Stage IV colorectal cancer had been previously regarded as universally incurable. With the advent of aggressive surgical and ablative techniques, however, and the use of combination chemotherapy in the adjuvant or neoadjuvant setting, an ever-increasing portion of the stage IV population is being treated with curative intent. Defining the limits of curability is a challenge, however. Not all patients with stage IV disease are, or realistically will become, candidates for curative resection, and despite substantial improvements in systemic chemotherapy over the past two decades, pathologic complete responses to chemotherapy are still vanishingly rare
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