NEOADJUVANT chemo-reirradiation alongside IOERT surgery produced manageable toxicity, and 75.7% two-year survival in patients with locally recurrent rectal cancer (LRRC).
Why This Multimodality Approach Matters
LRRC remains challenging, particularly in patients who have previously received radiotherapy and may face limited local options. A retrospective institutional analysis evaluated a multimodality strategy designed to improve resectability while balancing concerns about cumulative toxicity. The approach combined neoadjuvant chemo-reirradiation with extensive surgery and intraoperative electron beam radiotherapy.
Investigators reviewed patients treated between September 2021 and December 2024. The cohort included 40 patients who underwent chemo-reirradiation followed by resection with IOERT. Reported outcomes focused on acute and late treatment related toxicity graded by CTCAE, alongside overall survival and local re-recurrence-free survival. The median cumulative tumor dose was 113 Gy, using an α/β of 10 Gy.
Locally Recurrent Rectal Cancer Toxicity Profile
No grade 4 or 5 toxicities were observed, an important safety signal given prior irradiation and the intensity of combined treatment. Acute cumulative grade 3 toxicities occurred in 14 of 37 evaluable patients, representing 38%. The most frequent acute grade 3 events were erectile dysfunction in 5 of 37 patients, abscess formation in 4 of 37, and peripheral neuropathy in 2 of 37.
Late grade 3 toxicities were recorded in 13 of 30 evaluable patients, representing 43%. The most common late grade 3 events included erectile dysfunction in 5 of 30 patients, renal disorders in 5 of 30, and peripheral neuropathy in 2 of 30.
Survival and Local Control Signals
After a median follow-up of 21 months after surgery, the reported 2-year overall survival was 75.7%. Local re-recurrence-free survival at 2 years was 37.2%, reflecting ongoing local risk despite intensive therapy. The authors concluded that chemo-reirradiation plus surgery with IOERT demonstrated acceptable toxicity and favorable oncological outcomes in this high risk locally recurrent rectal cancer population, while emphasizing the need for longer follow-up to clarify toxicity risk factors.
Reference: Vande Kerckhove FEC et al. Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer. Radiat Oncol. 2025;doi:10.1186/s13014-025-02782-w.
