Chemo-Re-Irradiation and Salvage Surgery for Locally Recurrent Rectal Cancer

2][3][4] Pelvic tumor control and overall survival rates for recurrent rectal cancer are poor with surgery alone.If there is concern for close or positive margins, pelvic re-irradiation may be offered.Intraoperative radiation therapy is also an option at some centers, which may decrease the risk of local tumor recurrence. 5,6n this issue of Annals of Surgical Oncology, Dijkstra et al. reported on the safety and feasibility of (re)-irradiation in patients with recurrent rectal cancer previously treated with surgery ± pelvic irradiation. 7Patients with recurrent rectal cancer treated with salvage surgery were identified, and outcomes were compared between patients treated with prior pelvic radiation (re-irradiation cohort) and radiation-naı ¨ve patients (chemoradiation cohort).All patients were treated with daily conventional fractionated three-dimensional (3D) conformal radiation therapy and concurrent radiation-sensitizing capecitabine.Radiationnaı ¨ve patients were treated with 50 Gy (n = 26), whereas re-irradiation patients were treated with an attenuated dose of 30 Gy (n = 35).Surgical resection was approximate-ly12 weeks post completion of chemoradiation, and intraoperative radiation was permitted if there was concern for a close or positive surgical margin.There were no