Management of Stage IV rectal disease – How to incorporate radiation therapy, chemotherapy and surgery

Approximately 50–60% of patients diagnosed with rectal cancer either present with or will develop metastatic disease. Treatment for metastatic rectal cancer has evolved due to advances in both medical and surgery therapy and involves a combination of chemotherapy, radiation therapy and surgery. This multimodal therapy requires individualization due to a variety of patient and tumor characteristics and results in variability of regimens and the sequence of treatment for metastatic disease. In this article we will review various approaches to the treatment of metastatic rectal cancer combining multimodal chemotherapy, radiation and surgery.