The treatment of rectal cancer with synchronous liver metastases: A matter of strategy

Around one fifth of patients with rectal cancer (RC) have synchronous metastatic disease at the diagnosis. The optimal treatment sequence for patients with RC and synchronous liver metastases (LM) is complex and unclear, missing strong, evidence-based recommendations. From a clinical point of view, this situation is highly heterogeneous and the treatment strategy is generally determined by a number of factors, such as the potential resectability of primary tumor and LM, patients' characteristics, the presence of primary tumor-related symptoms and the response to therapies. Treatment options for these patients include systemic therapy, short-course radiotherapy (SC-RT), long-course chemoradiotherapy (LC-CRT) and surgery of the primary tumor and LM. The principal goal is to render the patients eligible to radical surgery, thus offering a chance of cure at least for some of them. This review summarizes the most appropriate treatment strategies which should be recommended in the different clinical scenarios of this heterogeneous condition.