The pattern of recurrence and survival after treatment failure in patients with rectal cancer treated with combined modality therapy

Rectal cancer is one of the most common types of cancer. Although surgery is the cornerstone curative treatment, combined modalities with radiotherapy and or chemotherapy have been proved to be an important component of treatments for locally advanced rectal cancer including Stage II and Stage III in terms of decreased local recurrence and increased overall survival in addition to surgical resection. Although total mesorectal excision (TME) has resulted in a significant reduction of local recurrence, neoadjuvant or adjuvant radiotherapy with or without chemotherapy is still an important modality for local control in the era of TME. The definitive treatment with the combined modalities including surgery, radiotherapy, and chemotherapy have significantly improved the treatment outcomes of patients with rectal cancer but cancer recurrence of both local regional and distant is still significant (1-9). It is important to analyze the patterns of such treatment failures and to explore possible ways to reduce the rate of recurrence, to treat the recurrence, and thus to improve the survival after recurrence.