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Retrospective review of total neoadjuvant therapy
Laila Babar1, Veli Bakalov2, Stephen Abel3
1Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States. laila.babar@ahn.org.
World Journal of Gastrointestinal Oncology
|October 31, 2019
Summary
Total neoadjuvant therapy (TNT) is increasingly used for rectal cancer, showing similar survival rates to standard treatment. This approach integrates multi-agent chemotherapy and neoadjuvant chemoradiotherapy before surgery.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiotherapy (nCRT) followed by surgery and postoperative chemotherapy (maChT).
- Delayed maChT administration in the standard approach raises concerns about distant metastases.
- Total neoadjuvant therapy (TNT), integrating both maChT and nCRT before resection, is emerging as a popular alternative.
Purpose of the Study:
- To analyze temporal trends in the utilization of total neoadjuvant therapy (TNT) for locally advanced rectal cancer.
- To compare the efficacy of TNT with the standard neoadjuvant chemoradiation approach in terms of survival outcomes.
Main Methods:
- Utilized the National Cancer Database to identify patients with Stage II-III locally advanced rectal cancer treated between 2004-2015.
- Defined TNT as multi-agent chemotherapy (maChT) initiated at least 90 days before neoadjuvant chemoradiotherapy (nCRT).
- Employed Kaplan-Meier curves and log-rank statistics for survival analysis, with multivariable Cox regression and propensity score analysis to control for bias.
Main Results:
- Identified 9066 patients; 8812 received standard nCRT, and 254 received TNT.
- TNT use was associated with more advanced disease (e.g., >1 positive node, Stage III) and increased significantly from 2010-2015.
- Both TNT and nCRT groups showed similar 5-year overall survival rates (76% vs. 78%).
Conclusions:
- A notable increase in TNT adoption for rectal cancer, particularly in patients with more advanced disease, was observed.
- Patients receiving TNT demonstrated comparable survival outcomes to those treated with standard nCRT.
- Ongoing randomized trials are crucial for further evaluating the role and benefits of TNT.
