# Understanding Treatment Options for Locally Recurrent Rectal Cancer: A Patient's Guide to the 2026 American Radium Society Guidelines

Recurrent rectal cancer that returns in the pelvis (called locoregionally recurrent rectal cancer, or LRRC) is one of the most challenging situations in colorectal oncology, but new evidence-based guidelines from the American Radium Society provide a clear roadmap for treatment. Based on a systematic review of 116 peer-reviewed studies published between 2013 and 2025, a multi-specialty committee of experts confirmed that achieving a margin-negative surgical resection (R0) is the single most important factor for long-term survival, with 5-year survival rates ranging from 30% to 58% when successful, compared to only 0%–20% without surgery. The guidelines emphasize that an individualized, multidisciplinary approach—combining surgery, chemotherapy, radiation therapy, and sometimes intraoperative radiation—offers patients the best chance for cure, while carefully balancing quality of life and treatment risks.

# Understanding Treatment Options for Locally Recurrent Rectal Cancer: A Patient's Guide to the 2026 American Radium Society Guidelines

## Table of Contents

- Key Points
- What Is Locoregionally Recurrent Rectal Cancer (LRRC)?
- How This Guideline Was Developed (Study Methods)
- How Doctors Evaluate Suspected Recurrence (Patient Workup)
- Key Finding 1: The Central Role of Surgery
- Key Finding 2: Preoperative and Perioperative Therapy
- Key Finding 3: Nonoperative Management (NOM)
- Clinical Implications for Patients
- Limitations of This Guideline
- Recommendations for Patients
- Frequently Asked Questions
- Source Information

## Key Points

- R0 surgical resection with negative margins is the strongest predictor of long-term survival in LRRC.
- Without surgery, 5-year survival is only 0-20%; with R0 resection, it ranges from 30% to 58%.
- Neoadjuvant chemoradiation before surgery can shrink tumors and increase chances of complete resection.
- Surgery often causes a temporary decline in quality of life for 6-9 months, improving by 12 months.
- Previously considered inoperable recurrences, including sacral or pelvic sidewall involvement, may now be resectable at experienced centers.

## What Is Locoregionally Recurrent Rectal Cancer (LRRC)?

When rectal cancer comes back in the same area after initial treatment—within the pelvis, near the original tumor site—it is called locoregionally recurrent rectal cancer, or LRRC. This is different from distant metastasis, where cancer spreads to organs like the liver or lungs. LRRC is a particularly difficult situation because the patient has already undergone treatment, and the recurrence can invade nearby structures such as the sacrum (tailbone area), pelvic sidewall, or surrounding organs.

The management of LRRC is complex and can be associated with both a poor prognosis and significant treatment-related side effects. Treatment choices depend on several factors: the location and extent of the recurrence, what therapies the patient has already received, the patient's overall health and performance status, their personal goals, and the anticipated side effects of treatment.

Treatment may include surgery, chemotherapy, immunotherapy, and/or radiation therapy (RT).

In 2012, the American College of Radiology (ACR) published appropriate use criteria for recurrent rectal cancer. In 2017, oversight transitioned to the American Radium Society (ARS). This update provides patients and doctors with evidence-based guidance for managing LRRC based on all available research published through mid-2025.

## How This Guideline Was Developed (Study Methods)

A multi-specialty committee of experts from all key fields involved in LRRC care developed this guideline. The committee included colorectal surgeons, radiation oncologists, medical oncologists, surgical oncologists, gastroenterologists, and radiologists. The goal was to answer five critical questions:

1. What is the role of surgery in treating LRRC?
1. What is the role of preoperative or perioperative (around-the-time-of-surgery) therapy?
1. What is the role of nonoperative management (managing cancer without surgery)?
1. What is the role of radiation therapy or reirradiation?
1. What is the role of systemic therapy (chemotherapy/immunotherapy)?

The research team conducted a comprehensive literature search using standard systematic review methodology. A medical librarian designed and conducted searches across four major medical databases: Ovid MEDLINE (1946 to present), Ovid Embase (1974 to present), the Cochrane Database of Systematic Reviews (2005 to present), and Scopus (1970 to present). The search covered studies published between **January 1, 2013, and July 16, 2025**, and was limited to English-language studies involving more than 25 patients.

