- Email: [email protected]
Management of rectal squamous cell carcinoma
+Model
ARTICLE IN PRESS
CLINRE-1002; No. of Pages 3
Clinics and Research in Hepatology and Gastroenterology (2017) xxx, xxx.e1—xxx.e3
Available online at
ScienceDirect www.sciencedirect.com
LETTER TO THE EDITOR Management of rectal squamous cell carcinoma To the Editor, Rectal squamous cell carcinoma (R-SCC) is a rare disease with an estimated incidence of 0.1—0.25‰ out of all colorectal malignancies [1,2] and less than 120 documented cases. R-SCC is defined as the combined absence of R-SCC metastasis from another organ, an anal SCC, and a squamous-lined anorectal fistula [2]. Due to the rareness of this disease, there is no consensus on its treatment. It is not clear if R-SCC should be treated with the same modalities as anal canal SCC (AC-SCC) or rectal adenocarcinomas. Here, we report two cases of locally advanced R-SCC and their respective treatment modalities. The first case (case 1) was a 50-year-old woman who consulted for rectal pain. Her past medical history included an appendectomy, endometriosis, and a tonsillectomy. The colonoscopy revealed a circumferential polypoid mass of the rectum from 4 to 9 cm of the anal margin (above the pectineal line). The second case (case 2) was a 63year-old woman who consulted for rectal tenesmus. Her past medical history included high blood pressure, type 2 diabetes, tobacco smoking-induced chronic obstructive pulmonary disease, and an appendectomy. The colonoscopy revealed a left hemi-circumferential mass of the rectum from 7 to 10 cm of the anal margin. For both patients, the pelvic magnetic resonance imaging (MRI) classified the lesion as mrT4N+ as the tumor invaded the pubo-rectal muscle for case 1, uterus and anal sphincter for case 2 (although it was strictly limited to the rectum on endoscopy), and perirectal nodes for both cases. The computed tomography (CT)-scan confirmed the local extension and showed no sign of distant metastasis. Biopsy confirmed the presence of a R-SCC. A multidisciplinary meeting proposed radiation therapy associated with concomitant chemotherapy with 5-fluorouracil (5-FU) and cisplatin. A derivative lateral stoma on the sigmoid colon was performed by laparoscopy before chemoradiation (CRT). The patients underwent CT-based simulation in the supine position. The clinical target volume (CTV) included the rectum, anal canal, mesorectum, bilateral ischiorectal fossa, presacral space, and internal iliac nodes. A 1 cm
isotropic margin was added to obtain the planning target volume (PTV). The volume was treated to a dose level of 50.4 Gy in 28 fractions delivered once daily, five days a week using a three field (one posterior and two opposed laterals) 3D-conformational radiotherapy technique. During radiation, the patients received 2 and 3 cycles of 5-FU at a dose of 1000 mg/m2 and cisplatin at a dose of 100 mg/m2 , respectively. The case 1 exhibited Grade 3 anusitis according to the Common Terminology Criteria for Adverse Events (CTCAE) International Classification. The case 2 exhibited Grade 1 rectitis and cystitis induced by radiotherapy and Grade 3 septic pancytopenia induced by chemotherapy and subsequently treated with antibiotics. For case 1, a pelvic MRI performed 6 weeks after CRT revealed that there was a partial response according to RECIST criteria (contrast enhancement persistence on the posterior wall of the rectum) and the patient underwent salvage surgery (SS) with proctectomy and total mesorectal excision 10 weeks after CRT, without positron emission tomography (PET/CT) scanning evaluation. The tumor was classified ypT0N0. For case 2, a pelvic MRI and CT-scan performed 6 weeks and 6 months after CRT revealed complete radiologic response, confirmed by a PET/CT scanning. After a follow-up at 21 and 16 months respectively, both patients remain asymptomatic and free of disease. The hypotheses proposed in order to explain the pathogenesis of SCC into an organ lined with glandular mucosa are differentiation of pluripotent stem cells, degeneration of ectopic embryonic nests from ectodermal cells, squamous differentiation of rectal adenoma, and squamous metaplasia after mucosal injury by external radiation or inflammatory bowel disease [1]. The risk factors postulated to be associated with the development of R-SCC include ulcerative colitis, smoking, human immune-deficiency virus, human papilloma virus, amebiasis, and schistosomiasis [3,4]. Table 1 summarizes all recent published series reporting 108 patients affected with R-SCC treated with curative intent. CRT was the primary treatment for 94 patients and SS was needed for 23 (24%) whereas 7 had planned surgery (PS) (7%). This strategy can offer a DFS ranging from 64% to 100% [2,4—9]. Radiotherapy should deliver a dose of at least 50.4 Gy. Doses lower than 45 Gy appear to be associated with higher local recurrence rates [1,2] and some authors have even suggested that a minimum dose of 54 Gy is advisable for local control [1]. According to RTOG guidelines, the CTV
http://dx.doi.org/10.1016/j.clinre.2017.03.012 2210-7401/© 2017 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Delhorme J-B, et al. Management of rectal squamous cell carcinoma. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.03.012
+Model
ARTICLE IN PRESS
CLINRE-1002; No. of Pages 3
xxx.e2 Table 1
Letter to the Editor Most recent series reporting treatment of rectal squamous cell carcinomas and its results for disease free survival.
