Role of Radiotherapy

  • Valentina Borzillo
  • Sara Falivene
  • Vincenzo Ravo
  • Rossella Di Franco
  • Paolo MutoEmail author
Part of the Updates in Surgery book series (UPDATESSURG)


In the treatment of locally advanced rectal cancer, neoadjuvant radiochemotherapy with total mesorectal excision (TME) significantly reduces local recurrence. Local recurrence of rectal cancer (LRRC) occurs in 5–10% of patients [1, 2, 3, 4]. LRRC represents an important clinical challenge, with significant symptoms (severe pain, rectal bleeding, discharge, and change in bowel habits), poor quality of life, and poor survival [5]. In 40–60% of patients, LRRC is the only manifestation of disease; in the remaining patients, distant metastases are detected within a median of 6 months after the diagnosis of the LRRC [6]. Prognosis is poor, with a 5-year overall survival (OS) rate of ~9%, which increases to ~57% after potentially curative (R0) surgery. Radical surgery is the only option to control this disease [7, 8]. However, curative R0 resection can be achieved in only about 20–30% of all patients with LRRC [1]. In addition, it is important to select patients carefully for radical surgery due to high postoperative morbidity (15–68%) [9, 10, 11, 12] and mortality [13, 14, 15, 16] rates. Radiotherapy is an effective approach for relieving symptoms and improving local control (LC) in patients with LRRC.


