This thesis focused on several aspects to further improve locally advanced and recurrent rectal cancer management. During last decade, rectal cancer treatment has shifted increasingly towards a personalized treatment depending on the local tumor and the presence of distant metastases. A multimodality treatment can result in relatively good long-term outcomes for both Locally advanced rectal cancer (LARC)and locally recurrent rectal cancer (LRRC). This thesis aimed to further improve the multimodality treatment in order to offer patients the best oncological care.
Briefly, the first part of this thesis, focusing on staging, showed a beneficial effect of restaging by thoraco-abdominal CT-scan after (chemo-)radiotherapy. It resulted in newly discovered distant metastases altering treatment in a substantial number of patients. Unfortunately, the beneficial effect of adding DCE sequences to local restaging by MR imaging after (chemo-)radiotherapy was limited.
The second part, which focused on LARC, suggested that applying IORT leads to improved local control in patients with a microscopically involved circumferential resection margin (CRM). Furthermore, the treatment of cT4 rectal cancer in high volume cT4 hospitals may lead to an improved overall survival, while the effect of the hospital volume in cT1-3 rectal cancer is limited.
The third part, focusing on LRRC, demonstrated that patients with local recurrences after previous pelvic radiotherapy and TME surgery should also be considered candidates for curative surgery. Additionally, it showed that complete resections with close margins between 0-2mm have a poorer outcome than wider resection margins of >2mm and that the effect of systemic therapy on the local recurrence in previously irradiated area was limited.

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C. Verhoef (Kees) , J.W.A. Burger (Jacobus)
Erasmus University Rotterdam
Department of Surgery

Alberda, W. (2018, October 17). The Multimodality Treatment of Locally Advanced and Locally Recurrent Rectal Cancer. Retrieved from