These NCCN Clinical Practice Guidelines in Oncology provide recommendations for the management of rectal cancer, beginning with the clinical presentation of the patient to the primary care physician or gastroenterologist through diagnosis, pathologic staging, neoadjuvant treatment, surgical management, adjuvant treatment, surveillance, management of recurrent and metastatic disease, and survivorship. This discussion focuses on localized disease. The NCCN Rectal Cancer Panel believes that a multidisciplinary approach, including representation from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology, is necessary for treating patients with rectal cancer.

  • 1

    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:1029.

  • 2

    Cheng L, Eng C, Nieman LZ. Trends in colorectal cancer incidence by anatomic site and disease stage in the United States from 1976 to 2005. Am J Clin Oncol 2011;34:573580.

    • Search Google Scholar
    • Export Citation
  • 3

    Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011;61:212236.

    • Search Google Scholar
    • Export Citation
  • 4

    Hemminki K, Chen B. Familial risk for colorectal cancers are mainly due to heritable causes. Cancer Epidemiol Biomarkers Prev 2004;13:12531256.

    • Search Google Scholar
    • Export Citation
  • 5

    Hemminki K, Eng C. Clinical genetic counselling for familial cancers requires reliable data on familial cancer risks and general action plans. J Med Genet 2004;41:801807.

    • Search Google Scholar
    • Export Citation
  • 6

    Ahsan H, Neugut AI, Garbowski GC. Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med 1998;128:900905.

    • Search Google Scholar
    • Export Citation
  • 7

    Bonelli L, Martines H, Conio M. Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel. A case-control study. Int J Cancer 1988;41:513517.

    • Search Google Scholar
    • Export Citation
  • 8

    Hampel H, Frankel WL, Martin E. Feasibility of screening for Lynch syndrome among patients with colorectal cancer. J Clin Oncol 2008;26:57835788.

    • Search Google Scholar
    • Export Citation
  • 9

    Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003;348:919932.

  • 10

    Galiatsatos P, Foulkes WD. Familial adenomatous polyposis. Am J Gastroenterol 2006;101:385398.

  • 11

    Aaltonen LA, Salovaara R, Kristo P. Incidence of hereditary nonpolyposis colorectal cancer and the feasibility of molecular screening for the disease. N Engl J Med 1998;338:14811487.

    • Search Google Scholar
    • Export Citation
  • 12

    Hampel H, Frankel WL, Martin E. Screening for the Lynch syndrome (hereditary nonpolyposis colorectal cancer). N Engl J Med 2005;352:18511860.

    • Search Google Scholar
    • Export Citation
  • 13

    Hendriks YM, de Jong AE, Morreau H. Diagnostic approach and management of Lynch syndrome (hereditary nonpolyposis colorectal carcinoma): a guide for clinicians. CA Cancer J Clin 2006;56:213225.

    • Search Google Scholar
    • Export Citation
  • 14

    Wright DM, Arnold JL, Parry B. Immunohistochemistry to detect hereditary nonpolyposis colorectal cancer in young patients: the 7-year Auckland experience. Dis Colon Rectum 2011;54:552558.

    • Search Google Scholar
    • Export Citation
  • 15

    Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives. Genet Med 2009;11:3541.

    • Search Google Scholar
    • Export Citation
  • 16

    Edge SB, Byrd D, Compton C, eds. AJCC Cancer Staging Manual 7th Edition. New York: Springer; 2010.

  • 17

    Jessup JM, Gunderson LL, Greene FL. 2010 staging system for colon and rectal carcinoma. Ann Surg Oncol 2011;18:15131517.

  • 18

    Altekruse SF, Kosary CL, Krapcho M. SEER Cancer Statistics Review, 1975–2007. National Cancer Institute. Bethesda, MD. Available at: http://seer.cancer.gov/csr/1975-2007/. Accessed November 5, 2012.

    • Search Google Scholar
    • Export Citation
  • 19

    Gunderson LL, Jessup JM, Sargent DJ. Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol 2010;28:256263.

    • Search Google Scholar
    • Export Citation
  • 20

    Lo DS, Pollett A, Siu LL. Prognostic significance of mesenteric tumor nodules in patients with stage III colorectal cancer. Cancer 2008;112:5054.

    • Search Google Scholar
    • Export Citation
  • 21

    Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology 2007;51:141149.

  • 22

    Puppa G, Maisonneuve P, Sonzogni A. Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging. Mod Pathol 2007;20:843855.

    • Search Google Scholar
    • Export Citation
  • 23

    Ueno H, Mochizuki H. Clinical significance of extrabowel skipped cancer infiltration in rectal cancer. Surg Today 1997;27:617622.

  • 24

    Ueno H, Mochizuki H, Hashiguchi Y. Extramural cancer deposits without nodal structure in colorectal cancer: optimal categorization for prognostic staging. Am J Clin Pathol 2007;127:287294.

    • Search Google Scholar
    • Export Citation
  • 25

    Washington MK, Berlin J, Branton P. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009;133:15391551.

    • Search Google Scholar
    • Export Citation
  • 26

    Compton CC, Fielding LP, Burgart LJ. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000;124:979994.

