Total neoadjuvant therapy in rectal cancer: the evidence and expectations
Language English Country Netherlands Media print-electronic
Document type Journal Article, Review
PubMed
37926376
DOI
10.1016/j.critrevonc.2023.104196
PII: S1040-8428(23)00284-6
Knihovny.cz E-resources
- Keywords
- Non-operative management, Rectal cancer, Risk-based approach, Total neoadjuvant therapy,
- MeSH
- Chemoradiotherapy MeSH
- Combined Modality Therapy MeSH
- Humans MeSH
- Motivation MeSH
- Rectal Neoplasms * therapy pathology MeSH
- Neoadjuvant Therapy * MeSH
- Antineoplastic Combined Chemotherapy Protocols therapeutic use MeSH
- Neoplasm Staging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Current management of locally advanced rectal cancer achieves high cure rates, distant metastatic spread being the main cause of patients' death. Total neoadjuvant therapy (TNT) employs (chemo)radiotherapy and combined chemotherapy prior to surgery to improve the treatment outcomes. TNT has been shown to reduce significantly distant metastases, increase disease-free survival by 5 - 10% in 3 years, and finally also overall survival (≈ 5% in 7 years). It proved to double the rate of pathologic complete responses, making it an attractive strategy for non-operative management to avoid permanent colostomy in patients with distal tumors. In addition, it endorses adherence to the therapy due to better tolerance and, potentially, shortens its overall duration. A number of questions related to TNT remain currently unresolved including the indications, preferred radiotherapy and chemotherapy regimens, their sequence, timing of surgery, and role of adjuvant therapy. A stratified approach may be the optimal way to go.
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