Rectal cancer can recur locally or often in the liver or lungs, and it is important to determine if the recurrence is only local or metastatic. Treatment depends on the site of recurrence as defined by physical and x-ray examinations and scans.
• If local disease can be removed, there is a chance for cure.
• Often the recurrence can be in one area such as the rectal area, liver or lung, where surgical removal may possibly
lead to a cure or significantly prolonged survival.
• Alternatively, intra-arterial chemotherapy with an implantable portable pump can sometimes give significant
palliation ( See "Stage IV" ).
• Hepatic intra-arterial chemotherapy with 5-FUDR for liver metastases has been studied. This approach has been
shown to produce a higher overall response rate without significant improvement in survival. In several studies,
there is increased local toxicity including liver function abnormalities and biliary sclerosis ( See "Stage IV" ).
• As in Stage IV, chemotherapy with single-agent 5-FU or 5-FU in combination with leucovorin , or with
interferon with or without leucovorin (investigational), may improve survival and achieve significant palliation.
Various doses are used. Lower-dose leucovorin + 5-FU has the same response and survival as high-dose
leucovorin +5-FU. 5-FU + levamisole has no role in recurrent colorectal cancer.