    • Search Google Scholar
    • Export Citation
  • 27

    Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin 2004;54:295308.

  • 28

    Nagtegaal ID, Marijnen CA, Kranenbarg EK. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002;26:350357.

    • Search Google Scholar
    • Export Citation
  • 29

    Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26:303312.

    • Search Google Scholar
    • Export Citation
  • 30

    Wibe A, Rendedal PR, Svensson E. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 2002;89:327334.

    • Search Google Scholar
    • Export Citation
  • 31

    Gavioli M, Luppi G, Losi L. Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. Dis Colon Rectum 2005;48:18511857.

    • Search Google Scholar
    • Export Citation
  • 32

    Rodel C, Martus P, Papadoupolos T. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23:86888696.

    • Search Google Scholar
    • Export Citation
  • 33

    Nissan A, Stojadinovic A, Shia J. Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone. J Clin Oncol 2006;24:40784084.

    • Search Google Scholar
    • Export Citation
  • 34

    Fujita S, Shimoda T, Yoshimura K. Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection. J Surg Oncol 2003;84:127131.

    • Search Google Scholar
    • Export Citation
  • 35

    Liebig C, Ayala G, Wilks J. Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 2009;27:51315137.

  • 36

    Quah HM, Chou JF, Gonen M. Identification of patients with high-risk stage II colon cancer for adjuvant therapy. Dis Colon Rectum 2008;51:503507.

    • Search Google Scholar
    • Export Citation
  • 37

    Compton CC. Key issues in reporting common cancer specimens: problems in pathologic staging of colon cancer. Arch Pathol Lab Med 2006;130:318324.

    • Search Google Scholar
    • Export Citation
  • 38

    Lai LL, Fuller CD, Kachnic LA, Thomas CR Jr. Can pelvic radiotherapy be omitted in select patients with rectal cancer? Semin Oncol 2006;33:S7074.

    • Search Google Scholar
    • Export Citation
  • 39

    Glynne-Jones R, Mawdsley S, Novell JR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language. Colorectal Dis 2006;8:800807.

    • Search Google Scholar
    • Export Citation
  • 40

    Adam IJ, Mohamdee MO, Martin IG. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994;344:707711.

    • Search Google Scholar
    • Export Citation
  • 41

    Mawdsley S, Glynne-Jones R, Grainger J. Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival? Int J Radiat Oncol Biol Phys 2005;63:745752.

    • Search Google Scholar
    • Export Citation
  • 42

    Sarli L, Bader G, Iusco D. Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 2005;41:272279.

  • 43

    Wong SL, Ji H, Hollenbeck BK. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 2007;298:21492154.

  • 44

    Pocard M, Panis Y, Malassagne B. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens. Dis Colon Rectum 1998;41:839845.

    • Search Google Scholar
    • Export Citation
  • 45

    Tepper JE, O’Connell MJ, Niedzwiecki D. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001;19:157163.

    • Search Google Scholar
    • Export Citation
  • 46

    Baxter NN, Morris AM, Rothenberger DA, Tepper JE. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys 2005;61:426431.

    • Search Google Scholar
    • Export Citation
  • 47

    Wichmann MW, Muller C, Meyer G. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg 2002;137:206210.

    • Search Google Scholar
    • Export Citation
  • 48

    Turner RR, Nora DT, Trocha SD, Bilchik AJ. Colorectal carcinoma nodal staging. Frequency and nature of cytokeratin-positive cells in sentinel and nonsentinel lymph nodes. Arch Pathol Lab Med 2003;127:673679.

    • Search Google Scholar
    • Export Citation
  • 49

    Wood TF, Nora DT, Morton DL. One hundred consecutive cases of sentinel lymph node mapping in early colorectal carcinoma: detection of missed micrometastases. J Gastrointest Surg 2002;6:322329; discussion 229–330.

    • Search Google Scholar
    • Export Citation
  • 50

    Yasuda K, Adachi Y, Shiraishi N. Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann Surg Oncol 2001;8:300304.

    • Search Google Scholar
    • Export Citation
  • 51

    Braat AE, Oosterhuis JW, Moll FC. Sentinel node detection after preoperative short-course radiotherapy in rectal carcinoma is not reliable. Br J Surg 2005;92:15331538.

    • Search Google Scholar
    • Export Citation
  • 52

    Wiese D, Sirop S, Yestrepsky B. Ultrastaging of sentinel lymph nodes (SLNs) vs. non-SLNs in colorectal cancer—do we need both? Am J Surg 2010;199:354358; discussion 358.

    • Search Google Scholar
    • Export Citation
  • 53

    Noura S, Yamamoto H, Miyake Y. Immunohistochemical assessment of localization and frequency of micrometastases in lymph nodes of colorectal cancer. Clin Cancer Res 2002;8:759767.

    • Search Google Scholar
    • Export Citation
  • 54

    Mescoli C, Albertoni L, Pucciarelli S. Isolated tumor cells in regional lymph nodes as relapse predictors in stage I and II colorectal cancer. J Clin Oncol 2012;30:965971.

