Common management of primary rectal carcinoma in patients with stage IV disease at the diagnosis.

Rectal cancer is one of the more common neoplasms of Western countries. It is commonly diagnosed at a precocious stage but, because of local relapse and/or metastatic disease, only half of radically resected patients can be considered free of disease. In patients presenting at diagnosis with stage IV disease the best treatment is still unknown. If the patient is a candidate for surgical resection, the primary tumor should be treated as in a patient without metastatic disease. If metastases are unresectable, the treatment of the primary lesion is palliative and, according to the patients' symptoms, it is usually represented by a chemotherapy approach. It is still unclear whether to reserve radiotherapy only for the symptomatic cases. This paper examines the factors pertinent to clinical trials designed for stage IV rectal cancer with resectable and unresectable metastases and reviews the existing data supporting palliative therapy for symptomatic and asymptomatic primary tumors.