Here is how the evidence was assembled:

- 244 articles were initially identified through the search strategy
- 80 articles met all inclusion criteria after screening
- 23 additional studies were added through "backward citation searching" (finding important studies cited in the reference lists of the articles already found)
- 13 of the original 43 citations from the 2012 bibliography were retained because they still contributed meaningful evidence
- 9 additional studies were included for context but did not directly guide recommendations
-
**116 peer-reviewed trials** ultimately served as the evidence base

The quality of the evidence varied considerably. Of the 116 references:

-
**10 were well-designed randomized phase 2/3 trials** (the strongest type of evidence)
-
**29 were moderately well-designed studies** that accounted for most common biases (matched cohort studies and phase 2 trials)
-
**76 had design limitations** (retrospective reviews, which look back at past patient records)
-
**1 was a meta-analysis** (a statistical combination of multiple studies)

To rate treatment options, the committee used the well-established **RAND/University of California Los Angeles (UCLA) consensus methodology, also known as the modified Delphi method**. The expert panel completed two rounds of voting. Each treatment option was placed into one of three categories: (1) usually not appropriate, (2) may be appropriate, or (3) usually appropriate.

## How Doctors Evaluate Suspected Recurrence (Patient Workup)

When a patient is suspected of having LRRC, doctors use a multi-step approach that combines physical assessment, blood tests, and advanced imaging. A detailed history and physical examination is essential, with particular attention to new pelvic pain, changes in bowel habits, urinary or gynecological symptoms, bleeding, or pelvic nerve-related symptoms (such as pain shooting down the leg) that often accompany recurrent disease.

**Blood tests:** Doctors routinely check serum carcinoembryonic antigen (CEA), a tumor marker. Rising CEA levels can be an early warning sign of recurrence, although normal CEA levels do not completely rule out disease. Circulating tumor DNA (ctDNA)—fragments of tumor DNA found in the blood—is also emerging as a promising tool for evaluating suspected recurrence.

**Endoscopy:** Flexible sigmoidoscopy or colonoscopy allows doctors to directly examine the surgical anastomosis (where the colon was reconnected) or the rectal stump, take biopsies of suspicious lesions, and check for other abnormalities.

**Biopsy confirmation:** For recurrences at the pelvic sidewall or presacral area that cannot be reached with an endoscope, a CT-guided biopsy is used to confirm the diagnosis.

**Imaging:** Imaging plays a crucial role in determining the extent of disease and whether surgery is feasible.

-
**High-resolution pelvic MRI** is the preferred imaging method. It provides superior soft tissue detail, allowing doctors to see the full extent of disease, including presacral or sacral involvement, pelvic sidewall extension, potential invasion of nearby organs, and spread along sacral nerves or the lumbosacral plexus. Specialized MRI protocols with gadolinium contrast may be needed to fully define nerve involvement or the degree of sacral involvement.
-
**Contrast-enhanced CT** of the chest, abdomen, and pelvis is used to check for distant metastases, particularly in the liver and lungs.
-
**FDG-PET/CT or FDG-PET/MRI** may be used to distinguish between postoperative scar tissue (fibrosis) and active tumor, detect hidden metastatic sites, and guide surgical planning.

Doctors also look for specific patterns that affect surgical approach: points where the tumor may be fixed to pelvic structures, compromised surgical margins, and which anatomic compartments are involved.

## Key Finding 1: The Central Role of Surgery

Surgery remains one of the most complex areas in colorectal oncology. The central goal is achieving an **R0 resection**—meaning the tumor is completely removed with negative surgical margins (no cancer cells at the edge of the removed tissue). This goal must be balanced against substantial patient-, tumor-, and treatment-related considerations.

### What Determines Whether Surgery Is Possible?

Patient selection is fundamental. Doctors consider the biology of the disease, patterns of spread, and the overall goal of treatment. Recurrence that appears early after primary therapy—especially within the first 1–2 years—often reflects aggressive tumor biology. Elevated or rising CEA levels correlate with a higher risk of distant metastasis, which affects treatment decisions.

Patient performance status also matters. Some procedures, such as pelvic exenteration (removal of the rectum along with nearby organs like the bladder or reproductive organs), can place a significant burden on physical function and quality of life. This risk must align with the patient's goals of care.

### How Doctors Classify Recurrences

Over the decades, classification systems for LRRC have evolved. Early systems, such as those by Pilipshen and Suzuki, focused on the **degree of fixation**—how firmly the tumor was attached to surrounding structures. Suzuki's classification characterized tumors by number of fixation points: no points, one site, two sites, or three or more sites (possible points being posterior, pelvic sidewalls, or anterior). This system showed that fixation to the sacrum, pelvic sidewall muscles, or major blood vessels strongly predicted the difficulty of achieving a complete resection.

