Rectal Cancer Perforation: A Rare Complication Of Neo-Adjuvant Radiotherapy For Rectal Cancer

Purpose: Despite having a well established role in the treatment of locally advanced rectal cancer neoadjuvant radiotherapy is associated with various acute but usually self limited side effects, which can be occasionally severe thus outweighing the potential benefits.Method: We present a case of 51-year old male who experienced a spontaneous rectal perforation after neoadjuvant radiotherapy for transmural (T3) rectal cancer located 8cms from anal verge. Clinical circumstances were highly suggestive of acute radiation toxicity leading to tumor perforation. To our knowledge, such a complication of radiotherapy is extremely rare, albeit known with only few cases reported in English literature.Conclusion: Rectal cancer perforation, albeit rare, is a dangerous early complication of neo-adjuvant radiotherapy for transmural rectal cancer which may be worthy of consideration and discussion with the patient when commencing treatment. Role of prophylactic diverting colostomy in such patients with cancer above peritoneal reflection remains an open question which needs to be redressed by further studies.