    • Search Google Scholar
    • Export Citation
  • 55

    Rahbari NN, Bork U, Motschall E. Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol 2012;30:6070.

    • Search Google Scholar
    • Export Citation
  • 56

    Chung M, Lee J, Terasawa T. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2011;155:827838.

    • Search Google Scholar
    • Export Citation
  • 57

    Gorham ED, Garland CF, Garland FC. Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med 2007;32:210216.

    • Search Google Scholar
    • Export Citation
  • 58

    Lappe JM, Travers-Gustafson D, Davies KM. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007;85:15861591.

    • Search Google Scholar
    • Export Citation
  • 59

    Ma Y, Zhang P, Wang F. Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Clin Oncol 2011;29:37753782.

    • Search Google Scholar
    • Export Citation
  • 60

    Fedirko V, Riboli E, Tjonneland A. Prediagnostic 25-hydroxyvitamin D, VDR and CASR polymorphisms, and survival in patients with colorectal cancer in western European ppulations. Cancer Epidemiol Biomarkers Prev 2012;21:582593.

    • Search Google Scholar
    • Export Citation
  • 61

    Ng K, Meyerhardt JA, Wu K. Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer. J Clin Oncol 2008;26:29842991.

    • Search Google Scholar
    • Export Citation
  • 62

    Ng K, Sargent DJ, Goldberg RM. Vitamin D status in patients with stage IV colorectal cancer: findings from Intergroup trial N9741. J Clin Oncol 2011;29:15991606.

    • Search Google Scholar
    • Export Citation
  • 63

    Dietary Reference Intakes for Calcium and Vitamin D. Institute of Medicine of the National Academies; 2010. Available at: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed August 2, 2012.

    • Search Google Scholar
    • Export Citation
  • 64

    Cooper HS, Deppisch LM, Gourley WK. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology 1995;108:16571665.

    • Search Google Scholar
    • Export Citation
  • 65

    Hamilton SR, Bosman FT, Boffetta P. Carcinoma of the colon and rectum. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. WHO Classification of Tumours of the Digestive System. Lyon: IARC; 2010.

    • Search Google Scholar
    • Export Citation
  • 66

    Seitz U, Bohnacker S, Seewald S. Is endoscopic polypectomy an adequate therapy for malignant colorectal adenomas? Presentation of 114 patients and review of the literature. Dis Colon Rectum 2004;47:17891796.

    • Search Google Scholar
    • Export Citation
  • 67

    Ueno H, Mochizuki H, Hashiguchi Y. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 2004;127:385394.

    • Search Google Scholar
    • Export Citation
  • 68

    Volk EE, Goldblum JR, Petras RE. Management and outcome of patients with invasive carcinoma arising in colorectal polyps. Gastroenterology 1995;109:18011807.

    • Search Google Scholar
    • Export Citation
  • 69

    Garcia-Aguilar J, Hernandez de Anda E, Rothenberger DA. Endorectal ultrasound in the management of patients with malignant rectal polyps. Dis Colon Rectum 2005;48:910916; discussion 916–917.

    • Search Google Scholar
    • Export Citation
  • 70

    Winawer SJ, Zauber AG, Fletcher RH. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin 2006;56:143159; quiz 184–145.

    • Search Google Scholar
    • Export Citation
  • 71

    Nelson H, Petrelli N, Carlin A. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001;93:583596.

  • 72

    Kapiteijn E, Marijnen CA, Nagtegaal ID. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638646.

    • Search Google Scholar
    • Export Citation
  • 73

    Schoellhammer HF, Gregorian AC, Sarkisyan GG, Petrie BA. How important is rigid proctosigmoidoscopy in localizing rectal cancer? Am J Surg 2008;196:904908; discussion 908.

    • Search Google Scholar
    • Export Citation
  • 74

    Baxter NN, Garcia-Aguilar J. Organ preservation for rectal cancer. J Clin Oncol 2007;25:10141020.

  • 75

    Rajput A, Bullard Dunn K. Surgical management of rectal cancer. Semin Oncol 2007;34:241249.

  • 76

    Weiser MR, Landmann RG, Wong WD. Surgical salvage of recurrent rectal cancer after transanal excision. Dis Colon Rectum 2005;48:11691175.

  • 77

    Wiig JN, Larsen SG, Giercksky KE. Operative treatment of locally recurrent rectal cancer. Recent Results Cancer Res 2005;165:136147.

  • 78

    Bartram C, Brown G. Endorectal ultrasound and magnetic resonance imaging in rectal cancer staging. Gastroenterol Clin North Am 2002;31:827839.

    • Search Google Scholar
    • Export Citation
  • 79

    Bipat S, Glas AS, Slors FJ. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004;232:773783.

    • Search Google Scholar
    • Export Citation
  • 80

    Klessen C, Rogalla P, Taupitz M. Local staging of rectal cancer: the current role of MRI. Eur Radiol 2007;17:379389.

  • 81

    Lahaye MJ, Engelen SM, Nelemans PJ. Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 2005;26:259268.

    • Search Google Scholar
    • Export Citation
  • 82

    Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology 2004;232:335346.

