Total Neoadjuvant Therapy for Rectal Cancer.

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Multimodal therapy, including radiation, chemotherapy, and surgery, is the standard for locally advanced rectal cancer.
• Treatment sequencing has evolved, with the German Rectal Cancer Trial approach (preoperative chemoradiation, surgery, adjuvant chemotherapy) being widely adopted.
• Recent advances focus on optimizing systemic therapy delivery and patient selection.

Purpose of the Study:

• To evaluate the impact of shifting chemotherapy to the preoperative setting in locally advanced rectal cancer.
• To assess the benefits of total neoadjuvant therapy (TNT) on systemic control and survival.
• To explore the potential for surgical omission in select patient groups undergoing TNT.

Main Methods:

• Review of evolving treatment paradigms for locally advanced rectal cancer.
• Analysis of outcomes associated with traditional neoadjuvant chemoradiation versus total neoadjuvant therapy.
• Identification of patient subgroups potentially benefiting from TNT and surgical omission.

Main Results:

• Total neoadjuvant therapy demonstrates superiority over traditional sequencing.
• TNT offers improved systemic control and overall survival benefits.
• TNT expands the possibility of omitting surgery in select rectal cancer patients.

Conclusions:

• Total neoadjuvant therapy represents a significant advancement in rectal cancer treatment.
• This approach enhances systemic treatment delivery and patient outcomes.
• TNT broadens therapeutic options, including non-operative management for eligible patients.