AGGRESSIVE MULTIMODALITY TREATMENT FOR LOCALLY ADVANCED IRRESECTABLE RECTAL-CANCER

Background Local failure rates are high for locally irresectable prima ry or recurrent colorectal cancer, even when chemoradiation therapy is employed. Aim This review evaluates evidence supporting aggressive pr eoperative chemoradiation followed by maximal surgical resection and i ntraoperative radiation therapy to achieve disease control and cure fo r patients with locally advanced irresectable primary or recurrent rec tal cancer. Results A 5-year survival rate of 42 per cent with a centr al failure rate of 2 per cent may be achieved in patients with locally irresectable primary rectal cancer. In patients with locally recurren t disease, these values at 5 years are 18 and 28 per cent respectively . The 5-year incidence of distant metastasis remains high, affecting 6 4 per cent of patients with primary cancer and 75 per cent of those wi th recurrent cancer. Conclusion A disease-free surgical resection marg in remains paramount to achieve cure. Encouraging trends exist, howeve r, for further evaluation of multimodality therapy as a means of reduc ing local recurrence of disease.