Total neoadjuvant treatment, non-operative management and radiotherapy-free strategies: New approaches for the management of proficient mismatch repair/microsatellite stable locally advanced rectal cancer. A narrative review and evidence-based algorithm

被引：0

作者：

Moretto, Roberto ^{[1
]}

Boccaccio, Chiara ^{[1
,2
]}

Landi, Matteo ^{[1
,2
]}

Masi, Gianluca ^{[1
,2
]}

Cremolini, Chiara ^{[1
,2
]}

机构：

[1] Azienda Osped Univ Pisana, Unit Med Oncol 2, Pisa, Italy

[2] Univ Pisa, Dept Translat Res & New Technol Med & Surg, Via Roma 67, I-56126 Pisa, Italy

来源：

EUROPEAN JOURNAL OF CANCER | 2025年 / 218卷

关键词：

Locally advanced rectal cancer; Total neoadjuvant treatment; Non-operative management; Radiotherapy-free approach; TOTAL MESORECTAL EXCISION; CLINICAL COMPLETE RESPONDERS; TRANSANAL ENDOSCOPIC MICROSURGERY; UNICANCER-PRODIGE; 23; PREOPERATIVE CHEMORADIOTHERAPY; OPEN-LABEL; INTERNATIONAL WATCH; POSTOPERATIVE CHEMORADIOTHERAPY; ADJUVANT CHEMOTHERAPY; DISTANT METASTASES;

D O I：

10.1016/j.ejca.2025.115261

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

In recent years, new therapeutic approaches have emerged in addition to classical neoadjuvant (chemo)radiotherapy for the treatment of locally advanced rectal cancer (LARC): total neoadjuvant treatment, non-operative management, and radiotherapy-free strategy. While the introduction of these approaches in a relatively short timeframe has quickly increased our therapeutic armamentarium, on the other hand it has complicated the decision-making process regarding the choice of the most appropriate treatment strategy for each patient with LARC. Therefore, a tool to interpret the evidence from clinical trials and to translate them into daily practice is highly demanded. In the present review, we address how these new developments are changing the multimodal treatment of LARC and offer an algorithm to integrate them into clinical practice.

引用

页数：11

共 81 条

[1] The current knowledge on radiosensitivity of ovarian follicle development stages [J].

Adriaens, I. ;

Smitz, J. ;

Jacquet, P. .

HUMAN REPRODUCTION UPDATE, 2009, 15 (03) :359-377

[2]

Al B., 2024, J Natl Compr Cancer Netw

[3] Total neoadjuvant treatment (TNT) with non-operative management (NOM) for proficient mismatch repair locally advanced rectal cancer (pMMR LARC): First results of NO-CUT trial [J].

Amatu, A. ;

Zampino, M. G. ;

Bergamo, F. ;

Mosconi, S. ;

Sibio, D. ;

Gerardi, M. ;

Prete, A. A. ;

Filippone, F. R. ;

Ferrari, G. ;

Borin, S. ;

Galuppo, S. ;

Mariano, S. ;

Tosi, F. M. ;

Bonazzina, E. F. ;

Patelli, G. ;

Ghezzi, S. ;

Lazzari, L. ;

Bencardino, K. ;

Bianchi, A. Sartore ;

Siena, S. .

ANNALS OF ONCOLOGY, 2024, 35 :S431-S432

[4] Organ Preservation and Survival by Clinical Response Grade in Patients With Rectal Cancer Treated With Total Neoadjuvant Therapy A Secondary Analysis of the OPRA Randomized Clinical Trial [J].

不详 .

JAMA NETWORK OPEN, 2024, 7 (01)

[5] Can we Save the rectum by watchful waiting or TransAnal surgery following (chemo)Radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC)? Protocol for the international, multicentre, rolling phase II/IIII partially randomized patient preference trial evaluating long-course concurrent chemoradiotherapy versus short-course radiotherapy organ preservation approaches [J].

Bach, Simon P. .

COLORECTAL DISEASE, 2022, 24 (05) :639-651

[6] Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study [J].

