Radiochemotherapy Versus Surgery in Nonmetastatic Anorectal Neuroendocrine Carcinoma: A Multicenter Study by the Association des Gastro-Entérologues Oncologues.
Neuroendocrine carcinomas (NEC) of the anus or the rectum are a rare disease, accounting for less than 1% of all digestive malignancies. Most are metastatic at diagnosis and treated with a platinum-based chemotherapy. No guidelines for localized tumors exist. The purpose of this study was to describe the characteristics of anorectal localized NEC, their management and their outcomes.We retrospectively reviewed patients from 11 French centers with anorectal localized NEC. We compared 2 therapeutic managements: surgery (group A) versus chemotherapy with or without radiation (group B). Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method.A total of 24 patients were identified with a median follow-up of 25 months (3-60 months). Median age was 63 years old and 17 had a rectal tumor (71%). Mean Ki-67 was 72% (range: 20-100), and 75% of the tumors had a high proliferative index (Ki-67 > 50%). Global PFS and OS were 13.1 and 44.1 months, respectively. Thirty-seven percent of patients were in group A and 63% in group B. There was no difference between group A and group B, whether in terms of PFS (13.0 months vs. 13.2 months, P = 0.75) or OS (49.1 months vs. 39.2 months, P = 0.42).In patients with anorectal localized NEC, chemotherapy with or without radiation obtained a similar outcome as surgery and this conservative approach could be deemed a reasonable option.
From the Department of Gastroenterology and Digestive Oncology, Cochin Teaching Hospital, Paris Descartes University, Paris, France (BB, RC); Department of Digestive Oncology, Georges Pompidou European Hospital, Paris Descartes University, Paris, France (CL, PR); Department of Gastroenterology, Edouard Herriot Hospital, Lyon, France (TW); Department of Gastroenterology, Tours Teaching Hospital, Tours Cedex 9, France (TL); Department of Medical Oncology, Claudius Regaud Institute, Toulouse, France (RG); Department of Gastroenterology, Rennes Teaching Hospital, Rennes, France (SM); Department of Gastroenterology, Poitiers Teaching Hospital, Poitiers, France (DT); Department of Medical Oncology, Leon Berard Hospital, Lyon, France (FD); Department of Gastroenterology, Saint Louis Hospital, Paris, France (NL); Department of Digestive Oncology, Saint Antoine Hospital, Paris, France (PA); Department of Medical Oncology, Oscar Lambret Hospital, Lille, France (FEH); and Department of Pathology, Cochin Teaching Hospital, Paris Descartes University, Paris, France (BT).
Bertrand
B
Brieau
Céline
C
Lepère
Thomas
T
Walter
Thierry
T
Lecomte
Rosine
R
Guimbaud
Sylvain
S
Manfredi
David
D
Tougeron
Françoise
F
Desseigne
Nelson
N
Lourenco
Pauline
P
Afchain
Farid
F
El Hajbi
Benoit
B
Terris
Philippe
P
Rougier
Romain
R
Coriat
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies