Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer

F E C Vande Kerckhove; F Piqeur; E Banken; N C Morsink; D C Rijkaart; J S Cnossen; R H N Tijssen; C C A Huibregtse Bimmel-Nagel; I E G van Hellemond; J Nederend; H J T Rutten; J G Bloemen; J W A Burger; A E Verrijssen; H M U Peulen

doi:10.1186/s13014-025-02782-w

Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer

F E C Vande Kerckhove^*
, F Piqeur
, E Banken
, N C Morsink
, D C Rijkaart
, J S Cnossen
, R H N Tijssen
, C C A Huibregtse Bimmel-Nagel
, I E G van Hellemond
, J Nederend
, H J T Rutten
, J G Bloemen
, J W A Burger
, A E Verrijssen
, H M U Peulen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Chemo-reirradiation has emerged as a feasible neoadjuvant therapy to improve resectability in locally recurrent rectal cancer (LRRC). However, its combination with surgery and intraoperative electron radiotherapy (IOERT) raises concerns regarding cumulative toxicity. This retrospective study aimed to evaluate acute and late toxicity profiles, local control and survival outcomes, following this multimodal approach in our institution.

METHODS: LRRC patients who underwent chemo-reirradiation and surgery with IOERT (median cumulative tumour dose of 113 Gy, α/β = 10 Gy) between September 2021 to December 2024 were retrospectively analysed. Acute and late treatment-related toxicities (CTCAE) were recorded in a prospectively maintained database. Secondary outcomes were overall survival (OS) and local re-recurrence-free survival (LRFS).

RESULTS: Among 40 patients, no grade 4 or 5 toxicities were observed. Acute cumulative treatment-related grade 3 toxicities occurred in 14/37 (38%) patients, predominantly consisting of erectile dysfunction (5/37, 14%), abscess formation (4/37, 11%) or peripheral neuropathy (2/37, 5%). Late grade 3 toxicities occurred in 13/30 (43%) patients, comprising mainly of erectile dysfunction (5/30, 17%), renal disorders (5/30, 17%) or peripheral neuropathy (2/30, 7%). After a median follow-up period of 21 months (IQR 12-32) after surgery, 2-year overall survival (OS) and local re-recurrence-free survival (LRFS) were 75.7% and 37.2%, respectively.

CONCLUSION: In previously irradiated LRRC patients, a multimodality approach combining chemo-reirradiation and extensive surgery with IOERT demonstrated acceptable treatment-related toxicities and favourable oncological outcomes for this high-risk population. Further research with longer follow-up is warranted to identify risk factors associated with treatment-related toxicity.

Original language	English
Article number	21
Number of pages	10
Journal	Radiation Oncology
Volume	21
Issue number	1
Early online date	23 Dec 2025
DOIs	https://doi.org/10.1186/s13014-025-02782-w
Publication status	Published - 23 Dec 2025

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10.1186/s13014-025-02782-wLicence: CC BY

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Vande Kerckhove, F. E. C., Piqeur, F., Banken, E., Morsink, N. C., Rijkaart, D. C., Cnossen, J. S., Tijssen, R. H. N., Huibregtse Bimmel-Nagel, C. C. A., van Hellemond, I. E. G., Nederend, J., Rutten, H. J. T., Bloemen, J. G., Burger, J. W. A., Verrijssen, A. E., & Peulen, H. M. U. (2025). Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer. Radiation Oncology, 21(1), Article 21. https://doi.org/10.1186/s13014-025-02782-w

@article{08f45455656144f69cc9aa50355e827f,

title = "Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer",

abstract = "BACKGROUND: Chemo-reirradiation has emerged as a feasible neoadjuvant therapy to improve resectability in locally recurrent rectal cancer (LRRC). However, its combination with surgery and intraoperative electron radiotherapy (IOERT) raises concerns regarding cumulative toxicity. This retrospective study aimed to evaluate acute and late toxicity profiles, local control and survival outcomes, following this multimodal approach in our institution.METHODS: LRRC patients who underwent chemo-reirradiation and surgery with IOERT (median cumulative tumour dose of 113 Gy, α/β = 10 Gy) between September 2021 to December 2024 were retrospectively analysed. Acute and late treatment-related toxicities (CTCAE) were recorded in a prospectively maintained database. Secondary outcomes were overall survival (OS) and local re-recurrence-free survival (LRFS).RESULTS: Among 40 patients, no grade 4 or 5 toxicities were observed. Acute cumulative treatment-related grade 3 toxicities occurred in 14/37 (38\%) patients, predominantly consisting of erectile dysfunction (5/37, 14\%), abscess formation (4/37, 11\%) or peripheral neuropathy (2/37, 5\%). Late grade 3 toxicities occurred in 13/30 (43\%) patients, comprising mainly of erectile dysfunction (5/30, 17\%), renal disorders (5/30, 17\%) or peripheral neuropathy (2/30, 7\%). After a median follow-up period of 21 months (IQR 12-32) after surgery, 2-year overall survival (OS) and local re-recurrence-free survival (LRFS) were 75.7\% and 37.2\%, respectively.CONCLUSION: In previously irradiated LRRC patients, a multimodality approach combining chemo-reirradiation and extensive surgery with IOERT demonstrated acceptable treatment-related toxicities and favourable oncological outcomes for this high-risk population. Further research with longer follow-up is warranted to identify risk factors associated with treatment-related toxicity.",

author = "\{Vande Kerckhove\}, \{F E C\} and F Piqeur and E Banken and Morsink, \{N C\} and Rijkaart, \{D C\} and Cnossen, \{J S\} and Tijssen, \{R H N\} and \{Huibregtse Bimmel-Nagel\}, \{C C A\} and \{van Hellemond\}, \{I E G\} and J Nederend and Rutten, \{H J T\} and Bloemen, \{J G\} and Burger, \{J W A\} and Verrijssen, \{A E\} and Peulen, \{H M U\}",

