Opening the operating theatre to oncology: treatment of locally recurrent rectal cancer with peritoneal metastasis by simultaneous hyperthermic intraperitoneal chemotherapy and intraoperative electron beam radiotherapy.

Despite advances in multimodality therapies and surgical technique, locally recurrent rectal cancers (LRRC) and those with peritoneal metastasis (PM) remain challenging for surgeons and oncologists. Although total pelvic exenteration (TPE) and cytoreductive surgery (CRS) for peritoneal disease may enable removal of the main tumour mass and macroscopically visible peritoneal spread, respectively, local recurrence from an R1 resection, and peritoneal recurrence from microscopic peritoneal disease, remain key concerns. Combining radical surgery with oncological adjuncts such as intraoperative electron beam radiotherapy (IOERT), and hyperthermic intraperitoneal chemotherapy (HIPEC), may improve outcomes in this field. Nevertheless the application of both together is poorly reported. Here we describe a case of LRRC with PM treated with TPE and simultaneous HIPEC and IOERT.