Refining Multimodal Therapy for Rectal Cancer

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Abstract
For a short time, the treatment of rectal cancer seemed clear and definitive. The 1990 National Institutes of Health consensus statement concluded, “Combined postoperative chemotherapy and radiation therapy improves local control and survival in stage II and III patients and is recommended.”1 At the time, the generally accepted treatment was conventional bowel resection followed by adjuvant radiation therapy (at a dose of 45 to 55 Gy) and chemotherapy if pathological findings confirmed the presence of transmural invasion or positive lymph nodes. Although the consensus statement introduced multimodal therapy as the standard treatment, results from subsequent randomized, controlled trials challenged that . . .