinary Congress on Urological Cancers) scientific committee and he collaborates with IAEA (International Atomic Energy Agency). He actively participates in protocol development either as principal investigator or co-investigator, with a particular interest in clinical research in gastrointestinal and genitourinary cancers. He is reviewer for more than 15 peer-reviewed journals and he is member of the Editorial Committee of the ESTRO tipsRO (Technical Innovations and Patients Support in Radiation Oncology) journal. He is the author or co-author of over 90 journal articles and is a co-editor of 3 textbooks.

Specialty Preferences: Radiation oncology/genitourinary tumors; radiation oncology/GI tumors.

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