Bach, Simon P. ;

Gilbert, Alexandra ;

Brock, Kristian ;

Korsgen, Stephan ;

Geh, Ian ;

Hill, James ;

Gill, Talvinder ;

Hainsworth, Paul ;

Tutton, Matthew G. ;

Khan, Jim ;

Robinson, Jonathan ;

Steward, Mark ;

Cunningham, Christopher ;

Levy, Bruce ;

Beveridge, Alan ;

Handley, Kelly ;

Kaur, Manjinder ;

Marchevsky, Natalie ;

Magill, Laura ;

Russell, Ann ;

Quirke, Philip ;

West, Nicholas P. ;

Sebag-Montefiore, David .

LANCET GASTROENTEROLOGY & HEPATOLOGY, 2021, 6 (02) :92-105

[7] Risk and location of distant metastases in patients with locally advanced rectal cancer after total neoadjuvant treatment or chemoradiotherapy in the RAPIDO trial [J].

Bahadoer, Renu R. ;

Hospers, Geke A. P. ;

Marijnen, Corrie A. M. ;

Peeters, Koen C. M. J. ;

Putter, Hein ;

Dijkstra, Esmee A. ;

Kranenbarg, Elma Meershoek-Klein ;

Roodvoets, Annet G. H. ;

van Etten, Boudewijn ;

Nilsson, Per J. ;

Glimelius, Bengt ;

van de Velde, Cornelis J. H. .

EUROPEAN JOURNAL OF CANCER, 2023, 185 :139-149

[8] Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial [J].

Bahadoer, Renu R. ;

Dijkstra, Esmee A. ;

van Etten, Boudewijn ;

Marijnen, Corrie A. M. ;

Putter, Hein ;

Kranenbarg, Elma Meershoek-Klein ;

Roodvoets, Annet G. H. ;

Nagtegaal, Iris D. ;

Beets-Tan, Regina G. H. ;

Blomqvist, Lennart K. ;

Fokstuen, Tone ;

ten Tije, Albert J. ;

Capdevila, Jaume ;

Hendriks, Mathijs P. ;

Edhemovic, Ibrahim ;

Cervantes, Andres ;

Nilsson, Per J. ;

Glimelius, Bengt ;

van de Velde, Cornelis J. H. ;

Hospers, Geke A. P. .

LANCET ONCOLOGY, 2021, 22 (01) :29-42

[9] Patient-Reported Outcomes During and After Treatment for Locally Advanced Rectal Cancer in the PROSPECT Trial (Alliance N1048) [J].

Basch, Ethan ;

Dueck, Amylou C. ;

Mitchell, Sandra A. ;

Mamon, Harvey ;

Weiser, Martin ;

Saltz, Leonard ;

Gollub, Marc ;

Rogak, Lauren ;

Ginos, Brenda ;

Mazza, Gina L. ;

Colgrove, Brian ;

Chang, George ;

Minasian, Lori ;

Denicoff, Andrea ;

Thanarajasingam, Gita ;

Musher, Benjamin ;

George, Thomas ;

Venook, Alan ;

Farma, Jeffrey ;

O'Reilly, Eileen ;

Meyerhardt, Jeffrey A. ;

Shi, Qian ;

Schrag, Deborah .

JOURNAL OF CLINICAL ONCOLOGY, 2023, 41 (21) :3724-+

[10] Predicting the Risk of Bowel-Related Quality-of-Life Impairment After Restorative Resection for Rectal Cancer: A Multicenter Cross-Sectional Study [J].

Battersby, Nick J. ;

Juul, Therese ;

Christensen, Peter ;

Janjua, Ahmed Z. ;

Branagan, Graham ;

Emmertsen, Katrine J. ;

Norton, Christine ;

Hughes, Robert ;

Laurberg, Soren ;

Moran, Brendan J. .

DISEASES OF THE COLON & RECTUM, 2016, 59 (04) :270-280

← 1 2 3 4 5 6 7 8 9 →