Recurrent Locally Rectal Cancer

The goal for the treatment of patients with isolated local recurrence should be local tumour control, as this will determine the quality of the remaining life. Negative predictors of poor prognosis in case of recurrence are: elevated CEA level, APR as primary surgery and male sex. Relapse after APR is often unre-sectable as it occurs in a pattern of diffuse pelvic cancer or laterally situated masses invading the pelvic sidewall. In addition, the smaller anatomical margins in males diminish the chance of curative resection [93]. In resectable rectal cancer recurrence, LAR, Hartmann's procedure or APR are surgical options preferred, in fit patients, where local clearance is possible and expectation of life is reasonably good.

RT alone (50 Gy) or combined with chemotherapy permits salvage surgery in selected cases of patients with isolated pelvic recurrence.

Authors reported good response to multimodality treatment in patients with advanced pelvic recurrence who underwent RT (45 Gy), concomitant infusion of 5-FU and mitomycin C, IORT (10-15 Gy) and surgery. Radical resection rate was 45% and 5-year overall survival 22% [94].

Pelvic exenteration is an option, although controversial, affected by a high morbidity rate (median survival of 20 months) [95].

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