Overall Survival Rectal Cancer Total Mesorectal Excision Stereotactic Body Radiotherapy Local Control Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Bouchard P, Efron J (2010) Management of recurrent rectal cancer. Ann Surg Oncol 17:1343–1356CrossRefPubMedGoogle Scholar
  2. 2.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMedGoogle Scholar
  3. 3.
    Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: Increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701CrossRefPubMedGoogle Scholar
  4. 4.
    Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): A multicentre, randomised trial. Lancet 373:811–820CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Camilleri-Brennan J, Steele RJ (2001) The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol 27:349–353CrossRefPubMedGoogle Scholar
  6. 6.
    Van den Brink M, Stiggelbout AM, Van den Hout WB et al (2004) Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. J Clin Oncol 22:3958–3964CrossRefPubMedGoogle Scholar
  7. 7.
    Sagar PM, Pemberton JH (1996) Surgical management of locally recurrent rectal cancer. Br J Surg 83:293–304CrossRefPubMedGoogle Scholar
  8. 8.
    Caricato M, Borzomati D, Ausania F, Valeri S, Rosignoli A, Coppola R (2006) Prognostic factors after surgery for locally recurrent rectal cancer: an overview. Eur J Surg Oncol 32:126–132CrossRefPubMedGoogle Scholar
  9. 9.
    Wells BJ, Stotland P, Ko MA et al (2007) Results of an aggressive approach to resection of locally recurrent rectal cancer. Ann Surg Oncol 14:390–395CrossRefPubMedGoogle Scholar
  10. 10.
    Heriot AG, Byrne CM, Lee P et al (2008) Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum 51:284–291CrossRefPubMedGoogle Scholar
  11. 11.
    Asoglu O, Karanlik H, Muslumanoglu M et al (2007) Prognostic and predictive factors after surgical treatment for locally recurrent rectal cancer: a single institute experience. Eur J Surg Oncol 33:1199–1206CrossRefPubMedGoogle Scholar
  12. 12.
    Vermaas M, Ferenschild FT, Nuyttens JJ et al (2005) Preoperative radiotherapy improves outcome in recurrent rectal cancer. Dis Colon Rectum 48:918–928CrossRefPubMedGoogle Scholar
  13. 13.
    Gunderson LL, Sosin H (1974) Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer 34:1278–1292CrossRefPubMedGoogle Scholar
  14. 14.
    Saito N, Koda K, Takiguchi N et al (2003) Curative surgery for local pelvic recurrence of rectal cancer. Dig Surg 20:192–199CrossRefPubMedGoogle Scholar
  15. 15.
    Wanebo HJ, Antoniuk P, Koness RJ et al (1999) Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 42:1438–1448CrossRefPubMedGoogle Scholar
  16. 16.
    De Wilt JHW, Vermaas M, Ferenschild FTJ et al (2007) Management of locally advanced primary and recurrent rectal cancer. Clin Colon Rectal Surg 20:255–264CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Braendengen M, Tveit KM, Berglund A et al (2008) Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol 26:3687–3694CrossRefPubMedGoogle Scholar
  18. 18.
    Rödel C, Grabenbauer GG, Matzel KE et al (2000) Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer. Dis Colon Rectum 43:312–319CrossRefPubMedGoogle Scholar
  19. 19.
    Mohiuddin M, Marks G, Marks J (2002) Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer 95:1144–1150CrossRefPubMedGoogle Scholar
  20. 20.
    Valentini V, Morganti AG, Gambacorta MA et al (2006) Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study. Int J Radiat Oncol Biol Phys 64:1129-1139CrossRefPubMedGoogle Scholar
  21. 21.
    Das P, Delclos ME, Skibber JM et al (2010) Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation. Int J Radiat Oncol Biol Phys 77:60–65CrossRefPubMedGoogle Scholar
  22. 22.
    Glimelius B (2003) Recurrent rectal cancer. The pre-irradiated primary tumour: Can more radiotherapy be given? Colorectal Dis 5:501–503CrossRefPubMedGoogle Scholar
  23. 23.
    Koom WS, Choi Y, Shim SJ et al (2012) Reirradiation to the pelvis for recurrent rectal cancer. J Surg Oncol 105:637–642CrossRefPubMedGoogle Scholar
  24. 24.
    Cai G, Zhu J, Hu W, Zhang Z (2014) Accelerated hyperfractionated intensity-modulated radiotherapy for recurrent/unresectable rectal cancer in patients with previous pelvic irradiation: results of a phase II study. Radiat Oncol 9:278CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Ellis RJ, Nag S, Kinsella TJ (2000) Alternative techniques of intraoperative radiotherapy. Eur J Surg Oncol 26(Suppl A):S25–S27PubMedGoogle Scholar
  26. 26.
    Nuyttens JJ, Kolkman-Deurloo IK, Vermaas M et al (2004) Highdose- rate intraoperative radiotherapy for close or positive margins in patients with locally advanced or recurrent rectal cancer. Int J Radiat Oncol Biol Phys 58:106–112CrossRefPubMedGoogle Scholar
  27. 27.
    Willett CG, Shellito PC, Tepper JE et al (1991) Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma. Cancer 67:1504–1508.CrossRefPubMedGoogle Scholar
  28. 28.
    Martinez-Monge R, Nag S, Martin EW (1999) Three different intraoperative radiation modalities (electron beam, high-dose-rate brachytherapy, and iodine-125 brachytherapy) in the adjuvant treatment of patients with recurrent colorectal adenocarcinoma. Cancer 86:236–247.CrossRefPubMedGoogle Scholar
  29. 29.
    Haddock MG, Miller RC, Nelson H et al (2011) Combined modality therapy including intra-operative electron irradiation for locally recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 79:143–150CrossRefPubMedGoogle Scholar
  30. 30.
    Mirnezami R, Chang GJ, Das P et al (2013) Intraoperative radiotherapy in colorectal cancer: Systematic review and meta-analysis of techniques, long-term outcomes, and complications. Surg Oncol 22:22–35CrossRefPubMedGoogle Scholar
  31. 31.
    Kim MS, Choi C, Yoo S et al (2008) Stereotactic body radiation therapy in patients with pelvic recurrence from rectal carcinoma. Jpn J Clin Oncol 38:695–700CrossRefPubMedGoogle Scholar
  32. 32.
    Defoe SG, Bernard ME, Rwigema JC et al (2011) Stereotactic body radiotherapy for the treatment of presacral recurrences from rectal cancers. J Cancer Res Ther 7:408–411CrossRefPubMedGoogle Scholar
  33. 33.
    Mantel F, Flentje M, Guckenberger M (2013) Stereotactic body radiation therapy in the reirradiation situation-a review. Radiat Oncol 8:7CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Rwigema JCM, King C, Wang PC et al (2014) Stereotactic body radiation therapy for abdominal and pelvic oligometastases: Dosimetric targets for safe and effective local control. Pract Radiat Oncol 5:e183–e191CrossRefPubMedGoogle Scholar
  35. 35.
    Barney BM, Olivier KR, Macdonald OK, et al (2012) Clinical outcomes and dosimetric considerations using stereotactic body radiotherapy for abdominopelvic tumors. Am J Clin Oncol 35:537–542CrossRefPubMedGoogle Scholar
  36. 36.
    Schulz-Ertner D, Tsujii H (2007) Particle radiation therapy using proton and heavier ion beams. J Clin Oncol 25:953–964CrossRefPubMedGoogle Scholar
  37. 37.
    Tsujii H, Mizoe JE, Kamada T et al (2004) Overview of clinical experiences on carbon ion radiotherapy at NIRS. Radiother Oncol 73(Suppl 2):S41–S49CrossRefPubMedGoogle Scholar
  38. 38.
    Koizumi M, Saga T, Yoshikawa K et al (2008) 11C-methionine-PET for evaluation of carbon ion radiotherapy in patients with pelvic recurrence of rectal cancer. Mol Imaging Biol 10:374–380CrossRefPubMedGoogle Scholar
  39. 39.
    Mobaraki A, Ohno T, Yamada S et al (2010) Cost-effectiveness of carbon ion radiation therapy for locally recurrent rectal cancer. Cancer Sci 101:1834-1839CrossRefPubMedGoogle Scholar
  40. 40.
    Yamada S, Shinoto M, Shigeo Y et al (2009) Current status and perspective of heavy ion beam therapy for patients with pelvic recurrence after primarily resected rectal cancer. Gan To Kagaku Ryoho 36:1263–1266PubMedGoogle Scholar
  41. 41.
    Combs SE, Kieser M, Habermehl D et al (2012) Phase I/II trial evaluating carbon ion radiotherapy for the treatment of recurrent rectal cancer: the PANDORA-01 trial. BMC Cancer 12:137CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Valentina Borzillo
  • Sara Falivene
  • Vincenzo Ravo
  • Rossella Di Franco
  • Paolo Muto
    • 1
    Email author
  1. 1.Radiotherapy, Department of Diagnostic Imaging, Radiant and Metabolic TherapyIstituto Nazionale Tumori - IRCCS Fondazione G. PascaleNaplesItaly

Personalised recommendations