No evidence of distal sacrectomy at the level of S3. The lobulated T2 hyperintense and enhancing tumour in the right gluteal region involving the ischiorectal fossae, right piriformis and abutting partially resected sacrum is larger. Today the largest more central component measures 11 x 11.7 x 10.7 cm (AP x LR x CC) and there 2 large tongues of tumour extending inferiorly and laterally into the gluteus musculature on the right which have markedly increased in size.
The tumour no above the right lateral wall of the rectum however there is preservation of the mesorectal fat plane. This
Enlarging enhancing bony lesions in the posterior right ilium in keeping with progressive metastatic disease.
Conclusion: Progressive local and metastatic disease.