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Total neoadjuvant therapy: Fact, fantasy, or fallacy?

Arun Nagarajan1

  • 1Department of Hematology/Oncology, Cleveland Clinic, Weston, FL, 33331, USA.

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Summary

Total neoadjuvant therapy (TNT) is emerging as a new approach for rectal cancer management. This review examines the evidence for TNT

Keywords:
ChemoradiotherapyCirculating tumor DNAConsolidation chemotherapyGALAXYMinimal residual diseaseOPRAPRODIGE-23RAPIDORectal cancerTotal neoadjuvant therapy

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Area of Science:

  • Oncology
  • Gastroenterology

Background:

  • Colorectal cancer is a leading cause of cancer death in the U.S.
  • Rectal cancer accounts for one-third of colorectal cases, with a 5-year survival rate of 67%.
  • Traditional management for locally advanced rectal cancer has seen limited progress.

Purpose of the Study:

  • To review the current evidence on total neoadjuvant therapy (TNT) for rectal cancer.
  • To analyze the facts, fantasies, and fallacies surrounding TNT.
  • To discuss the potential of TNT in improving survival rates.

Main Methods:

  • Review of high-quality data from randomized prospective trials.
  • Analysis of existing literature on rectal cancer treatment strategies.
  • Evaluation of the efficacy and safety of TNT.

Main Results:

  • TNT aims to improve outcomes by eradicating minimal residual disease.
  • Growing interest in TNT is driven by high metastatic disease death rates.
  • Evidence from trials is now available to assess TNT's role.

Conclusions:

  • TNT represents a significant shift in rectal cancer management.
  • Further research and clinical trials are needed to solidify TNT's place in treatment protocols.
  • Evaluating the long-term impact of TNT on survival is crucial.