The Multimodality Treatment of Locally Advanced and Locally Recurrent Rectal Cancer

Abstract

This thesis focused on several aspects to further improve locally advanced and recurrent rectal cancer management. During last decade, rectal cancer treatment has shifted increasingly towards a personalized treatment depending on the local tumor and the presence of distant metastases. A multimodality treatment can result in relatively good long-term outcomes for both Locally advanced rectal cancer (LARC)and locally recurrent rectal cancer (LRRC). This thesis aimed to further improve the multimodality treatment in order to offer patients the best oncological care. Briefly, the _first part_ of this thesis, focusing on staging, showed a beneficial effect of restaging by thoraco-abdominal CT-scan after (chemo-)radiotherapy. It resulted in newly discovered distant metastases altering treatment in a substantial number of patients. Unfortunately, the beneficial effect of adding DCE sequences to local restaging by MR imaging after (chemo-)radiotherapy was limited. The _second part,_ which focused on LARC, suggested that applying IOR