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Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer

By: David Jeans
Posted: Friday, May 18, 2018

A new study has pointed toward the benefits of total neoadjuvant therapy (TNT) in treating locally advanced rectal cancer, finding short-term advantages over the traditional chemoradiotherapy and adjuvant chemotherapy. The findings of this retrospective cohort analysis support the NCCN guidelines that point to TNT as a viable treatment strategy for rectal cancer. However, long-term follow-up will determine whether the benefits of this approach translate into improved survival.

Published in the Journal of the American Medical Association Oncology by a team led by Martin R. Weiser, MD, of Memorial Sloan Kettering Cancer Center (MSK), New York, the study drew on records from MSK. A total of 811 patients who presented with locally advanced rectal cancer (T3/4 or node-positive) between June 2009 and March 2015 were identified. Of those patients, 308 were treated with TNT (induction fluorouracil- and oxaliplatin-based chemotherapy followed by chemoradiotherapy) and 320 were treated with chemoradiotherapy with planned adjuvant chemotherapy.

Those in the TNT cohort had a higher complete response rate than did those in the chemoradiotherapy with planned adjuvant chemotherapy cohort (36% vs. 21%). Complete response included both pathologic complete response in those who had surgery and sustained clinical complete response for at least 12 months after treatment in those who did not have surgery. Furthermore, those treated with TNT were more likely to have temporary ileostomy reversed within 15 weeks of surgery.

“Total neoadjuvant therapy was associated with improved delivery of systemic therapy and increased response to treatment, and it provides a promising platform for nonoperative watch-and-wait protocols,” Dr. Weiser and colleagues concluded.


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