We thank John Marks, MD, and Gerald Marks, MD, for their work defining an unpublished algorithm for treatment planning that incorporates tumor location, staging features, and response to neoadjuvant therapy. Magnetic resonance images and interpretation provided by Paul Knechtges, MD. We also thank Marcos Metzer for providing illustrations.
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Review Article
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Shifting concepts in rectal cancer management†‡
A Review of Contemporary Primary Rectal Cancer Treatment Strategies
Article first published online: 9 APR 2012
DOI: 10.3322/caac.21138
Copyright © 2012 American Cancer Society, Inc.
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How to Cite
Kosinski, L., Habr-Gama, A., Ludwig, K. and Perez, R. (2012), Shifting concepts in rectal cancer management. CA: A Cancer Journal for Clinicians, 62: 173–202. doi: 10.3322/caac.21138
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DISCLOSURES: The authors report no conflicts of interest.
Publication History
- Issue published online: 7 MAY 2012
- Article first published online: 9 APR 2012
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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. CA Cancer J Clin 2012;. © 2012 American Cancer Society.