Combined modality therapy: Is it necessary for everyone?

Survival and relapse in rectal cancer are intimately associated with disease stage. Although surgery remains the primary treatment modality for rectal cancer, its limitations as an isolated curative treatment are well recognized. Trimodality therapy combining surgery, chemotherapy, and radiation has improved local recurrence rates and survival in patients with advanced rectal tumors (T3/4) or those with nodal involvement (N1/2). With the broad application of trimodality therapy, concern for over-treatment in select groups of patients exists. Current investigations are now focused on identifying subsets of favorable-risk patients who may benefit from tailored therapy and reducing exposure to unnecessary treatment-related risk.