Authors
Year
Number of patients (curative intent)
Primary treatment
Other treatments
Disease free survival
Yeh et al. [1]
2012
6
SS, n = 2
66% at 44 months
Musio et al. [2] Nahas et al. [3]
2015 2007
8 12
SS, n = 2 SS, n = 7 pCRT, n = 2
87.5% at 42 months 100% at 31 months
Rasheed et al. [4] Tronconi et al. [5]
2009 2010
6 6
SS, n = 2 SS, n = 1
100% at 48 months 83% at 39 months
Péron et al. [6]
2015
11
SS, n = 4
64% at 56 months
Clark et al. [7] Sturgeon et al. [8] Loganadane et al. [9]
2008 2014 2016
7 14 23
SS, n = 1 SS = 2 SS = 2
100% at 18 months 72% at 54 months 78% at 85 months
Wang et al. [10]
2011
7
pCRT, n = 2
57% at 39 months
Ozuner et al. [11]
2015
8
CRT, n = 5 Surgery, n = 1 CRT, n = 8 CRT, n = 9 Surgery, n = 2 CT, n = 1 CRT, n = 6 CRT, n = 5 CRT+ PS = 1 CRT, n = 10 RT, n = 1 CRT, n = 7 CRT, n = 14 CRT, n = 21 CRT + PS, n = 2 CRT, n = 2 CRT+ PS, n = 3 Surgery, n = 2 Surgery, n = 7 CRT+ PS, n = 1
pRT, n = 3 pCT, n = 5
37.5% at 42 months
CRT: chemoradiation; PS: planned surgery; SS: salvage surgery; p: postoperative; CT: chemotherapy; RT: radiotherapy; n: number of patients.
should include the rectum, mesorectum, presacral space and internal iliac nodes. Inclusion of the canal and ischiorectal fossas into CTV should be considered when those structures are invaded. External iliac nodes are not routinely included in the CTV except for R-SCC extended into anal canal, into gynecologic or genitourinary structures, or evidence of invaded lymph nodes on pretherapeutic imaging. Modalities of evaluation of the treatment’s response and systematic surgery policy after CRT seem questionable considering the 30 patients reported in Table 1 who underwent PS (n = 7) or SS (n = 23) after CRT, where no residual tumor was found in 60% of cases (n = 18: 6 after PS (85%), 12 after SS (52%)). As organ-preserving policy with CRT has become a standard of care for AC-SCC and is emerging for rectal adenocarcinoma, a ‘‘watch and wait’’ strategy after CRT avoiding an unnecessary radical surgery in 60% of cases may be relevant. The optimal delay of evaluating response to CRT remains controversial as a premature evaluation may falsely conclude to an incomplete response or relapse in 52% of cases (as in case 1). AC-SCC guidelines recommend assessing the response at least 6 weeks after CRT but recent data suggest that the optimal time for evaluation is 26 weeks (Act II trial). As for AC-SCC, some authors have suggested that PET/CT scanning is advisable at a baseline level and maybe helpful prior to any SS [1]. With a negative predictive value of nearly 100%, PET/CT scanning may allow to avoid surgery if negative. Surgery as the primary treatment results in a higher rate of incomplete resection (R2) [1,10] and does not appear to achieve equivalent DFS rates as CRT in spite of postoperative radiation and/or chemotherapy [1,10,11]. But, those patients had significantly more stage I and IV tumors [11] than patients treated with primary CRT (although age, gender, symptoms were similar).
A CRT with at least 50.4 Gy and a 5-FU based regimen appears to be the most efficient treatments for R-SCC. SS could be considered in cases of partial response or recurrence after CRT. Surgery as a primary treatment seems to lead to lower DFS rates than CRT and incomplete resection.