  • 83

    Guillem JG, Cohen AM. Current issues in colorectal cancer surgery. Semin Oncol 1999;26:505513.

  • 84

    Lindsetmo RO, Joh YG, Delaney CP. Surgical treatment for rectal cancer: an international perspective on what the medical gastroenterologist needs to know. World J Gastroenterol 2008;14:32813289.

    • Search Google Scholar
    • Export Citation
  • 85

    You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg 2007;245:726733.

    • Search Google Scholar
    • Export Citation
  • 86

    Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002;45:200206.

    • Search Google Scholar
    • Export Citation
  • 87

    Yamamoto S, Watanabe M, Hasegawa H. The risk of lymph node metastasis in T1 colorectal carcinoma. Hepatogastroenterology 2004;51:9981000.

  • 88

    Landmann RG, Wong WD, Hoepfl J. Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum 2007;50:15201525.

    • Search Google Scholar
    • Export Citation
  • 89

    Nash GM, Weiser MR, Guillem JG. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum 2009;52:577582.

  • 90

    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982;69:613616.

  • 91

    Steup WH, Moriya Y, van de Velde CJH. Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer 2002;38:911918.

    • Search Google Scholar
    • Export Citation
  • 92

    Schlag PM. Surgical sphincter preservation in rectal cancer. Oncologist 1996;1:288292.

  • 93

    Marr R, Birbeck K, Garvican J. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 2005;242:7482.

    • Search Google Scholar
    • Export Citation
  • 94

    Nagtegaal ID, van de Velde CJ, van der Worp E. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 2002;20:17291734.

    • Search Google Scholar
    • Export Citation
  • 95

    Parfitt JR, Driman DK. The total mesorectal excision specimen for rectal cancer: a review of its pathological assessment. J Clin Pathol 2007;60:849855.

    • Search Google Scholar
    • Export Citation
  • 96

    den Dulk M, Putter H, Collette L. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer 2009;45:11751183.

    • Search Google Scholar
    • Export Citation
  • 97

    Pahlman L, Bohe M, Cedermark B. The Swedish rectal cancer registry. Br J Surg 2007;94:12851292.

  • 98

    Jayne DG, Guillou PJ, Thorpe H. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007;25:30613068.

    • Search Google Scholar
    • Export Citation
  • 99

    Ng SSM, Leung KL, Lee JFY. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 2008;15:24182425.

    • Search Google Scholar
    • Export Citation
  • 100

    Lujan J, Valero G, Biondo S. Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4,970 patients. Surg Endosc, in press.

    • Search Google Scholar
    • Export Citation
  • 101

    Kang SB, Park JW, Jeong SY. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 2010;11:637645.

    • Search Google Scholar
    • Export Citation
  • 102

    Jayne DG, Thorpe HC, Copeland J. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 2010;97:16381645.

    • Search Google Scholar
    • Export Citation
  • 103

    Wagman LD. Laparoscopic and open surgery for colorectal cancer: reaching equipoise? J Clin Oncol 2007;25:29962998.

  • 104

    Araujo SE, da Silva eSousa AH Jr, de Campos FG. Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sao Paulo 2003;58:133140.

    • Search Google Scholar
    • Export Citation
  • 105

    Kuhry E, Schwenk WF, Gaupset R. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2008:CD003432.

  • 106

    Lee JK, Delaney CP, Lipman JM. Current state of the art in laparoscopic colorectal surgery for cancer: Update on the multi-centric international trials. Ann Surg Innov Res 2012;6:5.

    • Search Google Scholar
    • Export Citation
  • 107

    Xiong B, Ma L, Zhang C. Laparoscopic versus open total mesorectal excision for middle and low rectal cancer: a meta-analysis of results of randomized controlled trials. J Laparoendosc Adv Surg Tech A 2012;22:674684.

    • Search Google Scholar
    • Export Citation
  • 108

    Peeters KC, van de Velde CJ, Leer JW. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 2005;23:61996206.

    • Search Google Scholar
    • Export Citation
  • 109

    Gunderson LL, Sargent DJ, Tepper JE. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol 2004;22:17851796.

    • Search Google Scholar
    • Export Citation
  • 110

    Tepper JE, O’Connell M, Niedzwiecki D. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control—final report of intergroup 0114. J Clin Oncol 2002;20:17441750.

    • Search Google Scholar
    • Export Citation
  • 111

    Guillem JG, Diaz-Gonzalez JA, Minsky BD. cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol 2008;26:368373.

    • Search Google Scholar
    • Export Citation
  • 112

    Sauer R, Becker H, Hohenberger W. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:17311740.

  • 113

    Wagman R, Minsky BD, Cohen AM. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biol Phys 1998;42:5157.

    • Search Google Scholar
    • Export Citation
  • 114

    Sauer R, Liersch T, Merkel S. Preoperative Versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 2012;30:19261933.

    • Search Google Scholar
    • Export Citation
  • 115

    Kachnic LA. Should preoperative or postoperative therapy be administered in the management of rectal cancer? Semin Oncol 2006;33:S6469.

