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Review
. 2024 May 31;16(11):2093.
doi: 10.3390/cancers16112093.

Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?

Kentaro Ochiai  1   2 , Neal Bhutiani  1 , Atsushi Ikeda  1 , Abhineet Uppal  1 , Michael G White  1 , Oliver Peacock  1 , Craig A Messick  1 , Brian K Bednarski  1 , Yi-Qian Nancy You  1 , John M Skibber  1 , George J Chang  1 , Tsuyoshi Konishi  1
Affiliations
Review

Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?

Kentaro Ochiai et al. Cancers (Basel). .

Abstract

Total neoadjuvant therapy (TNT) is a novel strategy for rectal cancer that administers both (chemo)radiotherapy and systemic chemotherapy before surgery. TNT is expected to improve treatment compliance, tumor regression, organ preservation, and oncologic outcomes. Multiple TNT regimens are currently available with various combinations of the treatments including induction or consolidation chemotherapy, triplet or doublet chemotherapy, and long-course chemoradiotherapy or short-course radiotherapy. Evidence on TNT is rapidly evolving with new data on clinical trials, and no definitive consensus has been established on which regimens to use for improving outcomes. Clinicians need to understand the advantages and limitations of the available regimens for multidisciplinary decision making. This article reviews currently available evidence on TNT for rectal cancer. A decision making flow chart is provided for tailor-made use of TNT regimens based on tumor location and local and systemic risk.

Keywords: rectal cancer; total neoadjuvant therapy; watch and wait.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Treatment decision flow chart. EMVI: extramural vascular invasion, LN: lymph node, LAR: low anterior resection, ISR: intersphincteric resection, APR: abdomino-perineal resection, and CRM: circumferential resection margin.
Figure 2
Figure 2
Tumor height according to the relationship between the tumor, peritoneal reflection and the expected procedure. APR: abdomino-perineal resection, and LAR: low anterior resection.
See this image and copyright information in PMC

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