Total neoadjuvant therapy for rectal cancer: a guide for surgeons

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Rectal cancer management is rapidly evolving with new treatment paradigms.
• Total neoadjuvant therapy (TNT) is emerging as a key strategy for locally advanced rectal cancer.
• Landmark trials like RAPIDO and PRODIGE-23 support TNT's role.

Purpose of the Study:

• To provide a primer on Total Neoadjuvant Therapy (TNT) for general surgeons.
• To outline the indications, benefits, and drawbacks of various TNT regimens.
• To aid surgeons in advocating for optimal patient treatment strategies.

Main Methods:

• Review of recent landmark randomized controlled trials (e.g., RAPIDO, PRODIGE-23).
• Analysis of different components within TNT protocols, including radiation, chemotherapy, and sequencing.
• Synthesis of current evidence to present a pragmatic overview.

Main Results:

• TNT is a viable option for selected patients with locally advanced rectal cancer.
• Potential benefits include improved systemic disease control, better adherence, and reduced ostomy time.
• Significant variability exists among TNT regimens regarding radiation, chemotherapy, and treatment order.

Conclusions:

• Familiarity with diverse TNT regimens is essential for rectal cancer surgeons.
• Optimizing TNT strategies can enhance patient outcomes and treatment adherence.
• This overview aims to empower surgeons in clinical decision-making for rectal cancer patients.