Disclosure of interest The authors have no potential conflicts of interest to disclose.
References [1] Yeh J, Hastings J, Rao A, Abbas MA. Squamous cell carcinoma of the rectum: a single institution experience. Tech Coloproctol 2012;16:349—54, http://dx.doi.org/10.1007/ s10151-012-0848-z. [2] Musio D, De Felice F, Manfrida S, Balducci M, Meldolesi E, Gravina GL, et al. Squamous cell carcinoma of the rectum: the treatment paradigm. Eur J Surg Oncol 2015;41:1054—8, http://dx.doi.org/10.1016/j.ejso.2015.03.239. [3] Nahas CSR, Shia J, Joseph R, Schrag D, Minsky BD, Weiser MR, et al. Squamous-cell carcinoma of the rectum: a rare but curable tumor. Dis Colon Rectum 2007;50:1393—400, http://dx.doi.org/10.1007/s10350-007-0256-z. [4] Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum — report of six patients and literature review. Colorectal Dis 2009;11:191—7, http://dx.doi.org/10.1111/j.1463-1318.2008.01560.x. [5] Tronconi MC, Carnaghi C, Bignardi M, Doci R, Rimassa L, Di Rocco M, et al. Rectal squamous cell carcinoma treated with chemoradiotherapy: report of six cases.
Please cite this article in press as: Delhorme J-B, et al. Management of rectal squamous cell carcinoma. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.03.012
+Model CLINRE-1002; No. of Pages 3
ARTICLE IN PRESS
Letter to the Editor
[6]
[7]
[8]
[9]
[10]
[11]
Int J Colorectal Dis 2010;25:1435—9, http://dx.doi.org/10. 1007/s00384-010-0988-4. Péron J, Bylicki O, Laude C, Martel-Lafay I, Carrie C, Racadot S. Nonoperative management of squamous-cell carcinoma of the rectum. Dis Colon Rectum 2015;58:60—4, http://dx.doi.org/10.1097/DCR.0000000000000218. Clark J, Cleator S, Goldin R, Lowdell C, Darzi A, Ziprin P. Treatment of primary rectal squamous cell carcinoma by primary chemoradiotherapy: should surgery still be considered a standard of care? Eur J Cancer (Oxf Engl 1990) 2008;44:2340—3, http://dx.doi.org/10.1016/j.ejca.2008.07.004. Sturgeon JD, Crane CH, Krishnan S, Minsky BD, Skibber JM, Rodriguez-Bigas MA, et al. Definitive chemoradiation for squamous cell carcinoma of the rectum. Am J Clin Oncol 2014, http://dx.doi.org/10.1097/COC.0000000000000126. Loganadane G, Servagi-Vernat S, Schernberg A, Schlienger M, Touboul E, Bosset J-F, et al. Chemoradiation in rectal squamous cell carcinoma: bi-institutional case series. Eur J Cancer (Oxf Engl 1990) 2016;58:83—9, http://dx.doi.org/10.1016/ j.ejca.2016.02.005. Wang MLC, Heriot A, Leong T, Ngan SYK. Chemoradiotherapy in the management of primary squamous-cell carcinoma of the rectum. Colorectal Dis 2011;13:296—301, http://dx.doi. org/10.1111/j.1463-1318.2009.02154.x. Ozuner G, Aytac E, Gorgun E, Bennett A. Colorectal squamous cell carcinoma: a rare tumor with poor prognosis. Int J Colorectal Dis 2015;30:127—30, http://dx.doi.org/10.1007/ s00384-014-2058-9.
