Total neoadjuvant therapy for locally advanced rectal cancer in Spain: results from a national patterns-of-care...

To assess clinical practice patterns, technological availability, and national consensus in the management of locally advanced rectal cancer (LARC) in radiation oncology departments across Spain following the implementation of total neoadjuvant therapy (TNT).

We designed a national survey and addressed it to radiation oncologists members of the Gastrointestinal Tumors Group of the Spanish Society of Radiation Oncology (SEOR-GI). The anonymous questionnaire included 30 items covering TNT regimens, indications for chemoradiotherapy (CRT) or short-course radiotherapy (SCRT), nodal management, use of boost, management of oligometastatic disease, and watch-and-wait (W&W) protocols. A descriptive analysis of the responses was performed, presenting data as absolute and relative frequencies.

Between May and July 2025, 56 valid responses were collected from principal Spanish regions. All centers reported using TNT, with CRT followed by consolidation chemotherapy being the predominant regimen (67.9%). CRT was mainly used for cT3b-T4b tumors, while SCRT was reserved for cases with lower local risk or for systemic intensification strategies. W&W protocols were available in 82.1% of departments, and 85.5% included lateral lymph nodes. Multiple national consensus guidelines (≥70%) were identified, aligning with major international clinical guidelines.

This national survey shows homogeneous clinical practices and the rapid adoption of TNT and organ-preservation strategies in managing LARC in Spain. The findings emphasize the need to unify national protocols and encourage collaborative research.