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Comparative Study
. 2024 Nov 28;22(1):317.
doi: 10.1186/s12957-024-03590-4.

Neoadjuvant therapy in rectal cancer-one year follow-up results of standard versus total neoadjuvant strategies

Luís Correia Gomes  1 , Bernardo Alves Pereira  2 , Isália Miguel  2 , Ana Luís  2 , Ana Pina  2 , Cátia Pedro  3 , Daniela Cavadas  4 , Daniela Pereira  5 , Joana Lemos  6 , João Maciel  4 , João Oliveira  2 , José Venâncio  7 , Madalena Santos  2 , Manuel Limbert  4 , Miguel Braga  7 , Miriam Abdulrehman  3 , Pedro Freitas  2 , Ricardo Fonseca  5 , Teresa Ferreira  8 , Isadora Rosa  6
Affiliations
Comparative Study

Neoadjuvant therapy in rectal cancer-one year follow-up results of standard versus total neoadjuvant strategies

Luís Correia Gomes et al. World J Surg Oncol. .

Abstract

Background: Locally advanced rectal cancer (LARC) poses a significantly challenge in clinical management, requiring a multimodal treatment approach. Among innovative strategies, Total Neoadjuvant Therapy (TNT) has emerged, delivering all planned chemotherapy before surgery.

Objective: Our aim was to evaluate the real-world application and efficacy of TNT and to compare it with the non-TNT standard strategy.

Methods: This retrospective study compared locally advanced rectal adenocarcinoma patients treated with Total Neoadjuvant Therapy (TNT) in 2022 with those who underwent traditional chemoradiotherapy (CRT) in 2020-2021. The primary endpoints were the pathologic complete response rate and the sustained clinical complete response rate in patients under W&W.

Results: Among 107 patients (54.2% male, mean age 62.48 years), non-TNT (67 patients) and TNT (40 patients) mean follow-ups were 26.7 and 8.2 months, respectively. No differences in gender(p = 0.163), staging (p = 0.707), or location (p = 0.727) were noted. TNT patients received more short-course radiotherapy (42.5% vs1.5%, p < 0.001). Clinical responses favored TNT (p = 0.030) with no significant differences in pathological responses, recurrence rates, or survival. TNT exhibited higher chemotherapy completion (p = 0.007) and lower adverse events (p < 0.001). Post-surgery events showed no significant differences (p = 0.470). Single center with retrospective design and carries limitations that may restrict the generalizability of the findings and the relatively short follow-up duration are our main limitations.

Conclusion: Our data add to the body of literature favoring the TNT treatment strategy for locally advanced rectal cancer, aiming to achieve comparable complete response rates with less adverse events.

Keywords: Adjuvant chemotherapy; Chemoradiotherapy; Complete clinical response; Locally advanced rectal cancer; Total neoadjuvant therapy; Treatment completion rates.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the local institutional Ethical Committee board (Comissão de Etica para a Saúde of Instituto Português de Oncologia de Lisboa Francisco Gentil, with the protocol code UIC/1649). Consent for publication: The manuscript does not contain any individual person’s data in any form, so inform consent is not necessary. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(a) Without re-evaluation. TNT: Total Neoadjuvant Therapy, TME: Total Mesorectal Excision, mrf: Mesorectal fascia; EMVI: Extramural Venous Invasion
Fig. 2
Fig. 2
Estimated survival curve with Kaplan–Meier. There’s no difference regarding disease-free and estimated survival between both groups. TNT: Total Neoadjuvant Treatment
Fig. 3
Fig. 3
Disease-free curve with Kaplan–Meier. There's no difference regarding disease-free and estimated survival between both groups. TNT: Total Neoadjuvant Treatment
See this image and copyright information in PMC

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