PhD defence J.M. (Jan) van Rees

Summary:

Rectal cancer is a worldwide cause of cancer-related mortality with increasing incidence. Although marked improvements have been made in rectal cancer management, which have significantly improved oncologic outcomes, the disease burden remains high up until today. A main contributor to this burden is so-called advanced rectal cancer. Advanced rectal cancer comprises locally advanced rectal cancer, rectal cancer that recurs in the pelvic area, and stage IV rectal cancer. Curative treatment of these diseases is a major challenge, and may endanger the balance between acceptable oncological- and functional outcomes. Novel treatment strategies for patients with advanced disease, such as chemoradiation and pelvic exenteration surgery, have improved oncological survival rates, but come with a price. Treatment-related morbidity and even mortality, as well significant loss of quality and standard of living, are the devastating consequences that patients have to accept for a chance to live. The objective of this thesis is to provide the multimodality management of rectal cancer with novel insights and innovative treatment methods, and focuses on patients with rectal cancer that is beyond the margins of the disease.