Total Neoadjuvant Therapy Approach for the Treatment of Locally Advanced Rectal Cancer: Where Do We Stand?

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Locally advanced rectal cancer (LARC) management often involves neoadjuvant chemoradiotherapy, surgery, and adjuvant chemotherapy.
• Total neoadjuvant therapy (TNT), administering all chemotherapy before definitive treatment, is an emerging alternative with increasing evidence.
• Multidisciplinary evaluation is crucial for considering TNT in LARC treatment strategies.

Purpose of the Study:

• To review current data and controversies surrounding total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC).
• To analyze the characteristics of studies evaluating TNT in LARC, including inclusion criteria, radiotherapy fractionation, systemic agents, and timing.
• To assess the surgical and long-term oncological outcomes associated with different TNT approaches.

Main Methods:

• Systematic review of published studies on TNT for LARC.
• Analysis of radiotherapy fractionation, chemotherapy regimens, and treatment sequencing.
• Evaluation of surgical outcomes and long-term oncological results.

Main Results:

• Solid evidence supports the use of TNT in patients with LARC.
• No specific TNT regimen has demonstrated superiority over others.
• International guidelines permit tailored treatment selection based on patient-specific factors.

Conclusions:

• TNT is a well-supported treatment option for LARC.
• Treatment decisions for TNT should be individualized based on clinical and pathological characteristics.
• This review provides an evidence-based assessment of various TNT approaches for LARC.