Chapter 5 94 regimen was changed in 2010 with the addition of induction chemotherapy, which was administered significantly more frequently in patients with synchronous metastases. Again, no subgroup analysis was performed due to the low number of patients with a history of metastases or synchronous metastases before 2010. The strength of this study is that the study population comprises a true sample of surgically treated patients at a large tertiary referral centre, which provides insight into the outcomes of a curative treatment approach that might greatly benefit a highly selected group of patients. In conclusion, curative treatment of LRRC in patients with a history of metastases is possible in selected patients. Whether curative treatment should be offered to LRRC patients with synchronous metastases is questionable. Using a tailored approach, wherein the response to treatment and the natural behaviour of the disease can be observed for a prolonged duration, may enable selection of those patientswho are likely to benefit from locoregional treatment of metastases and LRRC, while sparing others extensive surgery and the associated morbidity.