However, these fixation-based approaches had limitations: they were subjective and did not distinguish between different anatomic compartments. Modern classification systems—enabled by high-resolution MRI—divide recurrences into three compartments:

-
**Central/anterior recurrences:** These are the least technically demanding and have the highest probability of R0 resection.
-
**Posterior recurrences:** These involve the sacrum and are more challenging.
-
**Lateral recurrences:** These involve the pelvic sidewall structures (nerves, blood vessels, and muscle) and are substantially more difficult to resect completely.
-
**Composite recurrences** (involving multiple compartments) may require multi-stage approaches by experienced cross-disciplinary surgical teams.

Sorrentino and colleagues validated that these compartment-based systems outperform earlier classifications in predicting whether an R0 or R1/R2 (positive margin) resection will be achieved, reinforcing their value in contemporary pre-surgical planning.

### Surgery Is the Only Potential Cure

Regardless of the scenario, surgery is generally considered the **only potentially curative treatment** for LRRC, particularly when prior radiation therapy has already been given. Long-term survival depends directly on the ability to achieve an R0 resection.

Comparative studies strongly support this principle. When patients do not undergo surgery, outcomes are poor:

- Across multiple series, nonoperative management strategies have 5-year overall survival (OS) rates of only **0%–20%**

- Population-based data from Norway show that patients who do not undergo resection experience a median survival of approximately **5–14 months**, with a 5-year survival of only **3% after radiation alone**

- Hagemans et al., in one of the largest modern series, found that nonsurgically managed patients had a 5-year survival of only **4%**, compared with **51%** in patients who underwent R0 surgical resection

### Survival After Successful R0 Resection

When R0 resection is achieved, 5-year overall survival commonly ranges from **30% to 50%**. Some contemporary series that use intraoperative radiation therapy (IORT) report survival approaching **55%–60%** in select patients. Specific study results include:

- Kusters et al. reported a 5-year OS of **58%** with R0 resection
- Denost et al. reported a 5-year OS of **35%** after R0 resection
- Dresen et al. reported a 5-year OS of **48%** after R0 resection in patients treated with multimodality therapy incorporating IORT. Patients who had R1/R2 resections (positive margins or residual gross disease) had substantially worse outcomes (hazard ratio, 2.11; 95% CI, 1.37–3.24; p = .001)
- Haddock et al. examined combined-modality therapy with intraoperative electron radiation (IOERT). They reported a 3-year local control of **77%** and a 5-year OS of **46%** in those who underwent R0 resection. Survival was substantially lower after R1 resection (**27%**) or R2 resection (**16%**)

### What Was Once Considered Hopeless May Now Be Treatable

Historically, certain patterns of disease spread were considered unresectable because of prohibitive surgical risk, high postoperative complications, or technical limitations. These included recurrent disease extending above the third sacral body (S3), unilateral or bilateral pelvic sidewall involvement, and invasion of major blood vessels such as the external iliac vessels or the aortoiliac axis.

However, contemporary series challenge these assumptions. Modern data show that en bloc vascular resection and reconstruction—including of the aortoiliac axis—can be performed safely in experienced centers and may achieve meaningful long-term survival in select patients. Similarly, sacropelvic resections that include high sacrectomy (above S3) have been demonstrated to be feasible and safe. Experienced centers report low surgical mortality, acceptable complication rates, and encouraging cancer outcomes in selected patients.

The message: tumor location and extent once viewed as absolute contraindications to surgery may now be selectively considered for curative-intent resection through multidisciplinary coordination involving chemotherapy, radiation, advanced surgical and reconstructive techniques, and refined perioperative care.

### The Risks and Quality of Life Considerations

LRRC is a highly morbid disease, and the treatments themselves carry significant side effects. The most common surgical complications include wound infection, abscess, or fistula (an abnormal connection between organs) that may require additional surgery, bleeding, bowel obstruction, ureteral obstruction, and neuropathy (nerve damage).

The risks are directly related to the extent of the operation. Sacrectomy, pelvic exenteration, and lateral/sidewall recurrences are generally more challenging and carry greater risk. An international multicenter cohort study proposed benchmark thresholds for quality assessment: a major complication rate of **≤53%** and a 90-day mortality rate of **≤6%**.

