Abstract
BackgroundSmall cell carcinoma of the rectum is a rare neoplasm with scant literature to guide treatment. We used the Surveillance Epidemiology and End Results (SEER) database to investigate the role of radiation therapy in the treatment of this cancer.MethodsThe SEER database (National Cancer Institute) was queried for locoregional cases of small cell rectal cancer. Years of diagnosis were limited to 1988–2010 (most recent available) to reduce variability in staging criteria or longitudinal changes in surgery and radiation techniques. Two month conditional survival was applied to minimize bias by excluding patients who did not survive long enough to receive cancer-directed therapy. Patient demographics between the RT and No_RT groups were compared using Pearson Chi-Square tests. Overall survival was compared between patients who received radiotherapy (RT, n = 43) and those who did not (No_RT, n = 28) using the Kaplan-Meier method. Multivariate Cox proportional hazards model was used to evaluate important covariates.ResultsMedian survival was significantly longer for patients who received radiation compared to those who were not treated with radiation; 26 mo vs. 8 mo, respectively (log-rank P = 0.009). We also noted a higher 1-year overall survival rate for those who received radiation (71.1% vs. 37.8%). Unadjusted hazard ratio for death (HR) was 0.495 with the use of radiation (95% CI 0.286-0.858). Among surgery, radiotherapy, sex and age at diagnosis, radiation therapy was the only significant factor for overall survival with a multivariate HR for death of 0.393 (95% CI 0.206-0.750, P = 0.005).ConclusionsUsing SEER data, we have identified a significant survival advantage with the use of radiation therapy in the setting of rectal small cell carcinoma. Limitations of the SEER data apply to this study, particularly the lack of information on chemotherapy usage. Our findings strongly support the use of radiation therapy for patients with locoregional small cell rectal cancer.
Highlights
Small cell carcinoma of the rectum is a rare neoplasm with scant literature to guide treatment
We looked to the literature for rectal small cell carcinomas (SCC) case reports, and found a broad range of treatment strategies and patient outcomes (Table 3)
Despite the inherent limitations with using the Surveillance Epidemiology and End Results (SEER) database, this study provides evidence for the benefit of radiation therapy for the treatment of rectal SCC
Summary
Small cell carcinoma of the rectum is a rare neoplasm with scant literature to guide treatment. Neuroendocrine neoplasias (NEN) arise from neural and endocrine cell types and can occur all throughout the body. NEN are broadly grouped into pulmonary and extrapulmonary primary sites and encompass a heterogeneous class of malignancies that vary widely in their clinical presentations and characteristics. The number of different iterations of NEN that arise as a function of primary site, grade and clinical presentation compounded by their relative infrequency has made clinical trial execution difficult and slowed the pace at which outcomes can be improved for the many subtypes [1,2,3]. Some of the literature use the term NET to refer more broadly to NEN, which encompass all grades of neuroendocrine neoplasms. The more aggressive and poorly differentiated grade III neuroendrocrine carcinomas (NEC) are further subdivided into small cell carcinomas (SCC) and large cell carcinomas (LCC)
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