title: Treatment of Locally Recurrent Rectal Carcinoma in Previously (Chemo)Irradiated Patients: A Review.
abstract: BACKGROUND
  Local recurrence after rectal cancer treatment occurs in ≈5% to 10% of patients. Neoadjuvant (chemo)radiotherapy for primary rectal cancer renders treatment of recurrent disease more difficult.
  
  
  OBJECTIVE
  The purpose of this study was to review contemporary multimodality therapies, including their outcome, for locally recurrent rectal carcinoma after (chemo)radiotherapy and complete surgical resection of primary rectal cancer.
  
  
  METHODS
  A comprehensive literature search of PubMed and EMBASE was performed.
  
  
  METHODS
  All English language articles presenting original patient data regarding treatment and the respective outcome of previously irradiated locally recurrent rectal cancer were included.
  
  
  METHODS
  All of the treatment modalities for locally recurrent rectal cancer were reviewed.
  
  
  METHODS
  Primary outcome parameters were local control, metastasis-free survival, and overall survival. Secondary outcome parameters were perioperative morbidity and mortality, and prognostic factors for treatment outcome.
  
  
  RESULTS
  Of 854 studies, 9 studies and 474 patients with locally recurrent rectal carcinoma were included. Various treatment regimens were used, most with curative intent. Reirradiation was composed of (neo-)adjuvant external beam radiotherapy (with or without concurrent chemotherapy), additional intraoperative radiotherapy, or intraoperative radiotherapy only. Surgical technique highly varied, depending on the extent of the lesion. Radiation toxicity, perioperative morbidity, and mortality were generally acceptable. Outcome was better after curative intent treatment, any surgical resection, and R0 resections in particular. Moreover, reirradiation is associated with increased complete resection rates, which in turn positively affected local control and overall survival.
  
  
  CONCLUSIONS
  Most studies were retrospectively designed, with highly variable therapies, patient populations, and duration of follow-up.
  
  
  CONCLUSIONS
  A complete resection is the most important prognostic factor and should be the goal of treatment in locally recurrent rectal carcinoma. Reirradiation seems safe and of additional value in reaching a complete resection. Considering the available evidence, at present reirradiation should be given on a case-specific basis, with all of the patients entering an international prospective database.
authors.affiliation: 1 Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 2 Department of Radiotherapy, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Wout
authors.initials: W
authors.lastname: van der Meij
authors.forename: Anouk J M
authors.initials: AJ
authors.lastname: Rombouts
authors.forename: Heidi
authors.initials: H
authors.lastname: Rütten
authors.forename: Andre J A
authors.initials: AJ
authors.lastname: Bremers
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
mesh_terms: D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy