Therapeutic approaches in the management of locally advanced rectal cancer

Surgical resection has been the mainstay of definitive therapy for rectal cancer. Historically, recurrence rates with surgery alone were upwards of 50% (1-3). Adjuvant therapy in the form of combined post-operative radiotherapy and 5-fluorouracil (5-FU)—based chemotherapy was shown to improve local control and provide an overall survival benefit over surgery alone or surgery plus irradiation (4,5). As such, postoperative chemoradiotherapy (CRT) was recommended as the standard of care in patients with stage II (T3-T4) or stage III (node positive) rectal cancer by a National Institute of Health consensus conference in 1990 (6)