ArticleCureus2025
Neoadjuvant Radiochemotherapy and Total Neoadjuvant Therapy in the Management of Locally Advanced Rectal Cancer.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
backgroundNeoadjuvant radiochemotherapy is a key treatment modality for locally advanced rectal cancer (LARC). Total neoadjuvant therapy (TNT) is a relatively new treatment approach consisting of neoadjuvant radiochemotherapy and consolidative or inductive chemotherapy followed by curative resection. In this study, we aimed to assess the treatment outcomes at a tertiary care center, focusing on neoadjuvant treatments, and to compare our results to the available literature. Methods: This retrospective cohort study included patients with LARC receiving TNT or neoadjuvant radiochemotherapy without postoperative chemotherapy between 2014 and 2023. Results: A total of 122 patients with LARC, with a median follow-up of 21.4 months, were included. Thirty-one patients received TNT (25.4%). Ninety-one patients (74.6%) received long-course radiochemotherapy. Sixty-eight patients (55.7%) were classified as high-risk. Twenty-six cases of distant metastases (21.3%) and nine cases of local recurrence (7.4%) were observed. Five-year progression-free and distant metastasis-free survival rates were 62.9% and 68.3%, respectively. The five-year local control was 92.7%. Poor post-treatment tumor regression grading (TRG) in the surgical specimen was found to be associated with worse progression-free survival (hazard ratio (HR): 2.55, p=0.028). Tumors in the lower rectum were associated with worse local control (HR: 5.70; p=0.044). Conclusions: Neoadjuvant radiochemotherapy, including TNT, for the treatment of LARC appears to be a safe and effective treatment option. TRG may play a role in identifying patients at high risk of early progression. Further research is warranted to determine the optimal TNT sequence and to improve patient selection to avoid over- and undertreatment.
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