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Related Concept Videos

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Related Experiment Video

Updated: Jun 11, 2025

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Total Neoadjuvant Therapy Versus Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer: A Multi-Institutional

Elif Şenocak Taşçı1, Arda Ulaş Mutlu2, Onur Saylık3

  • 1Department of Medical Oncology, Kanuni Sultan Süleyman Training and Research Hospital, 34295 Istanbul, Turkey.

Cancers
|September 28, 2024
PubMed
Summary

Total neoadjuvant therapy (TNT) improves outcomes for locally advanced rectal cancer (LARC) by increasing pathological complete response (pCR) and enabling non-operative management. This approach offers significant benefits over standard chemoradiotherapy (CRT).

Keywords:
chemoradiotherapyconsolidationinductionlocally advanced rectal cancerpathological complete responsetotal neoadjuvant therapy

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Area of Science:

  • Oncology
  • Gastrointestinal Cancer Research
  • Surgical Oncology

Background:

  • Locally advanced rectal cancer (LARC) management traditionally involves chemoradiotherapy (CRT).
  • Total neoadjuvant therapy (TNT) integrates chemotherapy and radiotherapy before surgery to optimize treatment.
  • TNT aims to improve resectability, pathological complete response (pCR), and patient survival.

Purpose of the Study:

  • To compare clinical outcomes of TNT versus standard CRT in LARC patients.
  • To evaluate the impact of TNT on pCR, survival, and non-operative management (NOM) rates.
  • To analyze treatment sequences within TNT (induction vs. consolidation chemotherapy).

Main Methods:

  • Retrospective multi-institutional analysis of 276 stage II-III LARC patients (2021-2024).
  • Comparison between patients receiving CRT (n=105) and TNT (n=171).
  • TNT group stratified by chemotherapy sequence (induction or consolidation).

Main Results:

  • TNT significantly increased pCR rates (21.8% vs. 2.9%, p < 0.001) compared to CRT.
  • TNT demonstrated lower rates of lymphatic, vascular, and perineural invasion.
  • Higher rates of NOM (16.9% vs. 0.9%, p < 0.001) and a longer interval to surgery were observed with TNT.

Conclusions:

  • Total neoadjuvant therapy is a superior treatment strategy for LARC compared to standard CRT.
  • TNT enhances pathological complete response, reduces tumor invasion, and increases non-operative management options.
  • TNT offers potential improvements in survival and quality of life for LARC patients.