Many modalities have been evaluated for the treatment of metastatic colorectal cancer: systemic chemotherapy, regional chemotherapy, ablative therapies, surgery and combined strategies. Systemic chemotherapy is the most widely used approach and for many years has been considered only in a palliative setting. After four decades 5-fluoruracil remains the mainstay of treatment with its different biomodulations and infusional regimens. However the availability of active new drugs such as irinotecan, oxali-platin and raltitrexed, oral agents such as capecita-bine and uracil-tegafur (UFT), and more recently the development of targeted molecular therapies such as cetuximab and bevacizumab has permitted the oncologist to leave behind nihilism and enter a promising new age.
About 50% of patients diagnosed with colorectal carcinoma have metastatic disease at the time of diagnosis or will develop metastases or local recurrences after diagnosis.
Rectal cancer requires a different approach to colon cancer in the pre-operative and adjuvant settings: metastatic diseases have the same treatment and randomised or phase II trials include both tumours.
This chapter reviews the evidence and focuses on state of the art research and everyday treatment of patients with metastatic rectal cancer.
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