Radiotherapy in recurrent and metastatic rectal cancer

Recurrent rectal cancer is more aggressive than the primary disease. Tri-modality treatments including surgery, chemotherapy (CT), and radiotherapy (RT) are effective for disease control in proper patients. Surgery may be recommended after RT for patients with good performance who have not previously received RT. Salvage therapies may be applied both with external RT and intraoperative RT. Re-irradiation is an option in selected patients who have previously received RT. Palliative RT can be applied in patients who have a poor prognosis and symptoms like pain and hemorrhage. In recent years, the disease with limited distant metastasis has been evaluated in a more curative manner with the concept of "oligo-metastatic disease. " Surgery, interventional radiology, and radiation oncology provide different options for lung and liver metastases seen synchronized with the primary disease. In radiotherapy field, while metastatic foci in a proper size and limited number may be safely ablated with stereotactic therapies, palliative radiotherapy is used more commonly in the presence of pain, fracture risk, compression, and hemorrhage in widespread disease.