LETTER TO THE EDITOR salvage surgery compared with squamous cancers of the anus. Distinguishing Anal Dis Colon Rectum. 2017;60:922–927. 2. Coghill AE, Shiels MS, Rycroft RK, et al. Rectal squamous cell Squamous Cell Carcinoma carcinoma in immunosuppressed populations: is this a distinct entity from anal cancer? AIDS. 2016;30:105–112. and Rectal Squamous Cell 3. Williams GT, Blackshaw AJ, Morson BC. Squamous carcinoma of the colorectum and its genesis. J Pathol. 1979;129:139–147. Carcinoma in Secondary 4. Kang H, O’Connell JB, Leonardi MJ, Maggard MA, McGory Data Sets ML, Ko CY. Rare tumors of the colon and rectum: a national review. Int J Colorectal Dis. 2007;22:183–189. To the Editor–We read with interest the efforts by Kulaylat 5. Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo- et al describing the outcomes of anal squamous cell radiotherapy: an alternative to surgery for squamous cell carcinoma (aSCC) versus rectal squamous cell carcinoma carcinoma of the rectum–report of six patients and literature review. Colorectal Dis. 2009;11:191–197. (rSCC) at Commission on Cancer hospitals. Surgeons 6. Musio D, De Felice F, Manfrida S, et al. Squamous cell encounter these distinct neoplastic entities rarely, and the carcinoma of the rectum: the treatment paradigm. Eur J Surg lack of a consensus approach for the latter often impedes Oncol. 2015;41:1054–1058. standardized decision-making. Ira L. Leeds, M.D., M.B.A. We congratulate the authors for using one of the James Freeland Griffin, M.D. largest sources of available data to describe a pathologic Sandy H. Fang, M.D. difference that counters the two entities’ histologic Department of Surgery similarities of the 2 entities. The authors importantly Johns Hopkins University School of Medicine cite that the lack of Williams’ criteria impairs the ability Baltimore, Maryland to distinguish proximally invasive aSCC from primary 2,3 rSCC. We believe that such a loss of distinction may limit even the conservative claims made regarding distinctive The Authors Reply radiosensitivity and potentially different roles for surgery. First, the authors found an rSCC prevalence nearly 2 To the Editor–We appreciate the comments provided by times higher than previous estimates that originated from Drs Leeds, Griffin, and Fang regarding our study that ob- studies that also failed to exclude invasive aSCC. Such a served differential overall survival for anal (aSCC) and high prevalence suggests misclassification and would favor rectal (rSCC) squamous cell cancers. We offer our col- more locally aggressive aSCC being misclassified, leading leagues from Johns Hopkins and the readers of Diseases of to a false survival advantage in the aSCC-labeled group. the Colon & Rectum the following response. Second, the authors note that surgery-first approaches Concerns were raised that, based on our inability to were excluded. Given ongoing controversies of the care of apply Williams’ criteria of exclusion (excluding metastatic 5,6 rSCC, excluding these cases would disproportionately squamous cancer of the rectum arising from another or- remove less-invasive rSCC tumors while not affecting the gan, squamous-lined fistulas involving the affected region aSCC group. Such a choice causes the rSCC-labeled group to of the rectum, and squamous cancers of the anus or vagina be a higher-risk population and cannot be readily compared. that secondarily extend into the rectum) to the patients We hope that future studies will focus on further described in the National Cancer Database (NCDB), our delineating aSCC and rSCC to determine the best course study may have overestimated the incidence of rSCC. We of treatment for these 2 different disease entities. agree with Leeds and colleagues that this is a potential limi- tation with our work. The implications of that limitation, REFERENCES however, may have been overstated by our colleagues. Leeds and colleagues wrote that we “found an rSCC prevalence 1. Kulaylat AS, Hollenbeak CS, Stewart DB. Squamous cancers of ≈2 times higher than previous estimates that originated the rectum demonstrate poorer survival and increased need for from studies that also failed to exclude invasive aSCC.” Funding/Support: Dr Leeds was supported by a National Institutes of Our colleagues cite as evidence for this statement a 2007 Health National Cancer Institute T32 training grant (T32CA126607-08) (which is Reference 7 in our article) that reviewed article during preparation of this letter. Dis Colon Rectum 2018; 61: e19 Dis Colon Rectum 2018; 61: e19–e21 DOI: 10.1097/DCR.0000000000001015 DOI: 10.1097/DCR.0000000000001016 © The ASCRS 2018 © The ASCRS 2018 DISEASES OF THE COLON & RECTUM VOLUME 61: 3 (2018) e19 Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.
Diseases of the Colon & Rectum – Wolters Kluwer Health
Published: Mar 1, 2018
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