xxx.e3 Jean-Baptiste Delhorme a,∗ Waisse Waissi b Benoit Romain a Catherine Schumacher b Kelle C. Freel c Patrick Dufour d Cécile Brigand a Serge Rohr a a Service de chirurgie générale et digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 2, avenue Molière, 67200 Strasbourg, France b Département de radiothérapie, centre Paul Strauss, 3, rue de la Porte-de-l’Hôpital, 67065 Strasbourg Cedex, France c Département de génétique, génomique et microbiologie, Université de Strasbourg/CNRS, UMR 7156, 28, rue Goethe, 67083 Strasbourg Cedex, France d Département d’oncologie médicale, centre Paul Strauss, 3, rue de la Porte-de-l’Hôpital, 67065 Strasbourg Cedex, France ∗
Corresponding author. E-mail address: [email protected] (J.-B. Delhorme)
Please cite this article in press as: Delhorme J-B, et al. Management of rectal squamous cell carcinoma. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.03.012
ARTICLE IN PRESS
CLINRE-1002; No. of Pages 3
Clinics and Research in Hepatology and Gastroenterology (2017) xxx, xxx.e1—xxx.e3
Available online at
ScienceDirect www.sciencedirect.com
LETTER TO THE EDITOR Management of rectal squamous cell carcinoma To the Editor, Rectal squamous cell carcinoma (R-SCC) is a rare disease with an estimated incidence of 0.1—0.25‰ out of all colorectal malignancies [1,2] and less than 120 documented cases. R-SCC is defined as the combined absence of R-SCC metastasis from another organ, an anal SCC, and a squamous-lined anorectal fistula [2]. Due to the rareness of this disease, there is no consensus on its treatment. It is not clear if R-SCC should be treated with the same modalities as anal canal SCC (AC-SCC) or rectal adenocarcinomas. Here, we report two cases of locally advanced R-SCC and their respective treatment modalities. The first case (case 1) was a 50-year-old woman who consulted for rectal pain. Her past medical history included an appendectomy, endometriosis, and a tonsillectomy. The colonoscopy revealed a circumferential polypoid mass of the rectum from 4 to 9 cm of the anal margin (above the pectineal line). The second case (case 2) was a 63year-old woman who consulted for rectal tenesmus. Her past medical history included high blood pressure, type 2 diabetes, tobacco smoking-induced chronic obstructive pulmonary disease, and an appendectomy. The colonoscopy revealed a left hemi-circumferential mass of the rectum from 7 to 10 cm of the anal margin. For both patients, the pelvic magnetic resonance imaging (MRI) classified the lesion as mrT4N+ as the tumor invaded the pubo-rectal muscle for case 1, uterus and anal sphincter for case 2 (although it was strictly limited to the rectum on endoscopy), and perirectal nodes for both cases. The computed tomography (CT)-scan confirmed the local extension and showed no sign of distant metastasis. Biopsy confirmed the presence of a R-SCC. A multidisciplinary meeting proposed radiation therapy associated with concomitant chemotherapy with 5-fluorouracil (5-FU) and cisplatin. A derivative lateral stoma on the sigmoid colon was performed by laparoscopy before chemoradiation (CRT). The patients underwent CT-based simulation in the supine position. The clinical target volume (CTV) included the rectum, anal canal, mesorectum, bilateral ischiorectal fossa, presacral space, and internal iliac nodes. A 1 cm
isotropic margin was added to obtain the planning target volume (PTV). The volume was treated to a dose level of 50.4 Gy in 28 fractions delivered once daily, five days a week using a three field (one posterior and two opposed laterals) 3D-conformational radiotherapy technique. During radiation, the patients received 2 and 3 cycles of 5-FU at a dose of 1000 mg/m2 and cisplatin at a dose of 100 mg/m2 , respectively. The case 1 exhibited Grade 3 anusitis according to the Common Terminology Criteria for Adverse Events (CTCAE) International Classification. The case 2 exhibited Grade 1 rectitis and cystitis induced by radiotherapy and Grade 3 septic pancytopenia induced by chemotherapy and subsequently treated with antibiotics. For case 1, a pelvic MRI performed 6 weeks after CRT revealed that there was a partial response according to RECIST criteria (contrast enhancement persistence on the posterior wall of the rectum) and the patient underwent salvage surgery (SS) with proctectomy and total mesorectal excision 10 weeks after CRT, without positron emission tomography (PET/CT) scanning evaluation. The tumor was classified ypT0N0. For case 2, a pelvic MRI and CT-scan performed 6 weeks and 6 months after CRT revealed complete radiologic response, confirmed by a PET/CT scanning. After a follow-up at 21 and 16 months respectively, both patients remain asymptomatic and free of disease. The hypotheses proposed in order to explain the pathogenesis of SCC into an organ lined with glandular mucosa are differentiation of pluripotent stem cells, degeneration of ectopic embryonic nests from ectodermal cells, squamous differentiation of rectal adenoma, and squamous metaplasia after mucosal injury by external radiation or inflammatory bowel disease [1]. The risk factors postulated to be associated with the development of R-SCC include ulcerative colitis, smoking, human immune-deficiency virus, human papilloma virus, amebiasis, and schistosomiasis [3,4]. Table 1 summarizes all recent published series reporting 108 patients affected with R-SCC treated with curative intent. CRT was the primary treatment for 94 patients and SS was needed for 23 (24%) whereas 7 had planned surgery (PS) (7%). This strategy can offer a DFS ranging from 64% to 100% [2,4—9]. Radiotherapy should deliver a dose of at least 50.4 Gy. Doses lower than 45 Gy appear to be associated with higher local recurrence rates [1,2] and some authors have even suggested that a minimum dose of 54 Gy is advisable for local control [1]. According to RTOG guidelines, the CTV
http://dx.doi.org/10.1016/j.clinre.2017.03.012 2210-7401/© 2017 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Delhorme J-B, et al. Management of rectal squamous cell carcinoma. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.03.012
+Model
ARTICLE IN PRESS
CLINRE-1002; No. of Pages 3
xxx.e2 Table 1
Letter to the Editor Most recent series reporting treatment of rectal squamous cell carcinomas and its results for disease free survival.
