Total Neoadjuvant Therapy with Induction FOLFIRINOX and Concurrent Chemoradiation for Locally Advanced Lower-Middle...

IntroductionLocally advanced rectal cancer (LARC) remains a therapeutic challenge, with significant risks of both locoregional and distant relapse. Total neoadjuvant therapy (TNT), which combines induction chemotherapy and chemoradiotherapy (CRT) prior to surgery, has emerged as a potentially more effective strategy than traditional approaches, yet data from low- and middle-income countries (LMICs) remain limited. This study evaluates the efficacy and toxicity of induction FOLFIRINOX followed by concurrent CRT in Vietnamese patients with lower-middle LARC.MethodsA retrospective analysis was conducted on adult patients (n = 72) with clinical stage T3-T4 M0 rectal adenocarcinoma. All patients received induction FOLFIRINOX for six cycles and preoperative CRT, followed by total meso-rectal excision (TME), and adjuvant chemotherapy as indicated. The primary endpoint was pathologic complete response (pCR, ypT0N0); secondary endpoints were 3-year disease-free survival (DFS) and safety. The study conforms to STROBE guidelines.ResultsPathological complete response was achieved in 25.0% of patients. The 3-year DFS reached 90.6%. Treatment feasibility was high, with 93.06% completing all 6 induction cycles; hematologic adverse events, particularly leukopenia and neutropenia, were the most common toxicities but were generally manageable with supportive care, while nonhematological toxicities were predominantly mild. R0 resection rate was 100% and sphincter-preserving surgery was 86.1%.ConclusionIn a LMIC setting, induction FOLFIRINOX followed by CRT shows promising efficacy and tolerable toxicity in LARC. These findings support early, intensified systemic therapy to enhance local control and mitigate metastatic spread.