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Related Experiment Video

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How We Treat Localized Rectal Cancer-An Institutional Paradigm for Total Neoadjuvant Therapy.

Falk Roeder1, Sabine Gerum1, Stefan Hecht2

  • 1Department of Radiation Oncology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria.

Cancers
|November 26, 2022
PubMed
Summary

Total neoadjuvant therapy (TNT) shows promise for locally advanced rectal cancer, improving complete response rates and reducing metastasis. Early immunotherapy results are also encouraging for specific tumor types, suggesting broader clinical application.

Keywords:
CRTTNTchemoradiotherapymicrosatellite instabilitymismatch-repair-deficiencyorgan-sparingradiotherapyrectal cancertotal neoadjuvant therapy

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Area of Science:

  • Oncology
  • Gastroenterology

Background:

  • Locally advanced rectal cancer (LARC) treatment traditionally involves surgery, radiotherapy (RT), and chemotherapy (CHT).
  • Total neoadjuvant therapy (TNT) integrates these modalities before surgery to enhance outcomes.
  • Emerging data suggests immunotherapy efficacy in microsatellite instability-high (MSI-high)/mismatch-repair-deficient (dMMR) rectal cancers.

Purpose of the Study:

  • To evaluate the potential of Total Neoadjuvant Therapy (TNT) in improving pathological complete response (pCR) and reducing distant metastases in LARC.
  • To explore the role of upfront immunotherapy in MSI-high/dMMR rectal tumors.
  • To propose a practical treatment algorithm for LARC based on current evidence.

Main Methods:

  • Review and interpretation of existing clinical data on TNT and immunotherapy for LARC.
  • Analysis of pathological complete response (pCR) rates and distant metastasis risk.
  • Assessment of organ-sparing strategy feasibility.

Main Results:

  • TNT may increase pCR rates and decrease distant metastases in LARC.
  • Increased response rates with TNT may facilitate organ-sparing approaches.
  • Upfront immunotherapy shows promising results in MSI-high/dMMR rectal cancer.

Conclusions:

  • Existing data supports the adoption of TNT and immunotherapy in clinical practice for LARC.
  • A practical treatment algorithm is proposed, integrating TNT and immunotherapy concepts.
  • Further research may refine treatment standards, but current evidence warrants clinical consideration.