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What Predicts Complete Response to Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer?

Sumeyye Yilmaz1, David Liska1, Madison L Conces2

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Diseases of the Colon and Rectum
|September 11, 2024
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Total neoadjuvant therapy for rectal cancer achieved a 37% complete response rate. Low rectal tumors and no extramural vascular invasion predicted response, with combined MRI and sigmoidoscopy improving prediction accuracy.

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Area of Science:

  • Oncology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Total neoadjuvant therapy (TNT) for stage II and III rectal cancer involves chemotherapy and chemoradiation before surgery.
  • TNT is linked to higher complete response rates, defined as pathological complete response or sustained clinical complete response.

Purpose of the Study:

  • Identify predictors of complete response to TNT in rectal cancer.
  • Compare diagnostic tools (sigmoidoscopy, MRI) for predicting complete response.

Main Methods:

  • Retrospective cohort study at a single tertiary care center.
  • Included 119 patients with stage II-III rectal cancer treated with TNT between 2015-2021.
  • Assessed complete response rate, predictors, and diagnostic tool accuracy.

Main Results:

  • The overall complete response rate was 37%.
  • Low rectal tumors (OR 1.5) and absence of extramural vascular invasion (OR 2.2) were predictors of complete response.
  • Sigmoidoscopy showed higher sensitivity (76.0%) and specificity (72.5%) than MRI (62.5%, 69.2%) for predicting response; combined techniques improved specificity to 82.5%.

Conclusions:

  • A 37% complete response rate was observed with TNT for rectal cancer.
  • Low rectal tumors and absence of EMVI are key predictors of response.
  • Combined MRI and sigmoidoscopy offer the best prediction of complete response.