Authors
Year
Number of patients (curative intent)
Primary treatment
Other treatments
Disease free survival
Yeh et al. [1]
2012
6
SS, n = 2
66% at 44 months
Musio et al. [2] Nahas et al. [3]
2015 2007
8 12
SS, n = 2 SS, n = 7 pCRT, n = 2
87.5% at 42 months 100% at 31 months
Rasheed et al. [4] Tronconi et al. [5]
2009 2010
6 6
SS, n = 2 SS, n = 1
100% at 48 months 83% at 39 months
Péron et al. [6]
2015
11
SS, n = 4
64% at 56 months
Clark et al. [7] Sturgeon et al. [8] Loganadane et al. [9]
2008 2014 2016
7 14 23
SS, n = 1 SS = 2 SS = 2
100% at 18 months 72% at 54 months 78% at 85 months
Wang et al. [10]
2011
7
pCRT, n = 2
57% at 39 months
Ozuner et al. [11]
2015
8
CRT, n = 5 Surgery, n = 1 CRT, n = 8 CRT, n = 9 Surgery, n = 2 CT, n = 1 CRT, n = 6 CRT, n = 5 CRT+ PS = 1 CRT, n = 10 RT, n = 1 CRT, n = 7 CRT, n = 14 CRT, n = 21 CRT + PS, n = 2 CRT, n = 2 CRT+ PS, n = 3 Surgery, n = 2 Surgery, n = 7 CRT+ PS, n = 1
pRT, n = 3 pCT, n = 5
37.5% at 42 months
CRT: chemoradiation; PS: planned surgery; SS: salvage surgery; p: postoperative; CT: chemotherapy; RT: radiotherapy; n: number of patients.
should include the rectum, mesorectum, presacral space and internal iliac nodes. Inclusion of the canal and ischiorectal fossas into CTV should be considered when those structures are invaded. External iliac nodes are not routinely included in the CTV except for R-SCC extended into anal canal, into gynecologic or genitourinary structures, or evidence of invaded lymph nodes on pretherapeutic imaging. Modalities of evaluation of the treatment’s response and systematic surgery policy after CRT seem questionable considering the 30 patients reported in Table 1 who underwent PS (n = 7) or SS (n = 23) after CRT, where no residual tumor was found in 60% of cases (n = 18: 6 after PS (85%), 12 after SS (52%)). As organ-preserving policy with CRT has become a standard of care for AC-SCC and is emerging for rectal adenocarcinoma, a ‘‘watch and wait’’ strategy after CRT avoiding an unnecessary radical surgery in 60% of cases may be relevant. The optimal delay of evaluating response to CRT remains controversial as a premature evaluation may falsely conclude to an incomplete response or relapse in 52% of cases (as in case 1). AC-SCC guidelines recommend assessing the response at least 6 weeks after CRT but recent data suggest that the optimal time for evaluation is 26 weeks (Act II trial). As for AC-SCC, some authors have suggested that PET/CT scanning is advisable at a baseline level and maybe helpful prior to any SS [1]. With a negative predictive value of nearly 100%, PET/CT scanning may allow to avoid surgery if negative. Surgery as the primary treatment results in a higher rate of incomplete resection (R2) [1,10] and does not appear to achieve equivalent DFS rates as CRT in spite of postoperative radiation and/or chemotherapy [1,10,11]. But, those patients had significantly more stage I and IV tumors [11] than patients treated with primary CRT (although age, gender, symptoms were similar).
A CRT with at least 50.4 Gy and a 5-FU based regimen appears to be the most efficient treatments for R-SCC. SS could be considered in cases of partial response or recurrence after CRT. Surgery as a primary treatment seems to lead to lower DFS rates than CRT and incomplete resection.
