Local management of the primary tumor in stage IV rectal cancer

Over the past 2 decades, the survival of patients with metastatic colorectal cancer has improved considerably. With multidisciplinary treatment, a select group of stage IV patients can be treated with curative intent. The natural history and clinical course of stage IV rectal cancer varies considerably between individuals, and optimal management involves complex treatment decisions. The focus of this review is to explore the current issues and controversies surrounding the local management of the primary tumor in the setting of resectable as well as unresectable metastatic rectal cancer. The integration of systemic therapy and radiotherapy with surgical resection will be reviewed from various perspectives.