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NCCN Guidelines for Patients



Rectal Cancer, Version 1.2017


Nonmetastatic cancer

Local recurrence

Local recurrence

Guide 9

lists the treatment options for local

recurrences. Local recurrence may occur in the

rectum or close to where the rectum was. Options

are grouped by whether you can have surgery or not.

If the cancer is small enough, your first treatment

may be surgery. Chemoradiation should follow. If

the cancer is large, you may have chemoradiation

first followed by surgery. IORT may be added. If

surgery isn’t an option, chemotherapy with or without

radiation may be received.

For chemoradiation, capecitabine or infusional 5-FU

is preferred. The side effects of these regimens may

be too much for you. In this case, bolus 5-FU/LV may

be received.

I had surgery, radiation,

chemotherapy, and more surgeries.

Obviously, it was not a walk in

the park. I met a woman my age

who had the same cancer, same

treatments and doctors I had,

only she was diagnosed 6 months

prior to me. Talking with her was

extremely beneficial for the both of



Survivor, Stage III

Guide 9. Local recurrence

Surgery status

What are the options?

You may be able

to have surgery


• Transabdominal resection


• Capecitabine or infusional 5-FU

+ radiation

• Bolus 5-FU/LV + radiation


• Capecitabine or infusional

5-FU + radiation

• Bolus 5-FU/LV + radiation


• Transabdominal resection ± IORT

You will likely not

be able to have



• Chemotherapy ± radiation therapy