Individualizing multi-modality therapy for locally advanced rectal cancer: incorporating new data into practice

With the publication of several recent studies, the therapeutic approach for locally advanced rectal cancer has been radically transformed and now allows for more tailored, patient-centered care. A patient with a cT3N1 rectal cancer may have numerous treatment options based on the explosion of data, so it is critical to understand how to implement the new approaches in clinical practice. This review summarizes the progress in the management of locally advanced rectal cancer based on the recently published clinical trials and critically appraises the literature on the options for sequencing of therapy and omitting components of multimodality therapy. With the expanding management options, a number of important questions remain regarding how to better individualize use of multimodality therapy for patients with Stage II or III rectal cancer, in particular with regard to predicting response to therapy and identifying the appropriate sequencing and/or omission of therapies.