Multimodality approaches for rectal cancer

Since the NIH Consensus Conference in 1990, surgical, radiation, and chemotherapeutic advances have helped to improve local control and overall survival for patients with stage II/III rectal cancer. Based on the results of the recently completed German trial, patients with T3 and/or N1 to 2 rectal cancer should receive preoperative combined modality therapy, and undergo TME with adequate nodal dissection. This sequence of treatment allows for the better local control and sphincter preservation while optimizing survival. In addition, the toxicity profile compares favorably to intensive short course radiation or postoperative CMT. As we look toward the future, evaluation of molecular markers and treatment with targeted therapies offer the opportunity to tailor treatments to individuals to maximize the therapeutic gain.