Desley van Zoggel

Chapter 9 156 Another goal of any type of pre-surgical treatment is to able to monitor tumour behaviour. When a patient develops multiple distant metastases during systemic induction chemotherapy, which is a sign of a bad prognosis, an extended surgical resection of the local recurrence will most likely only result in decreased quality of life. The most important goal is to be able to offer the right patient the right treatment plan. All treatment modalities available for LRRC are paired with considerable morbidity risks. Therefore, it is very important to find the right balance between undertreatment and overtreatment. The scientific challenge for LRRC treatment is to clarify selection criteria to be able to establish which patient will benefit from which available treatment option. This thesis also highlights two major imaging techniques that canbe implementedduring neoadjuvant treatment. Being able to adequately assess and predict response during neoadjuvant treatment helps to continually evaluate the chosen course of treatment and aid in decision-making. The historical figure shows an improvement in survival results. However, treatment strategies have become more elaborate and specialised. Current treatment strategies stretch the limits of the health care system, requiring intensive collaboration between centres, providing modern tools for (neoadjuvant) treatment options and keeping up with changing protocols. This all results in a treatment that imposes a large financial burden on the health care system, while only serving a relatively rare patient group. The costs of treatment can be justified when significant results are being achieved. For patients, the most important aspect is quality of life. LRRC treatment, getting more elaborate over the years, can very possibly lead to complications and addedmorbidity. When no significant survival benefit is gained, the risk of morbidity might not be worth it. It is of utmost importance to be able to select the right patient for the right treatment strategy. While scientifically based guides to better patient selection are being investigated, the patient needs to be informed about different options and should be involved in the decision making process.