In the Netherlands around 10.000 patients are diagnosed with colorectal carcinoma every year, of who about 2500 have rectal carcinoma (www.oncoline.nl). It is the third most common cancer in men ... Show moreIn the Netherlands around 10.000 patients are diagnosed with colorectal carcinoma every year, of who about 2500 have rectal carcinoma (www.oncoline.nl). It is the third most common cancer in men (after prostate and lung cancer) and the second most common in women (after breast cancer). In the treatment of rectal cancer a multi-disciplinary approach is the best way to achieve optimal outcomes. Imaging, (neo)adjuvant therapy, surgery and pathology will be discussed separately to define their role in the treatment of rectal cancer. The principle investigation method of this thesis is the analysis of the patterns of local recurrence of rectal cancer. By determination of the location of locally recurrent rectal cancer on imaging and relating these to patient, treatment and tumor variables, the mechanism of local relapse genesis is reconstructed. By doing this the effect of neoadjuvant treatment, surgery, intra-operative radiotherapy and adjuvant treatment on local control can be quantified. First patterns of local recurrence are described for rectal cancer in general (Chapters 3-5) and then only for locally advanced rectal cancer (Chapters 6-7). Subsequently, the effect of preoperative evaluation of local recurrent rectal cancer on results of the multimodality treatment of local relapse is analyzed (Chapters 8-9). Show less
