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Predicting Tumor Regrowth in Patients Undergoing Non-Operative Management after Total Neoadjuvant Therapy.

Kamil Erozkan1, Emily Simon1, Emily Steinhagen1

  • 1Division of Colorectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

Journal of Gastrointestinal Cancer
|November 3, 2025
PubMed
Summary
This summary is machine-generated.

Predicting tumor regrowth after total neoadjuvant treatment (TNT) for locally advanced rectal cancer (LARC) in non-operative management (NOM) remains challenging. This study found no significant predictors of regrowth in patients undergoing NOM after TNT, highlighting the need for further research.

Keywords:
Clinical complete responseNon-operative managementRectal CancerTotal Neoadjuvant TherapyTotal mesorectal excisionTumor regrowth

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Area of Science:

  • Oncology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Total neoadjuvant treatment (TNT) is standard for locally advanced rectal cancer (LARC), improving complete clinical response (cCR) rates.
  • Non-operative management (NOM) is increasingly used for organ preservation after TNT, but tumor regrowth is a concern.
  • Predictors of tumor regrowth during NOM after TNT are not well-defined, impacting surveillance strategies.

Purpose of the Study:

  • To identify predictors of tumor regrowth in patients with LARC undergoing non-operative management (NOM) after total neoadjuvant treatment (TNT).

Main Methods:

  • Retrospective review of LARC patients who completed TNT between 2019-2024.
  • Inclusion of patients with sustained cCR or tumor regrowth post-cCR; exclusion of those with pCR post-surgery for suspected regrowth.
  • Univariate analysis of demographic, histopathologic, biochemical, clinical, radiological, and treatment factors.

Main Results:

  • Of 137 LARC patients, 44 achieved cCR post-TNT. Ten patients experienced tumor regrowth, with 2 achieving pCR.
  • No statistically significant differences were found in analyzed factors between patients with and without tumor regrowth.
  • The study included 28 patients in the univariate analysis, with limited power due to a low number of regrowth events.

Conclusions:

  • No predictors of tumor regrowth were identified in patients undergoing NOM after TNT.
  • Limited event numbers restricted statistical power to detect meaningful associations.
  • Further investigation is warranted to refine surveillance and optimize NOM recommendations for LARC.