Changing the Treatment Paradigm for Locally Advanced Rectal Cancer

The dawn of the "modern" era for the treatment of rectal cancer began with the adoption of total mesorectal excision (TME) — a revolution in surgical care that emphasized the achievement of negative margins through sharp dissection along embryologic planes, resulting in a reduced risk of local recurrence. However, multimodal therapy for locally advanced rectal cancer has remained linked to treatment paradigms of the past. Guidelines for treatment with a combination of chemotherapy and radiotherapy in addition to surgery evolved from recommendations put forth in the early 1990s.1 Although advances in management have occurred, the focus has been largely on . . .