Reirradiation combined with chemotherapy for patients developing recurrent rectal cancer after radiation or chemo-radiation is feasible and provides high chances for cure and palliation. Nearly one half of patients with resected disease achieve long-term control of pelvic disease and up to 65% of them can have long-term (5 years) survival. Even in unresected patients, long-term control can be achieved in about 20% of cases with one out of five patients surviving after 5 years. Acute and late toxicity are not prohibitive if proper attention is paid to both radiation technique and surgical technique. Use of small radiation fields, exclusion of bowel and bladder, use of hyperfractionated radiation doses up to 40 Gy are recommended. Since most of treatment failures occur within the radiation treatment field, future studies should investigate methods to further improve local control, such as radiotherapy dose escalation by highly conformal radiotherapy techniques or the combination of radiotherapy with newer chemotherapeutic and biological agents. In view of the fact that about one half of surviving patients will develop distant metastases, innovative strategies for reduction of distant metastases should also be explored.
KeywordsRectal Cancer Total Mesorectal Excision Preoperative Radiotherapy Late Toxicity Pelvic Exenteration
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