Local Therapy Options for Recurrent Rectal and Anal Cancer: Current Strategies and New Directions

Purpose of Review: Although uncommon, locally recurrent rectal cancer (LRRC) and locally recurrent anal cancer (LRAC) after definitive chemoradiation can confer high morbidity and mortality. Although surgery is critical for management, recent studies show promising results with other locally directed and/or systemic treatment approaches. Here we review the literature to examine recent advances in management of this patient population. Recent Findings: For LRRC, studies demonstrate success with newer surgical approaches and redefine contraindications for surgery. The roles of brachytherapy, repeat external beam irradiation, and induction chemotherapy are under investigation. Advances in LRAC show that surgery remains a core element of treatment after primary chemoradiation failure. Recent reports of overall survival are promising. Summary: Surgery remains the mainstay of treatment for LRRC and LRAC, and overall survival is improving. Benefits of newer surgical, radiotherapeutic, and other treatment approaches are being elucidated. These findings pave the way for further improvements in cancer-specific outcomes and quality of life.