Intraoperative irradiation for locally advanced primary and recurrent rectal cancer

Encouraging trends exist for improvements in local control and possibly survival when IOERT is added to standard treatment (external irradiation, chemotherapy, resection) for locally advanced primary and recurrent rectal cancers. Disease control within the IOERT and external beam fields is decreased, however, when gross total resection cannot be accomplished. Therefore, 5-Fluorouracil (± other drugs) should consistently be considered during EBRT, and clinical trials should be undertaken to evaluate dose modifiers in conjunction with IOERT (sensitizers, hyperthermia, etc.). Since the incidence of distant metastases is excessive in patients with locally advanced primary and recurrent rectal cancers, maintenance, as well as concomitant chemotherapy, should be evaluated as a component of the aggressive treatment approaches discussed in this article.