Studies evaluating patient-reported quality of life before and after surgery for LRRC found several important patterns:

- Patients who have surgery for LRRC experience poorer quality of life for between **6 and 9 months** after surgery compared to their baseline
- Those managed without surgery have better quality of life for the first 6 months, but after that point, patients who had surgery report better quality of life
- R0 resection is associated with better quality of life beyond 12 months compared with R1 or R2 resection
- R2 resection offers no quality-of-life benefit compared with palliative nonoperative management
- Surgery is commonly associated with chronic perineal pain, significant impact on sexual and urinary function, and musculoskeletal symptoms affecting the pelvis and lower limbs—particularly in those undergoing sacrectomy
- Most patients will have a permanent stoma (colostomy)

Additionally, surgery has a significant impact on financial and occupational status, often limiting a patient's ability to return to work.

Surgery for LRRC is therefore a high-risk but potentially curative intervention. Outcomes depend on careful patient selection, anatomic classification, prior therapy, and the feasibility of achieving negative margins. The guiding principle: survival benefit is maximized when R0 resection is achievable. These approaches should only be considered when patients fully understand the risks and benefits and remain aligned with their goals and wishes.

## Key Finding 2: Preoperative and Perioperative Therapy

Because achieving an R0 surgical resection is by far the most important prognostic factor for long-term survival, the role of preoperative (neoadjuvant) therapy is primarily to help make that goal possible. Treatment given before surgery—chemotherapy, radiation therapy, or a combination—can shrink the tumor and improve the likelihood of achieving a margin-negative resection.

One important finding comes from a study by Alberda and colleagues, which suggests that LRRC within a previously irradiated field is **less responsive to systemic therapy** than distant metastases outside the radiation field. This is likely because prior radiation changes the tumor's environment and blood supply, making it harder for chemotherapy to reach the cancer cells. This also explains why it can be difficult to deliver sufficient postoperative therapy after surgery, as complications may delay or prevent additional treatment.

Although no randomized controlled trials currently exist specifically comparing neoadjuvant treatment versus upfront surgery for LRRC, the use of neoadjuvant therapy—primarily radiation—has been associated with improved outcomes in multiple studies:

-
**Tang et al.** conducted a retrospective study of 71 patients with LRRC and found that the combination of chemoradiation (CRT) and surgery was associated with improved progression-free survival (PFS) compared with patients treated with surgery alone or with chemotherapy/CRT without surgery
- Larger series from the **Cancer Registry of Norway**, the **Mayo Clinic**, and the **Catharina Hospital in the Netherlands** all demonstrate that neoadjuvant radiation combined with surgery provides the best opportunity to achieve an R0 resection and the potential for cure
- Dresen et al. (discussed above) confirmed the benefit of multimodality therapy incorporating intraoperative radiation therapy (IORT)

The key principle: **combining treatments works better than any single approach**. Radiation or chemoradiation before surgery can downstage the tumor, making an otherwise borderline-resectable tumor fully removable.

## Key Finding 3: Nonoperative Management (NOM)

Nonoperative management—meaning treating cancer with radiation and/or chemotherapy alone, without surgery—has gained momentum for primary rectal cancer, especially in patients who achieve a complete clinical response. However, the situation is different for patients with LRRC, who often present with disease that is more technically challenging or not amenable to resection.

The evidence for NOM in LRRC is limited and largely retrospective. Key findings include:

-
**Sorrentino et al.** demonstrated that in patients with LRRC receiving neoadjuvant treatment, a pathologic complete response (pCR)—meaning no cancer cells found in the surgical specimen—was associated with improved 5-year overall survival and a trend toward improved 5-year local recurrence-free survival. However, the pCR rate was only **16%**. This means the vast majority of patients did not achieve a complete response.
-
**Nordkamp et al.** reported similar results in a cohort of **345 patients** with LRRC, where **15%** of patients had a pCR, which was associated with more favorable outcomes. They suggested that a NOM approach might be considered in select patients.
- Based on radiographic response, LRRC appears to be **more radioresistant** (less responsive to radiation) than primary rectal cancer.
- In the multicenter phase 2 study by **Valentini et al.** investigating hyperfractionated reirradiation for patients with LRRC, completion of an R0 resection was independently associated with favorable local control and disease-free survival (DFS).
-
**Hagemans et al.** found **no difference in overall survival** between patients with LRRC who underwent an R2 resection (leaving gross disease behind) versus those who were managed nonsurgically.

The current evidence favors an R0 surgical resection as the only feasible means to achieve long-term local control and cure. However, in patients where an R0 or R1 resection cannot be achieved, NOM may be a reasonable consideration—and importantly, patients who have incomplete surgery (R2) do not appear to fare better than those who skip surgery entirely in terms of overall survival.

