World Journal of Surgical Oncology (Nov 2024)

Neoadjuvant therapy in rectal cancer—one year follow-up results of standard versus total neoadjuvant strategies

  • Luís Correia Gomes,
  • Bernardo Alves Pereira,
  • Isália Miguel,
  • Ana Luís,
  • Ana Pina,
  • Cátia Pedro,
  • Daniela Cavadas,
  • Daniela Pereira,
  • Joana Lemos,
  • João Maciel,
  • João Oliveira,
  • José Venâncio,
  • Madalena Santos,
  • Manuel Limbert,
  • Miguel Braga,
  • Miriam Abdulrehman,
  • Pedro Freitas,
  • Ricardo Fonseca,
  • Teresa Ferreira,
  • Isadora Rosa

DOI
https://doi.org/10.1186/s12957-024-03590-4
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 10

Abstract

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Abstract Background Locally advanced rectal cancer (LARC) poses a significantly challenge in clinical management, requiring a multimodal treatment approach. Among innovative strategies, Total Neoadjuvant Therapy (TNT) has emerged, delivering all planned chemotherapy before surgery. Objective Our aim was to evaluate the real-world application and efficacy of TNT and to compare it with the non-TNT standard strategy. Methods This retrospective study compared locally advanced rectal adenocarcinoma patients treated with Total Neoadjuvant Therapy (TNT) in 2022 with those who underwent traditional chemoradiotherapy (CRT) in 2020–2021. The primary endpoints were the pathologic complete response rate and the sustained clinical complete response rate in patients under W&W. Results Among 107 patients (54.2% male, mean age 62.48 years), non-TNT (67 patients) and TNT (40 patients) mean follow-ups were 26.7 and 8.2 months, respectively. No differences in gender(p = 0.163), staging (p = 0.707), or location (p = 0.727) were noted. TNT patients received more short-course radiotherapy (42.5% vs1.5%, p < 0.001). Clinical responses favored TNT (p = 0.030) with no significant differences in pathological responses, recurrence rates, or survival. TNT exhibited higher chemotherapy completion (p = 0.007) and lower adverse events (p < 0.001). Post-surgery events showed no significant differences (p = 0.470). Single center with retrospective design and carries limitations that may restrict the generalizability of the findings and the relatively short follow-up duration are our main limitations. Conclusion Our data add to the body of literature favoring the TNT treatment strategy for locally advanced rectal cancer, aiming to achieve comparable complete response rates with less adverse events.

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