The development and challenges of total neoadjuvant therapy in locally advanced rectal cancer
FENG Bo
MA Tao
Abstract：The standard treatment for locally advanced rectal cancer,involved either neoadjuvant chemoradiotherapy or short-course radiotherapy,followed by total mesorectal resection and postoperative adjuvant chemotherapy,which could significantly reduce local recurrence rate,but overall survival is not improved.Total neoadjuvant therapy(TNT),delivering the full course of radiotherapy and chemotherapy before surgery,has been demonstrated by several landmark randomized controlled trials to significantly enhance pathologic complete response rates and reduce distant metastasis rates,thereby prolonging disease-free survival and overall survival.For low rectal cancer,patients with a complete clinical response following TNT even have the opportunity to adapt watch and wait surveillance and achieve organ preservation of the rectum.However,there are still obstacles and challenges for TNT,such as suitable population,the optimal radiotherapy and chemotherapy regimens,as well as their sequence and the choice of adjuvant chemotherapy.A stratified approach based on high-resolution MR results may be a preferred regimen.
Keywords：locally advanced rectal cancertotal neoadjuvant therapypathological complete responsedistant metastasisorgan preservation
Publication Date：2024-07-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 744-751 )