Evaluating the effect of total neoadjuvant therapy versus standard neoadjuvant chemoradiotherapy and planned adjuvant chemotherapy on the survival of patients with locally advanced rectal cancer.

This study investigated the effect of total neoadjuvant therapy (TNT) versus standard neoadjuvant chemoradiotherapy (CRT) and planned adjuvant chemotherapy on the survival of patients with locally advanced rectal cancer (LARC). The data showed that TNT did not increase survival compared with standard CRT and planned adjuvant chemotherapy but increased the rate of complete response.

Rectal cancer (RC) is one of the most common types of cancer worldwide. RC involves the final part of the large intestine or rectum. The first choice for treatment of RC is usually surgery. Often, patients are given chemotherapy after surgery to make sure any remaining cancer cells are killed. However, in more advanced stages like LARC, chemotherapy with radiation is given before surgery (standard neoadjuvant chemoradiotherapy; CRT) to shrink the cancer so that it can be completely removed by surgery.

TNT is a newer approach to treat LARC. In TNT both systemic (whole body) chemotherapy and neoadjuvant CRT are given before surgery. TNT improves tumor response in patients with LARC compared to neoadjuvant CRT alone. However, the effect of TNT versus standard neoadjuvant CRT and planned adjuvant chemotherapy on the survival of patients with LARC are still unknown.

This study involved 624 patients with LARC. Patients were divided into 2 groups, based on the treatment they received before surgery. Group 1 included 311 patients who received standard neoadjuvant CRT and planned adjuvant chemotherapy. Group 2 included 313 patients who received TNT. Patients then underwent surgery or were entered in a watch-and-wait protocol.

The rate of complete response (complete disappearance of cancer cells) was significantly higher in group 2 (27%) compare to group 1 (20%). The average survival was similar in group 1 (4.9 years) versus group 2 (5 years). After 3 years, 94% of patients in group 1 were alive compared to 96% in group 2. This difference was not statistically significant. 

This study concluded that TNT did not improve the survival of patients with LARC compared to standard CRT and planned adjuvant chemotherapy. However, the authors suggested that a higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.

This study looked back in time at medical records. This study only included patients treated at a single institution in the USA. There were differences in the patients’ age and the clinical stage between the groups.