Disclosure of interest The authors have no potential conflicts of interest to disclose.
References [1] Yeh J, Hastings J, Rao A, Abbas MA. Squamous cell carcinoma of the rectum: a single institution experience. Tech Coloproctol 2012;16:349—54, http://dx.doi.org/10.1007/ s10151-012-0848-z. [2] Musio D, De Felice F, Manfrida S, Balducci M, Meldolesi E, Gravina GL, et al. Squamous cell carcinoma of the rectum: the treatment paradigm. Eur J Surg Oncol 2015;41:1054—8, http://dx.doi.org/10.1016/j.ejso.2015.03.239. [3] Nahas CSR, Shia J, Joseph R, Schrag D, Minsky BD, Weiser MR, et al. Squamous-cell carcinoma of the rectum: a rare but curable tumor. Dis Colon Rectum 2007;50:1393—400, http://dx.doi.org/10.1007/s10350-007-0256-z. [4] Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum — report of six patients and literature review. Colorectal Dis 2009;11:191—7, http://dx.doi.org/10.1111/j.1463-1318.2008.01560.x. [5] Tronconi MC, Carnaghi C, Bignardi M, Doci R, Rimassa L, Di Rocco M, et al. Rectal squamous cell carcinoma treated with chemoradiotherapy: report of six cases.
Please cite this article in press as: Delhorme J-B, et al. Management of rectal squamous cell carcinoma. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.03.012
+Model CLINRE-1002; No. of Pages 3
ARTICLE IN PRESS
Letter to the Editor
[6]
[7]
[8]
[9]
[10]
[11]
Int J Colorectal Dis 2010;25:1435—9, http://dx.doi.org/10. 1007/s00384-010-0988-4. Péron J, Bylicki O, Laude C, Martel-Lafay I, Carrie C, Racadot S. Nonoperative management of squamous-cell carcinoma of the rectum. Dis Colon Rectum 2015;58:60—4, http://dx.doi.org/10.1097/DCR.0000000000000218. Clark J, Cleator S, Goldin R, Lowdell C, Darzi A, Ziprin P. Treatment of primary rectal squamous cell carcinoma by primary chemoradiotherapy: should surgery still be considered a standard of care? Eur J Cancer (Oxf Engl 1990) 2008;44:2340—3, http://dx.doi.org/10.1016/j.ejca.2008.07.004. Sturgeon JD, Crane CH, Krishnan S, Minsky BD, Skibber JM, Rodriguez-Bigas MA, et al. Definitive chemoradiation for squamous cell carcinoma of the rectum. Am J Clin Oncol 2014, http://dx.doi.org/10.1097/COC.0000000000000126. Loganadane G, Servagi-Vernat S, Schernberg A, Schlienger M, Touboul E, Bosset J-F, et al. Chemoradiation in rectal squamous cell carcinoma: bi-institutional case series. Eur J Cancer (Oxf Engl 1990) 2016;58:83—9, http://dx.doi.org/10.1016/ j.ejca.2016.02.005. Wang MLC, Heriot A, Leong T, Ngan SYK. Chemoradiotherapy in the management of primary squamous-cell carcinoma of the rectum. Colorectal Dis 2011;13:296—301, http://dx.doi. org/10.1111/j.1463-1318.2009.02154.x. Ozuner G, Aytac E, Gorgun E, Bennett A. Colorectal squamous cell carcinoma: a rare tumor with poor prognosis. Int J Colorectal Dis 2015;30:127—30, http://dx.doi.org/10.1007/ s00384-014-2058-9.
xxx.e3 Jean-Baptiste Delhorme a,∗ Waisse Waissi b Benoit Romain a Catherine Schumacher b Kelle C. Freel c Patrick Dufour d Cécile Brigand a Serge Rohr a a Service de chirurgie générale et digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 2, avenue Molière, 67200 Strasbourg, France b Département de radiothérapie, centre Paul Strauss, 3, rue de la Porte-de-l’Hôpital, 67065 Strasbourg Cedex, France c Département de génétique, génomique et microbiologie, Université de Strasbourg/CNRS, UMR 7156, 28, rue Goethe, 67083 Strasbourg Cedex, France d Département d’oncologie médicale, centre Paul Strauss, 3, rue de la Porte-de-l’Hôpital, 67065 Strasbourg Cedex, France ∗
Corresponding author. E-mail address: [email protected] (J.-B. Delhorme)
Please cite this article in press as: Delhorme J-B, et al. Management of rectal squamous cell carcinoma. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.03.012