Reirradiation in the Management of Locally Recurrent Rectal Adenocarcinoma.

Rectal cancer recurrence after prior radiotherapy presents a difficult treatment challenge. Salvage treatment can be curative, however, it often requires multimodal therapy which can come with significant treatment related morbidity. Reirradiation is a common part of treatment considerations in this setting and presents challenges in balancing appropriately aggressive therapy to improve disease control and cure rates with the addition of excess toxicity. Surgery remains the mainstay of curative salvage therapy for locally recurrent rectal cancer (LRRC) after prior radiation. Preoperative reirradiation improves R0 resection rates and local control and is associated with improved disease control outcomes. Altered fractionationation and intraoperative radiotherapy are often used to improve the therapeutic ratio in the setting of reirradiation for LRRC. Herein we discuss the evidence supporting multimodal salvage therapy for LRRC, including the importance of surgical salvage, the benefits of reirradiation, various approaches for reirradiation, and treatment associated toxicities. Finally, we provide our recommendations for how to approach reirradiation for locally recurrent rectal cancer.