Isolated locally recurrent rectal cancer: a review of incidence, presentation, and management.
Locoregional recurrence after treatment for rectal cancer may be largely prevented by wide pelvic surgical margins, adjuvant radiotherapy, and chemotherapy. Approximately half of these recurrences will present with recurrence only at the surgical site; one third to one half will be resectable with conventional surgical procedures, but the rest will require extended resections, including sacrum and hypogastric vessels, to achieve clean margins. Only a small fraction of those treated will be cured. There is no proof that radiotherapy or chemotherapy added to surgical excision afford better results, since no trials have been or are likely to occur, given the rarity of the situation. However, best results seem to follow multimodality therapy using complete surgical resection and radiotherapy (IORT or brachytherapy with or without teletherapy) with chemopotentiation. Yet, there is no multimodality series with a sufficient number of patients and follow-up period to be able to distinguish the actual value of the treatment and which patients are most likely to benefit. It is important to note that there will be some patients with second LRR who can be further aided by aggressive locoregional therapy.
Hoffman
J P
JP
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111.
Riley
L
L
Carp
N Z
NZ
Litwin
S
S
D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D011182:Postoperative Care; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D015625:Tissue Expansion Devices