    • Search Google Scholar
    • Export Citation
  • 116

    Bujko K, Kepka L, Michalski W, Nowacki MP. Does rectal cancer shrinkage induced by preoperative radio(chemo)therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol 2006;80:412.

    • Search Google Scholar
    • Export Citation
  • 117

    Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev 2007:CD002102.

    • Search Google Scholar
    • Export Citation
  • 118

    Madoff RD. Chemoradiotherapy for rectal cancer—when, why, and how? N Engl J Med 2004;351:17901792.

  • 119

    O’Connell MJ, Martenson JA, Wieand HS. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 1994;331:502507.

    • Search Google Scholar
    • Export Citation
  • 120

    Smalley SR, Benedetti JK, Williamson SK. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol 2006;24:35423547.

    • Search Google Scholar
    • Export Citation
  • 121

    Andre T, Boni C, Navarro M. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009;27:31093116.

    • Search Google Scholar
    • Export Citation
  • 122

    Twelves C, Wong A, Nowacki MP. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 2005;352:26962704.

  • 123

    Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev 2009:CD006041.

    • Search Google Scholar
    • Export Citation
  • 124

    Gerard JP, Conroy T, Bonnetain F. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:46204625.

    • Search Google Scholar
    • Export Citation
  • 125

    Bosset JF, Calais G, Mineur L. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results—EORTC 22921. J Clin Oncol 2005;23:56205627.

    • Search Google Scholar
    • Export Citation
  • 126

    Bosset JF, Collette L, Calais G. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:11141123.

  • 127

    Collette L, Bosset JF, den Dulk M. Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 2007;25:43794386.

    • Search Google Scholar
    • Export Citation
  • 128

    Hofheinz RD, Wenz F, Post S. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 2012;13:579588.

    • Search Google Scholar
    • Export Citation
  • 129

    Roh MS, Yothers GA, O’Connell MJ. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04 [abstract]. J Clin Oncol 2011;29(Suppl):Abstract 3503.

    • Search Google Scholar
    • Export Citation
  • 130

    Aschele C, Cionini L, Lonardi S. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 2011;29:27732780.

    • Search Google Scholar
    • Export Citation
  • 131

    Gerard JP, Azria D, Gourgou-Bourgade S. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 2010;28:16381644.

    • Search Google Scholar
    • Export Citation
  • 132

    Gerard JP, Azria D, Gourgou-Bourgade S. Clinical results at 3 years of the ACCORD 12 randomized trial in rectal cancer [abstract]. J Clin Oncol 2012;30(Suppl):Abstract 389.

    • Search Google Scholar
    • Export Citation
  • 133

    Rodel C, Liersch T, Becker H. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 2012.

    • Search Google Scholar
    • Export Citation
  • 134

    Glynne-Jones R. Rectal cancer—the times they are a-changing. Lancet Oncol 2012;13:651653.

  • 135

    Dewdney A, Cunningham D, Tabernero J. Multicenter randomized phase II clinical trial comparing neoadjuvant oxaliplatin, capecitabine, and preoperative radiotherapy with or without cetuximab followed by total mesorectal excision in patients with high-risk rectal cancer (EXPERT-C). J Clin Oncol 2012;30:16201627.

    • Search Google Scholar
    • Export Citation
  • 136

    Chiorean EG, Sanghani S, Schiel MA. Phase II and gene expression analysis trial of neoadjuvant capecitabine plus irinotecan followed by capecitabine-based chemoradiotherapy for locally advanced rectal cancer: Hoosier Oncology Group GI03-53 Cancer Chemother Pharmacol 2012;70:2532.

    • Search Google Scholar
    • Export Citation
  • 137

    Kim SY, Hong YS, Kim DY. Preoperative chemoradiation with cetuximab, irinotecan, and capecitabine in patients with locally advanced resectable rectal cancer: a multicenter phase II study. Int J Radiat Oncol Biol Phys 2011;81:677683.

    • Search Google Scholar
    • Export Citation
  • 138

    Spigel DR, Bendell JC, McCleod M. Phase II study of bevacizumab and chemoradiation in the preoperative or adjuvant treatment of patients with stage II/III rectal cancer. Clin Colorectal Cancer 2012;11:4552.

    • Search Google Scholar
    • Export Citation
  • 139

    Fernandez-Martos C, Aparicio J, Salud A. Multicenter randomized phase II study of chemoradiation (CRT) followed by surgery (S) and chemotherapy (CT) versus induction CT followed by CRT and S in high-risk rectal cancer: GCR-3 final efficacy and safety results. J Clin Oncol 2009;27(Suppl):Abstract 4103.

    • Search Google Scholar
    • Export Citation
  • 140

    Marechal R, Vos B, Polus M. Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer: a randomized multicentric phase II study. Ann Oncol 2012;23:15251530.

    • Search Google Scholar
    • Export Citation
  • 141

    Nogue M, Salud A, Vicente P. Addition of bevacizumab to XELOX induction therapy plus concomitant capecitabine-based chemoradiotherapy in magnetic resonance imaging-defined poor-prognosis locally advanced rectal cancer: the AVACROSS study. Oncologist 2011;16:614620.

