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. 2023 Feb 1;15(3):921.
doi: 10.3390/cancers15030921.

Integrated Intensified Chemoradiation in the Setting of Total Neoadjuvant Therapy (TNT) in Patients with Locally Advanced Rectal Cancer: A Retrospective Single-Arm Study on Feasibility and Efficacy

Maria Chiara Lo Greco  1 , Madalina La Rocca  1 , Giorgia Marano  1 , Irene Finocchiaro  1 , Rocco Luca Emanuele Liardo  2 , Roberto Milazzotto  2 , Grazia Acquaviva  3 , Antonello Basile  4   5 , Stefano Palmucci  4   5 , Pietro Valerio Foti  4   5 , Stefano Pergolizzi  1   6 , Antonio Pontoriero  1   6 , Silvana Parisi  6 , Corrado Spatola  2   5
Affiliations

Integrated Intensified Chemoradiation in the Setting of Total Neoadjuvant Therapy (TNT) in Patients with Locally Advanced Rectal Cancer: A Retrospective Single-Arm Study on Feasibility and Efficacy

Maria Chiara Lo Greco et al. Cancers (Basel). .

Abstract

While surgery is considered the main treatment for early-stage rectal cancer, locally advanced rectal cancer needs to be handled with a multidisciplinary approach. Based on literature data suggesting promising advantages of total neoadjuvant therapy (TNT), we performed a retrospective, single-arm, single-center study on 45 patients affected by histologically and radiologically proven locally advanced rectal cancer, with the aim of analyzing the feasibility and short-term efficacy of an integrated intensified treatment in the setting of TNT. Each analyzed patient performed three cycles of FOLFOX4 or De Gramont induction chemotherapy (iCT), followed by concurrent chemoradiotherapy (CRT) with long course radiotherapy (LCRT) plus concomitant boost and continuous 5-FU infusion, followed by three cycles of FOLFOX4 or De Gramont consolidation chemotherapy (conCT) and then surgery with total mesorectal excision. At a median follow-up of 30 months, this strategy has shown to be feasible and effective in terms of pathological complete response (pCR) and short-term disease-free survival (DFS).

Keywords: chemoradiotherapy; conventionally fractionated radiotherapy; hypofractionated radiotherapy; intensified preoperative chemoradiotherapy; locally advanced rectal cancer; long course radiotherapy; total neoadjuvant therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Consort diagram showing the different application and feasibility of preoperative induction chemotherapy (FOLFOX4, De Gramont) radio-chemotherapy (CFRT, HFRT), and consolidation chemotherapy (FOLFOX4, De Gramont).
Figure 2
Figure 2
Comparation between pathological and radiological response.
Figure 3
Figure 3
Kaplan–Meier curves showing DFS rates comparing different risk groups (cTNM, patological response after neoadjuvant therapy).
See this image and copyright information in PMC

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