title: Combined Modality Therapy for Rectal Cancer.
abstract: The primary therapy for any potentially curative rectal cancer is surgery. For locally advanced tumors (i.e., T3-4 and/or node positive), the very high rate of local and distant recurrences has necessitated a standard adjuvant regimen of preoperative chemoradiation and postoperative chemotherapy. Several controversies regarding this approach remain, including the technique and fractionation scheme of radiation therapy prior to surgery, the choice of concomitant chemotherapy, and whether all patients require postoperative systemic therapy. Furthermore, in an era of improving staging imaging and surgical techniques, an opportunity for de-escalation of therapy to improve patient morbidity and quality of life may arise. At the same time, advances in radiation and systemic therapy may help facilitate less invasive, sphincter-preserving surgery. This review addresses these questions and others that remain areas of active clinical investigation.
authors.affiliation: From the *Harvard Radiation Oncology Program and †Division of Hematology and Oncology and ‡Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sagar A
authors.initials: SA
authors.lastname: Patel
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
mesh_terms: D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*