    • Search Google Scholar
    • Export Citation
  • 142

    Gay HA, Barthold HJ, O’Meara E. Pelvic normal tissue contouring guidelines for radiation therapy: a radiation therapy oncology group consensus panel atlas. Int J Radiat Oncol Biol Phys 2012;83:e353362.

    • Search Google Scholar
    • Export Citation
  • 143

    Francois Y, Nemoz CJ, Baulieux J. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 1999;17:2396.

    • Search Google Scholar
    • Export Citation
  • 144

    Habr-Gama A, Perez RO, Proscurshim I. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys 2008;71:11811188.

    • Search Google Scholar
    • Export Citation
  • 145

    Moore HG, Gittleman AE, Minsky BD. Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum 2004;47:279286.

    • Search Google Scholar
    • Export Citation
  • 146

    Tulchinsky H, Shmueli E, Figer A. An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 2008;15:26612667.

    • Search Google Scholar
    • Export Citation
  • 147

    Tran CL, Udani S, Holt A. Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg 2006;192:873877.

    • Search Google Scholar
    • Export Citation
  • 148

    Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997;336:980987.

    • Search Google Scholar
    • Export Citation
  • 149

    Birgisson H, Pahlman L, Gunnarsson U, Glimelius B. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 2005;23:86978705.

    • Search Google Scholar
    • Export Citation
  • 150

    Peeters KCMJ, Marijnen CAM, Nagtegaal ID. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 2007;246:693701.

    • Search Google Scholar
    • Export Citation
  • 151

    Siegel R, Burock S, Wernecke KD. Preoperative short-course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society. BMC Cancer 2009;9:50.

    • Search Google Scholar
    • Export Citation
  • 152

    Sebag-Montefiore D, Stephens RJ, Steele R. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009;373:811820.

    • Search Google Scholar
    • Export Citation
  • 153

    Stephens RJ, Thompson LC, Quirke P. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol 2010;28:42334239.

    • Search Google Scholar
    • Export Citation
  • 154

    van Gijn W, Marijnen CA, Nagtegaal ID. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011;12:575582.

    • Search Google Scholar
    • Export Citation
  • 155

    Bujko K, Nowacki MP, Nasierowska-Guttmejer A. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93:12151223.

    • Search Google Scholar
    • Export Citation
  • 156

    Ngan S, Fisher R, Goldstein D. A randomized trial comparing local recurrence (LR) rates between short-course (SC) and long-course (LC) preoperative radiotherapy (RT) for clinical T3 rectal cancer: an Intergroup trial (TROG, AGITG, CSSANZ, RACS) [abstract]. J Clin Oncol 2010;28;(Suppl):Abstract 3509.

    • Search Google Scholar
    • Export Citation
  • 157

    Das P, Skibber JM, Rodriguez-Bigas MA. Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol 2006;29:219224.

    • Search Google Scholar
    • Export Citation
  • 158

    Das P, Skibber JM, Rodriguez-Bigas MA. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 2007;109:17501755.

    • Search Google Scholar
    • Export Citation
  • 159

    Fietkau R, Barten M, Klautke G. Postoperative chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum 2006;49:12841292.

    • Search Google Scholar
    • Export Citation
  • 160

    Park IJ, You YN, Agarwal A. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol 2012;30:17701776.

    • Search Google Scholar
    • Export Citation
  • 161

    Silberfein EJ, Kattepogu KM, Hu CY. Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol 2010;17:28632869.

    • Search Google Scholar
    • Export Citation
  • 162

    Smith KD, Tan D, Das P. Clinical significance of acellular mucin in rectal adenocarcinoma patients with a pathologic complete response to preoperative chemoradiation. Ann Surg 2010;251:261264.

    • Search Google Scholar
    • Export Citation
  • 163

    Patel UB, Taylor F, Blomqvist L. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 2011;29:37533760.

    • Search Google Scholar
    • Export Citation
  • 164

    Janjan NA, Crane C, Feig BW. Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 2001;24:107112.

    • Search Google Scholar
    • Export Citation
  • 165

    Habr-Gama A, Perez RO, Nadalin W. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004;240:711717; discussion 717–718.

    • Search Google Scholar
    • Export Citation
  • 166

    Glynne-Jones R, Wallace M, Livingstone JI, Meyrick-Thomas J. Complete clinical response after preoperative chemoradiation in rectal cancer: is a “wait and see” policy justified? Dis Colon Rectum 2008;51:1019; discussion 19–20.

    • Search Google Scholar
    • Export Citation
  • 167

    Maas M, Beets-Tan RG, Lambregts DM. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 2011;29:46334640.

    • Search Google Scholar
    • Export Citation
  • 168

    Glynne-Jones R, Hughes R. Critical appraisal of the ‘wait and see’ approach in rectal cancer for clinical complete responders after chemoradiation. Br J Surg 2012;99:897909.

    • Search Google Scholar
    • Export Citation
  • 169

    Wolmark N, Wieand HS, Hyams DM. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst 2000;92:388396.

    • Search Google Scholar
    • Export Citation
  • 170

    Petersen SH, Harling H, Kirkeby LT. Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev 2012;3:CD004078.