note = "{\textcopyright} 2025. The Author(s).",

year = "2025",

month = dec,

day = "23",

doi = "10.1186/s13014-025-02782-w",

language = "English",

volume = "21",

journal = "Radiation Oncology",

issn = "1748-717X",

publisher = "BioMed Central Ltd",

number = "1",

}

Vande Kerckhove, FEC, Piqeur, F, Banken, E, Morsink, NC, Rijkaart, DC, Cnossen, JS, Tijssen, RHN, Huibregtse Bimmel-Nagel, CCA, van Hellemond, IEG, Nederend, J, Rutten, HJT, Bloemen, JG, Burger, JWA, Verrijssen, AE & Peulen, HMU 2025, 'Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer', Radiation Oncology, vol. 21, no. 1, 21. https://doi.org/10.1186/s13014-025-02782-w

TY - JOUR

T1 - Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy

T2 - outcomes of multimodality treatment for locally recurrent rectal cancer

AU - Vande Kerckhove, F E C

AU - Piqeur, F

AU - Banken, E

AU - Morsink, N C

AU - Rijkaart, D C

AU - Cnossen, J S

AU - Tijssen, R H N

AU - Huibregtse Bimmel-Nagel, C C A

AU - van Hellemond, I E G

AU - Nederend, J

AU - Rutten, H J T

AU - Bloemen, J G

AU - Burger, J W A

AU - Verrijssen, A E

AU - Peulen, H M U

PY - 2025/12/23

Y1 - 2025/12/23

N2 - BACKGROUND: Chemo-reirradiation has emerged as a feasible neoadjuvant therapy to improve resectability in locally recurrent rectal cancer (LRRC). However, its combination with surgery and intraoperative electron radiotherapy (IOERT) raises concerns regarding cumulative toxicity. This retrospective study aimed to evaluate acute and late toxicity profiles, local control and survival outcomes, following this multimodal approach in our institution.METHODS: LRRC patients who underwent chemo-reirradiation and surgery with IOERT (median cumulative tumour dose of 113 Gy, α/β = 10 Gy) between September 2021 to December 2024 were retrospectively analysed. Acute and late treatment-related toxicities (CTCAE) were recorded in a prospectively maintained database. Secondary outcomes were overall survival (OS) and local re-recurrence-free survival (LRFS).RESULTS: Among 40 patients, no grade 4 or 5 toxicities were observed. Acute cumulative treatment-related grade 3 toxicities occurred in 14/37 (38%) patients, predominantly consisting of erectile dysfunction (5/37, 14%), abscess formation (4/37, 11%) or peripheral neuropathy (2/37, 5%). Late grade 3 toxicities occurred in 13/30 (43%) patients, comprising mainly of erectile dysfunction (5/30, 17%), renal disorders (5/30, 17%) or peripheral neuropathy (2/30, 7%). After a median follow-up period of 21 months (IQR 12-32) after surgery, 2-year overall survival (OS) and local re-recurrence-free survival (LRFS) were 75.7% and 37.2%, respectively.CONCLUSION: In previously irradiated LRRC patients, a multimodality approach combining chemo-reirradiation and extensive surgery with IOERT demonstrated acceptable treatment-related toxicities and favourable oncological outcomes for this high-risk population. Further research with longer follow-up is warranted to identify risk factors associated with treatment-related toxicity.

AB - BACKGROUND: Chemo-reirradiation has emerged as a feasible neoadjuvant therapy to improve resectability in locally recurrent rectal cancer (LRRC). However, its combination with surgery and intraoperative electron radiotherapy (IOERT) raises concerns regarding cumulative toxicity. This retrospective study aimed to evaluate acute and late toxicity profiles, local control and survival outcomes, following this multimodal approach in our institution.METHODS: LRRC patients who underwent chemo-reirradiation and surgery with IOERT (median cumulative tumour dose of 113 Gy, α/β = 10 Gy) between September 2021 to December 2024 were retrospectively analysed. Acute and late treatment-related toxicities (CTCAE) were recorded in a prospectively maintained database. Secondary outcomes were overall survival (OS) and local re-recurrence-free survival (LRFS).RESULTS: Among 40 patients, no grade 4 or 5 toxicities were observed. Acute cumulative treatment-related grade 3 toxicities occurred in 14/37 (38%) patients, predominantly consisting of erectile dysfunction (5/37, 14%), abscess formation (4/37, 11%) or peripheral neuropathy (2/37, 5%). Late grade 3 toxicities occurred in 13/30 (43%) patients, comprising mainly of erectile dysfunction (5/30, 17%), renal disorders (5/30, 17%) or peripheral neuropathy (2/30, 7%). After a median follow-up period of 21 months (IQR 12-32) after surgery, 2-year overall survival (OS) and local re-recurrence-free survival (LRFS) were 75.7% and 37.2%, respectively.CONCLUSION: In previously irradiated LRRC patients, a multimodality approach combining chemo-reirradiation and extensive surgery with IOERT demonstrated acceptable treatment-related toxicities and favourable oncological outcomes for this high-risk population. Further research with longer follow-up is warranted to identify risk factors associated with treatment-related toxicity.

U2 - 10.1186/s13014-025-02782-w

DO - 10.1186/s13014-025-02782-w

M3 - Article

C2 - 41437065

SN - 1748-717X

VL - 21

JO - Radiation Oncology

JF - Radiation Oncology

IS - 1

M1 - 21

ER -

Neoadjuvant chemo-reirradiation followed by resection and intraoperative electron beam radiotherapy: outcomes of multimodality treatment for locally recurrent rectal cancer

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