Adjuvant chemotherapy after neoadjuvant chemoradiation and surgery: A quest to improve survival for stage II and III rectal cancer

Combined multimodality treatments, including radiation, chemotherapy, and total mesorectal excision have been studied extensively over the past few decades, with efforts toward improving rates of locoregional recurrence and disease-free and overall survival in rectal cancer. Predictive and prognostic markers to adjuvant systemic chemotherapy have been identified, with the goal of tailoring therapy and continuing improvement in survival. In our article, we discuss these factors, including tumor downstaging, pathologic node status, gene expression, and future directions in therapy of rectal cancer.