Preoperative radiation therapy followed by local excision

Radiation therapy followed by local excision results in local control rates that appear comparable to those of local excision alone (in highly selected patients) or local excision followed by adjuvant radiation therapy. A significant drawback of this approach, however, is the potential loss of important histological information, such as risk of lymph node metastasis, depth of tumor penetration, and presence of lymphatic or vascular invasion. Radiation therapy followed by local excision may be an option for treatment of more advanced T3 rectal cancers in patients who either refuse radical surgery or are medically unfit. The available data in the literature do not support the routine use of locals excision after radiation therapy in otherwise healthy patients with locally advanced rectal cancer.