## Clinical Implications for Patients

What does all of this mean for you or a loved one facing LRRC? Several important messages emerge from this comprehensive review.

**First, surgery offers the best chance for long-term survival.** The data are remarkably consistent: patients who achieve a complete (R0) surgical resection have 5-year survival rates of 30%–58%, while those who do not have surgery face survival rates of only 0%–20% at 5 years. Even a nearly complete surgery (R1) or incomplete surgery (R2) offers much less benefit than a complete resection.

**Second, a team approach is essential.** The committee emphasizes that an individualized, multidisciplinary approach—involving surgeons, radiation oncologists, medical oncologists, gastroenterologists, and radiologists—is required to ensure the best outcome. No single specialist can optimize care for this complex disease. If you are diagnosed with LRRC, seek care at a center with experience in this area, particularly one that offers advanced surgical techniques and intraoperative radiation therapy (IORT).

**Third, treatment before surgery matters.** Neoadjuvant chemoradiation can shrink tumors and increase the odds of achieving that crucial R0 resection. Although randomized data are lacking, the consistent findings across major centers support this approach.

**Fourth, quality of life matters—and it improves over time.** Surgery is hard, and quality of life typically declines for 6–9 months after the operation. But by 12 months, patients who had successful surgery generally report better quality of life than those who did not. This is important context when making treatment decisions: the short-term hardship of recovery can lead to long-term benefit.

**Fifth, hope exists for previously "inoperable" cases.** Advances in surgical technique mean that some recurrences once considered untreatable—such as those involving the sacrum above S3 or the pelvic sidewall—may now be surgically removed at experienced centers. If one center tells you surgery isn't possible, it may be worth getting a second opinion at a high-volume referral center.

**Finally, although this guideline does not suggest a major change from current practice, it provides reassuring evidence of the importance of combined-modality therapy.** The committee's rigorous review confirms that the treatment paradigm—surgery at the center, supported by radiation and chemotherapy—is the right one.

## Limitations of This Guideline

It's important to understand what this guideline can and cannot tell you. The evidence base for LRRC is not as strong as for primary rectal cancer. Of the 116 studies used, only 10 were well-designed randomized phase 2/3 trials. The majority (76 studies) were retrospective reviews, which can be subject to bias. There were 29 moderately well-designed studies (matched cohort and phase 2 trials) and 1 meta-analysis.

Several specific limitations should be noted:

-
**No randomized controlled trials exist** directly comparing neoadjuvant treatment versus upfront surgery for LRRC, so the recommendation for preoperative therapy relies on consistent but non-randomized evidence.
-
**Heterogeneity across studies:** Studies varied widely in terms of prior treatments patients had received, the location and extent of recurrences, and the specific treatments used, making direct comparisons difficult.
-
**Selection bias:** Patients who undergo surgery (especially R0 resection) tend to be healthier and have less extensive disease than those who don't, which may partly explain their better outcomes.
-
**The article's discussion of immunotherapy and specific systemic therapy details** (including the role of dMMR—deficient mismatch repair—as a biomarker) was in progress at the time this practice summary was compiled; patients should discuss the latest immunotherapy options with their oncologist.
-
**Quality of life data** come from a limited number of series and may not reflect all patient experiences.

Despite these limitations, the committee's confidence in its core recommendations is strengthened by the consistency of findings across many different studies, institutions, and countries.

## Recommendations for Patients

Based on this comprehensive guideline review, here is actionable advice for patients and families facing LRRC:

