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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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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Neoadjuvant Radiochemotherapy and Total Neoadjuvant Therapy in the Management of Locally Advanced Rectal Cancer.

Mücahit Yigit1, Siyer Roohani1,2,3, Annika Kurreck4

  • 1Radiation Oncology, Charité-Universitätsmedizin Berlin, Berlin, DEU.

Cureus
|December 15, 2025
PubMed
Summary

Total neoadjuvant therapy (TNT) and neoadjuvant radiochemotherapy are effective for locally advanced rectal cancer (LARC). Poor tumor regression grading (TRG) indicates higher progression risk, suggesting TRG

Keywords:
locally advanced rectal cancerneoadjuvant chemoradiotherapyneoadjuvant radiochemotherapyrectal cancertotal neoadjuvant therapy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Radiation Oncology

Background:

  • Neoadjuvant radiochemotherapy is standard for locally advanced rectal cancer (LARC).
  • Total neoadjuvant therapy (TNT) integrates neoadjuvant radiochemotherapy with chemotherapy before surgery.
  • This study evaluates TNT and standard neoadjuvant radiochemotherapy outcomes at a tertiary center.

Purpose of the Study:

  • To assess treatment outcomes for LARC patients receiving TNT or neoadjuvant radiochemotherapy.
  • To compare outcomes with existing literature.
  • To identify factors influencing treatment efficacy and recurrence.

Main Methods:

  • Retrospective cohort study of LARC patients (2014-2023).
  • Comparison of patients receiving TNT versus neoadjuvant radiochemotherapy without postoperative chemotherapy.
  • Analysis of treatment outcomes, including distant metastases, local recurrence, and survival rates.

Main Results:

  • 122 LARC patients included; 31 (25.4%) received TNT.
  • 21.3% experienced distant metastases; 7.4% had local recurrence.
  • Poor tumor regression grading (TRG) associated with worse progression-free survival (HR: 2.55).
  • Lower rectal tumors linked to poorer local control (HR: 5.70).

Conclusions:

  • Neoadjuvant radiochemotherapy, including TNT, is a safe and effective LARC treatment.
  • TRG can identify high-risk patients for early progression.
  • Further research needed for optimal TNT sequencing and patient selection.