Neuroendocrine Carcinoma of the Anus and Rectum: Patient Characteristics and Treatment Options

• Published in: Clinical colorectal cancer Vol. 20; no. 2; pp. e139 - e149
• Main Authors: Ueberroth, Benjamin E., Liu, Alex J., Starr, Jason S., Hobday, Timothy J., Ashman, Jonathan B., Mishra, Nitin, Bekaii-Saab, Tanios S., Halfdanarson, Thorvardur R., Sonbol, M. Bassam
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021
• Subjects: Anorectal; Chemotherapy; Multidisciplinary; NEC; Neuroendocrine; Chemotherapy; Anorectal; Neuroendocrine; NEC; Multidisciplinary
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2020.12.001

Anorectal neuroendocrine carcinomas (NECs) are uncommon malignancies with poor prognosis. Consensus guidelines exist for treating extrapulmonary NEC. However, limited data is available to guide treatment for anorectal NEC. In this study, we sought to review the clinical characteristics and outcomes of patients with NEC of the rectum and/or anus at Mayo Clinic. This is a retrospective study of all patients with the diagnosis of NEC of the anus and/or rectum treated across Mayo Clinic sites since 2000. Baseline patient characteristics, tumor pathology, imaging profiles, treatment strategies utilized, and survival outcomes were analyzed. Kaplan-Meier analysis was used with a significance level of P < .05. The study included a total of 38 patients with primary NEC of the anus and/or rectum. The median age at diagnosis was 55.5 years. The median follow-up was 18.8 months. Fifteen patients had locoregional disease (LRD) at diagnosis. The remaining 23 had metastatic disease. Overall survival was significantly shorter in patients with LRD compared with those with metastatic disease at diagnosis (18.1 vs. 13.8 months; P = .039). The majority (n = 11) of patients with LRD were treated with concurrent chemoradiation therapy, and 10 underwent surgical resection of the primary tumor. The majority (13/15) of patients with LRD progressed, with the majority (11/15) of progressions being distant. The median progression-free survival for patients with LRD was 5.7 months (1-year progression-free survival, 26.7%). Anorectal NEC is an aggressive malignancy with poor prognosis requiring multidisciplinary discussion. In addition, the systemic nature of anorectal NEC with distant recurrences in LRD and poor outcomes in metastatic disease emphasizes the need to further develop better systemic treatment options that can potentially improve outcomes in NEC. Anorectal neuroendocrine carcinoma is a rare, aggressive malignancy. The median overall survival of patients with locoregional disease in this study was 18 months, with significantly shorter overall survival of 14 months in patients with metastatic disease. The median progression-free survival was 6 months in patients with metastatic disease treated with chemotherapy (either etoposide/platinum or fluoropyrimidine regimens) with or without radiation therapy. Further study is warranted to determine the optimal multidisciplinary approach to treatment.