TABLE 2.

Variant 2: Initial treatment of a 60-year-old female without a significant past medical history, and an asymptomatic nonobstructing uT3N0 rectal cancer, bilobar hepatic metastases (50% liver replacement), and bilateral pulmonary metastases. KPS 90

Treatment	Rating*	Comments
Systemic 5-FU-based chemotherapy (FOLFOX/FOLFIRI ± bevacizumab)	9	Consider anti-EGFR agents with FOLFOX/FOLFIRI in wild-type KRAS tumors
Best supportive care	2
Surgical debulking of metastatic disease	1
Resection of rectal primary	1
Liver directed therapies (transarterial embolization, radiation, RFA)	1
Preoperative pelvic RT + concurrent 5-FU-based chemotherapy	1

^*Rating scale: 1–3, usually not appropriate; 4–6, may be appropriate; 7–9, usually appropriate.