Reirradiation combined with chemotherapy for patients developing recurrent rectal cancer after radiation or chemoradiation 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-year) 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. The use of small radiation fields, exclusion of the bowel and bladder, and the 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. 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 Small Bowel Obstruction Late Toxicity Circumferential Resection Margin Stereotactic Radiation Therapy
- Alberda WJ, Verhoef C, Nuyttens JJ, Rothbarth J, van Meerten E, de Wilt JH, Burger JW (2014) Outcome in patients with resectable locally recurrent rectal cancer after total mesorectal excision with and without previous neoadjuvant radiotherapy for the primary rectal tumor. Ann Surg Oncol 21(2):520–526. doi: 10.1245/s10434-013-3306-x CrossRefPubMedGoogle Scholar
- Dicle O, Obuz F, Cakmakci H (1999) Differentiation of recurrent rectal cancer and scarring with dynamic MR imaging. Br J Radiol 72:11559Google Scholar
- Haddock MG, Gunderson LL, Nelson H, Cha SS, Devine RM, Dozois RR, Wolff BG (2001) Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients. Int J Radiat Oncol Biol Phys 49:1267–1274Google Scholar
- Huebner RH, Park KC, Shepherd JE et al (2000) A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 41:117789Google Scholar
- Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, et al., German Rectal Cancer Study Group (2015) Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 16(8):979–89. doi: 10.1016/S1470-2045(15)00159-X
- Song CW, Lee YJ, Griffin RJ, Park I, Koonce NA, Hui S et al (2015) Indirect tumor cell death after high-dose hypofractionated irradiation: implications for stereotactic body radiation therapy and stereotactic radiation surgery. Int J Radiat Oncol Biol Phys 93(1):166–172CrossRefPubMedPubMedCentralGoogle Scholar
- Swedish Rectal Cancer Trial (1996) Local recurrence rate in a randomised multicentre trial of preoperative radiotherapy compared with operation alone in resectable rectal carcinoma. Eur J Surg 162:397–402Google Scholar
- Valentini V, van Stiphout RG, Lammering G, Gambacorta MA, Barba MC, Bebenek M et al (2011) Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol 29:3163–3172CrossRefPubMedGoogle Scholar
- van Gijn W, van Stiphout RG, van de Velde CJ, Valentini V, Lammering G, Gambacorta MA et al (2015) Nomograms to predict survival and the risk for developing local or distant recurrence in patients with rectal cancer treated with optional short-term radiotherapy. Ann Oncol 26:928–935CrossRefPubMedGoogle Scholar