Short Communication Treatment of primary rectal squamous cell carcinoma by primary chemoradiotherapy: Should surgery still be considered a standard of care? J. Clark a , S. Cleator b, * , R. Goldin c , C. Lowdell b , A. Darzi a , P. Ziprin a a Department of Bio Surgery and Surgical Technology, Faculty of Medicine, Imperial College, London, UK b Department of Oncology, Imperial College Healthcare NHS Trust, London, UK c Department of Histopathology, Faculty of Medicine Imperial College, London, UK ARTICLE INFO Article history: Received 16 May 2008 Received in revised form 23 June 2008 Accepted 1 July 2008 Available online 15 August 2008 Keywords: Rectal squamous cell carcinoma (SCC) Rectal cancer Primary chemoradiotherapy Stoma avoidance ABSTRACT Rectal squamous cell carcinoma is a rare tumour accounting for only 0.25% of all rectal car- cinomas, yet it carries a significant mortality and morbidity. Radical surgery has been advo- cated as the primary treatment modality with or without adjunctive therapies despite the proven benefits of primary chemoradiotherapy for squamous cell carcinoma (SCC) of the anus. This report describes 7 cases of rectal squamous cell carcinoma from a single institution over a four-year period, treated with primary chemoradiotherapy. All patients demon- strated significant tumour regression, and surgery to the primary tumour was avoided in all but one of these cases. Primary chemoradiotherapy can achieve excellent local control for rectal squamous cell carcinoma with surgery employed only for unresponsive or recurrent tumours. Ó 2008 Elsevier Ltd. All rights reserved. 1. Introduction Colorectal carcinoma remains a leading cause of cancer in the United Kingdom with 36,000 cases diagnosed per year. 1 Approximately, one-third of these are rectal in origin and over 97% of these are adenocarcinomas. 2 Primary rectal squamous cell carcinoma (SCC) is a rare tumour accounting for only 0.25% of all rectal cancers. 2,3 Previously reported treatment strategies vary considerably as there is a lack of scientific data due to this tumour’s rarity; however, there is a common per- ception that treatment should involve primary resection of the tumour. Following the ACT 1 trial, a UK multicentre trial that showed that radiation in combination with 5-Fluorouracil and Mitomycin C chemotherapy was superior to radiation alone for SCC anus, primary chemoradiotherapy has become the treatment of choice for tumours not suitable for local excision, so avoiding the high morbidity and particularly permanent colostomy associated with abdominoperineal resection (APR). 4,5 APR is now reserved for treatment failures. This report reviews the management of seven cases of pri- mary rectal SCC undertaken at a single specialist centre, who were treated with primary chemoradiotherapy, and discusses 0959-8049/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2008.07.004 * Corresponding author: Tel.: +44 20 7886 1132; fax: +44 20 7886 1840. E-mail address: s.cleator@imperial.ac.uk (S. Cleator). EUROPEAN JOURNAL OF CANCER 44 (2008) 2340 – 2343 available at www.sciencedirect.com journal homepage: www.ejconline.com