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Colorectal cancer, the fourth most common malignancy worldwide, accounts for 12% of all cancer deaths in the United States. According to National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) data estimates, 142,820 men and women will be diagnosed with colorectal cancer in 2013 (NCI, 2013). Rectal cancer is a subset of lower gastrointestinal (GI) malignancies and occurs with relatively common frequency. By definition, rectal malignancies begin anatomically just above the anal sphincter complex and extend proximally 12 to 15 cm (Fry, Mahmoud, Maron, & Bleier, 2008). The main histology of most rectal cancers is adenocarcinoma, which will be the subject of this article. In contrast to colon malignancies, the treatment for locally advanced rectal cancer typically involves some form of neoadjuvant chemoradiotherapy. For some locally advanced tumors, patients may achieve a complete pathologic response following neoadjuvant treatment. The decision to avoid radical surgery for those with complete pathologic response continues to be a provocative debate. To understand this debate, one has to consider the historical background and how standard treatment for locally advanced rectal cancer came into use.

Locally Advanced Rectal Cancer: Does Assessment of Response After Neoadjuvant Chemoradiotherapy Impact Management?