The use of intraoperative radiation therapy in the management of locally recurrent rectal cancer

Locally recurrent rectal cancer (LRRC) is associated with substantial tumor- and treatment-related morbidity. Curative-intent surgical resection is challenging, and when used as a single modality, the results have been poor. Durable local control (LC) and long-term overall survival (OS) may be achieved with combined modality therapy including radiotherapy (RT), chemotherapy, and surgical resection. RT dose escalation utilizing intra-operative RT (IORT), when combined with external beam RT (EBRT), may offer improved LC particularly for those who have undergone sub-total resection. Curative treatment options are still feasible in patients who experience LR following previous pelvic RT, with data supporting the safety and efficacy of EBRT, surgery, and IORT as long as clinicians are cognizant of repeat RT exposure to small bowel. Advancement in patient selection, RT treatment techniques, and systemic therapies offer an interesting opportunity to improve outcomes for patients with LRRC and should be evaluated further in prospective studies.