1.
**Seek care at a multidisciplinary, high-volume cancer center.** Look for a team that includes colorectal surgeons, radiation oncologists, medical oncologists, and radiologists who regularly manage recurrent rectal cancer. Ask about their experience with complex pelvic surgery, sacrectomy, and intraoperative radiation therapy (IORT).
1.
**Get a complete evaluation before making decisions.** This should include a thorough physical exam, CEA blood test, colonoscopy or flexible sigmoidoscopy with biopsy, high-resolution pelvic MRI, CT of the chest/abdomen/pelvis, and possibly a PET/CT scan. This ensures the full extent of disease is understood.
1.
**Discuss neoadjuvant (preoperative) therapy.** Ask whether chemotherapy, radiation therapy, or chemoradiation before surgery could improve your chances of a complete (R0) resection. This is often recommended, especially if you have not previously had pelvic radiation.
1.
**Understand the goal of surgery.** The ultimate goal is an R0 resection—removing all cancer with clear margins. Ask your surgeon about the likelihood of achieving this, the specific operation planned, and what the recovery will involve.
1.
**Have honest conversations about the risks and benefits.** Surgery for LRRC carries significant risks, including wound infections, fistulas, bleeding, nerve damage, and the likely need for a permanent stoma. Make sure you understand these risks and how they align with your personal goals and values.
1.
**Ask about quality of life expectations.** Expect a difficult recovery period of 6–9 months. Know that the long-term benefit—in terms of both survival and quality of life—favors those who achieve a complete resection.
1.
**If you are told surgery is not possible, consider a second opinion.** Advances in surgical techniques mean that some previously inoperable recurrences can now be treated at specialized centers. Recurrences involving the sacrum above S3 or the pelvic sidewall are no longer absolute contraindications at experienced centers.
1.
**If surgery truly is not feasible, nonoperative management is still an option.** While it offers lower chances of long-term cure, it may provide symptom control and quality-of-life benefits. Ask about clinical trials, including trials of immunotherapy (especially if your tumor has dMMR/MSI-H status—ask your doctor about biomarker testing).
1.
**Be an active participant in shared decision-making.** The guidelines emphasize that treatment should align with "patient goals, performance status, and anticipated treatment morbidities." Only you can weigh the value of aggressive treatment against its impact on your life.

## Frequently Asked Questions

### What is locoregionally recurrent rectal cancer (LRRC)?

LRRC means rectal cancer has returned in the same area after initial treatment, within the pelvis near the original tumor site. This is different from cancer spreading to organs like the liver or lungs. It can invade nearby structures such as the sacrum, pelvic sidewall, or surrounding organs, making treatment complex.

### What is the single most important factor for long-term survival in LRRC?

Achieving a margin-negative surgical resection, called R0 resection, is the most important factor. This means the entire tumor is removed with no cancer cells at the edge of the tissue. Studies show 5-year survival rates of 30% to 58% with R0 resection, compared with only 0% to 20% without surgery.

### What treatments are given before surgery for LRRC?

Neoadjuvant therapy, given before surgery, may include chemotherapy, radiation therapy, or both. Its main purpose is to shrink the tumor and improve the chance of achieving an R0 resection. Although no randomized trials directly compare this approach, many studies from major centers support combining preoperative radiation with surgery.

### What is nonoperative management (NOM) for LRRC and when might it be used?

Nonoperative management treats cancer with radiation and/or chemotherapy alone, without surgery. For LRRC, evidence is limited. It may be considered when an R0 or R1 resection cannot be achieved. Importantly, patients having incomplete surgery (R2) do not appear to live longer than those who skip surgery entirely.

### What are the risks and quality-of-life effects of surgery for LRRC?

Surgery carries significant risks, including wound infection, abscess, fistula, bleeding, bowel obstruction, ureteral obstruction, and nerve damage. Quality of life typically declines for 6 to 9 months after surgery, but by 12 months, patients who had successful surgery generally report better quality of life than those who did not have surgery.

### Should I get a second opinion if one center says surgery is not possible?

Yes. Advances in surgical technique mean that some recurrences once considered untreatable, such as those involving the sacrum above S3 or the pelvic sidewall, may now be surgically removed at experienced centers. If one center tells you surgery isn't possible, it may be worth seeking a second opinion at a high-volume referral center.

## Source Information

**Original article title:** Executive summary of American Radium Society Appropriate Use Criteria for the treatment of locoregionally recurrent rectal cancer.

**Authors:** Miller ED, Jethwa KR, Dozois E, Jin Z, Abood G, Akselrod D, Attallah J, Codipilly DC, Anker CJ, Hallemeier CL, Hassett LC, Kennedy T, Lee P, Ling DC, Newman NB, Sharma N, Small W, Tchelebi L, Russo S.

**Publication:** Cancer (Wiley Periodicals LLC on behalf of American Cancer Society), 2026; e70464. DOI: 10.1002/cncr.70464

**Received:** March 10, 2026 | **Revised:** April 23, 2026 | **Accepted:** April 30, 2026

**Note:** This patient-friendly article is based on peer-reviewed research published in a major oncology journal. It is intended for educational purposes and does not replace individualized medical advice from your healthcare team. Always discuss your specific situation with qualified medical professionals. The original article is open access under the terms of the Creative Commons Attribution-NonCommercial License.


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