    • Search Google Scholar
    • Export Citation
  • 171

    Benson AB, Catalan P, Meropol NJ. ECOG E3201: Intergroup randomized phase III study of postoperative irinotecan, 5-fluorouracil (FU), leucovorin (LV) (FOLFIRI) vs oxaliplatin, FU/LV (FOLFOX) vs FU/LV for patients (pts) with stage II/III rectal cancer receiving either pre or postoperative radiation (RT)/FU [abstract]. J Clin Oncol 2006;24(Suppl):Abstract 3526.

    • Search Google Scholar
    • Export Citation
  • 172

    Fakih M. Treating rectal cancer: key issues reconsidered. Oncology (Williston Park) 2008;22:14441446.

  • 173

    Minsky BD, Guillem JG. Multidisciplinary management of resectable rectal cancer. New developments and controversies. Oncology (Williston Park) 2008;22:14301437.

    • Search Google Scholar
    • Export Citation
  • 174

    Andre T, Boni C, Mounedji-Boudiaf L. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004;350:23432351.

    • Search Google Scholar
    • Export Citation
  • 175

    Biagi JJ, Raphael MJ, Mackillop WJ. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA 2011;305:23352342.

    • Search Google Scholar
    • Export Citation
  • 176

    Des Guetz G, Nicolas P, Perret GY. Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer 2010;46:10491055.

    • Search Google Scholar
    • Export Citation
  • 177

    Comparison of flourouracil with additional levamisole, higher-dose folinic acid, or both, as adjuvant chemotherapy for colorectal cancer: a randomised trial. QUASAR Collaborative Group. Lancet 2000;355:15881596.

    • Search Google Scholar
    • Export Citation
  • 178

    Jager E, Heike M, Bernhard H. Weekly high-dose leucovorin versus low-dose leucovorin combined with fluorouracil in advanced colorectal cancer: results of a randomized multicenter trial. Study Group for Palliative Treatment of Metastatic Colorectal Cancer Study Protocol 1. J Clin Oncol 1996;14:22742279.

    • Search Google Scholar
    • Export Citation
  • 179

    O’Connell MJ. A phase III trial of 5-fluorouracil and leucovorin in the treatment of advanced colorectal cancer. A Mayo Clinic/North Central Cancer Treatment Group study. Cancer 1989;63:10261030.

    • Search Google Scholar
    • Export Citation
  • 180

    Garcia-Aguilar J, Mellgren A, Sirivongs P. Local excision of rectal cancer without adjuvant therapy: a word of caution. Ann Surg 2000;231:345351.

    • Search Google Scholar
    • Export Citation
  • 181

    Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 2001;44:13451361.

  • 182

    Willett CG, Compton CC, Shellito PC, Efird JT. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer 1994;73:27162720.

    • Search Google Scholar
    • Export Citation
  • 183

    Schmoll HJ, Cartwright T, Tabernero J. Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 patients. J Clin Oncol 2007;25:102109.

    • Search Google Scholar
    • Export Citation
  • 184

    Hahnloser D, Haddock MG, Nelson H. Intraoperative radiotherapy in the multimodality approach to colorectal cancer. Surg Oncol Clin N Am 2003;12:9931013, ix.

    • Search Google Scholar
    • Export Citation
  • 185

    Valentini V, Balducci M, Tortoreto F. Intraoperative radiotherapy: current thinking. Eur J Surg Oncol 2002;28:180185.

  • 186

    Willett CG, Czito BG, Tyler DS. Intraoperative radiation therapy. J Clin Oncol 2007;25:971977.

  • 187

    Pietra N, Sarli L, Costi R. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 1998;41:11271133.

    • Search Google Scholar
    • Export Citation
  • 188

    Rodriguez-Moranta F, Salo J, Arcusa A. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol 2006;24:386393.

    • Search Google Scholar
    • Export Citation
  • 189

    Secco GB, Fardelli R, Gianquinto D. Efficacy and cost of risk-adapted follow-up in patients after colorectal cancer surgery: a prospective, randomized and controlled trial. Eur J Surg Oncol 2002;28:418423.

    • Search Google Scholar
    • Export Citation
  • 190

    Desch CE, Benson AB, Somerfield MR. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2005;23:85128519.

    • Search Google Scholar
    • Export Citation
  • 191

    Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2007:CD002200.

    • Search Google Scholar
    • Export Citation
  • 192

    Renehan AG, Egger M, Saunders MP, O’Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 2002;324:813813.

    • Search Google Scholar
    • Export Citation
  • 193

    Sargent DJ, Wieand HS, Haller DG. Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 2005;23:86648670.

    • Search Google Scholar
    • Export Citation
  • 194

    Guyot F, Faivre J, Manfredi S. Time trends in the treatment and survival of recurrences from colorectal cancer. Ann Oncol 2005;16:756761.

  • 195

    Li Destri G, Di Cataldo A, Puleo S. Colorectal cancer follow-up: useful or useless? Surg Oncol 2006;15:112.

  • 196

    Pfister DG, Benson AB III, Somerfield MR. Clinical practice. Surveillance strategies after curative treatment of colorectal cancer. N Engl J Med 2004;350:23752382.

