Total neoadjuvant therapy in rectal cancer: the evidence and expectations

被引:12
作者
Boublikova, Ludmila [1 ,2 ,3 ]
Novakova, Alena [1 ,2 ]
Simsa, Jaromir [4 ]
Lohynska, Radka [1 ,2 ]
机构
[1] Charles Univ Prague, Fac Med 1, Dept Oncol, Videnska 800, Prague 4, Czech Republic
[2] Thomayer Univ Hosp, Videnska 800, Prague 4, Czech Republic
[3] Charles Univ Prague, Fac Med 2, CLIP Dept Pediat Hematol & Oncol, Prague, Czech Republic
[4] Charles Univ Prague, Fac Med 1, Dept Surg, Prague, Czech Republic
关键词
Rectal cancer; Total neoadjuvant therapy; Non -operative management; Risk -based approach; SHORT-COURSE RADIOTHERAPY; UNICANCER-PRODIGE; 23; COLORECTAL-CANCER; PREOPERATIVE CHEMORADIOTHERAPY; NONOPERATIVE MANAGEMENT; RANDOMIZED-TRIAL; OPEN-LABEL; ADJUVANT CHEMOTHERAPY; ORGAN PRESERVATION; PHASE-III;
D O I
10.1016/j.critrevonc.2023.104196
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Current management of locally advanced rectal cancer achieves high cure rates, distant metastatic spread being the main cause of patients' death. Total neoadjuvant therapy (TNT) employs (chemo)radiotherapy and combined chemotherapy prior to surgery to improve the treatment outcomes. TNT has been shown to reduce significantly distant metastases, increase disease-free survival by 5 - 10% in 3 years, and finally also overall survival (approximate to 5% in 7 years). It proved to double the rate of pathologic complete responses, making it an attractive strategy for nonoperative management to avoid permanent colostomy in patients with distal tumors. In addition, it endorses adherence to the therapy due to better tolerance and, potentially, shortens its overall duration. A number of questions related to TNT remain currently unresolved including the indications, preferred radiotherapy and chemotherapy regimens, their sequence, timing of surgery, and role of adjuvant therapy. A stratified approach may be the optimal way to go.
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页数:10
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