title: Shifting concepts in rectal cancer management: a review of contemporary primary rectal cancer treatment strategies.
abstract: The management of rectal cancer has transformed over the last 3 decades and continues to evolve. Some of these changes parallel progress made with other cancers: refinement of surgical technique to improve organ preservation, selective use of neoadjuvant (and adjuvant) therapy, and emergence of criteria suggesting a role for individually tailored therapy. Other changes are driven by fairly unique issues including functional considerations, rectal anatomic features, and surgical technical issues. Further complexity is due to the variety of staging modalities (each with its own limitations), neoadjuvant treatment alternatives, and competing strategies for sequencing multimodal treatment even for nonmetastatic disease. Importantly, observations of tumor response made in the era of neoadjuvant therapy are reshaping some traditionally held concepts about tumor behavior. Frameworks for prioritizing and integrating complex data can help to formulate treatment plans for patients.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA. lkosinski@mcw.edu
authors.forename: Lauren
authors.initials: L
authors.lastname: Kosinski
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Kirk
authors.initials: K
authors.lastname: Ludwig
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Perez
mesh_terms: D001706:Biopsy; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D042241:Early Diagnosis; D006801:Humans; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000628:therapy*