    • Search Google Scholar
    • Export Citation
  • 197

    Locker GY, Hamilton S, Harris J. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol 2006;24:53135327.

    • Search Google Scholar
    • Export Citation
  • 198

    Macdonald JS. Carcinoembryonic antigen screening: pros and cons. Semin Oncol 1999;26:556560.

  • 199

    Rex DK, Kahi CJ, Levin B. Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer. CA Cancer J Clin 2006;56:160167.

    • Search Google Scholar
    • Export Citation
  • 200

    Green RJ, Metlay JP, Propert K. Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089. Ann Intern Med 2002;136:261269.

    • Search Google Scholar
    • Export Citation
  • 201

    Martin EW, Minton JP, Carey LC. CEA-directed second-look surgery in the asymptomatic patient after primary resection of colorectal carcinoma. Ann Surg 1985;202:310317.

    • Search Google Scholar
    • Export Citation
  • 202

    Yu TK, Bhosale PR, Crane CH. Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer. Int J Radiat Oncol Biol Phys 2008;71:11751180.

    • Search Google Scholar
    • Export Citation
  • 203

    Hoffman JP, Riley L, Carp NZ, Litwin S. Isolated locally recurrent rectal cancer: a review of incidence, presentation, and management. Semin Oncol 1993;20:506519.

    • Search Google Scholar
    • Export Citation
  • 204

    Lowy AM, Rich TA, Skibber JM. Preoperative infusional chemoradiation, selective intraoperative radiation, and resection for locally advanced pelvic recurrence of colorectal adenocarcinoma. Ann Surg 1996;223:177185.

    • Search Google Scholar
    • Export Citation
  • 205

    Dresen RC, Gosens MJ, Martijn H. Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol 2008;15:19371947.

    • Search Google Scholar
    • Export Citation
  • 206

    Kuehne J, Kleisli T, Biernacki P. Use of high-dose-rate brachytherapy in the management of locally recurrent rectal cancer. Dis Colon Rectum 2003;46:895899.

    • Search Google Scholar
    • Export Citation
  • 207

    Wang JJ, Yuan HS, Li JN. CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy. Med Oncol 2010;27:421429.

    • Search Google Scholar
    • Export Citation
  • 208

    Das P, Delclos ME, Skibber JM. Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation. Int J Radiat Oncol Biol Phys 2010;77:6065.

    • Search Google Scholar
    • Export Citation
  • 209

    Valentini V, Morganti AG, Gambacorta MA. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: a multicentric phase II study. Int J Radiat Oncol Biol Phys 2006;64:11291139.

    • Search Google Scholar
    • Export Citation
  • 210

    Schneider EC, Malin JL, Kahn KL. Surviving colorectal cancer: patient-reported symptoms 4 years after diagnosis. Cancer 2007;110:20752082.

  • 211

    Desnoo L, Faithfull S. A qualitative study of anterior resection syndrome: the experiences of cancer survivors who have undergone resection surgery. Eur J Cancer Care (Engl) 2006;15:244251.

    • Search Google Scholar
    • Export Citation
  • 212

    Gami B, Harrington K, Blake P. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 2003;18:987994.

    • Search Google Scholar
    • Export Citation
  • 213

    McGough C, Baldwin C, Frost G, Andreyev HJ. Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy. Br J Cancer 2004;90:22782287.

    • Search Google Scholar
    • Export Citation
  • 214

    Sprangers MA, Taal BG, Aaronson NK, te Velde A. Quality of life in colorectal cancer. Stoma vs. nonstoma patients. Dis Colon Rectum 1995;38:361369.

    • Search Google Scholar
    • Export Citation
  • 215

    Baxter NN, Habermann EB, Tepper JE. Risk of pelvic fractures in older women following pelvic irradiation. JAMA 2005;294:25872593.

  • 216

    Lange MM, Maas CP, Marijnen CA. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 2008;95:10201028.

  • 217

    Lange MM, Marijnen CA, Maas CP. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer 2009;45:15781588.

  • 218

    Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw 2009;7:883893.

  • 219

    Faul LA, Shibata D, Townsend I, Jacobsen PB. Improving survivorship care for patients with colorectal cancer. Cancer Control 2010;17:3543.

  • 220

    Dignam JJ, Polite BN, Yothers G. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 2006;98:16471654.

    • Search Google Scholar
    • Export Citation
  • 221

    Meyerhardt JA, Heseltine D, Niedzwiecki D. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 2006;24:35353541.

    • Search Google Scholar
    • Export Citation
  • 222

    Meyerhardt JA, Niedzwiecki D, Hollis D. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA 2007;298:754764.

    • Search Google Scholar
    • Export Citation
  • 223

    Meyerhardt JA, Giovannucci EL, Ogino S. Physical activity and male colorectal cancer survival. Arch Intern Med 2009;169:21022108.

  • 224

    Kushi LH, Byers T, Doyle C. American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2006;56:254281; quiz 313–254.

    • Search Google Scholar
    • Export Citation
  • 225

    Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press; 2005.

    • Search Google Scholar
    • Export Citation
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