Evaluating the effectiveness and safety of total neoadjuvant therapy versus standard neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

This study investigated the effectiveness and safety of total neoadjuvant therapy (TNT) versus standard neoadjuvant chemoradiotherapy (CRT) for the treatment of patients with locally advanced rectal cancer (LARC). The data showed that TNT was associated with improved outcomes compared with standard CRT for these patients.

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, 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 novel approach to treat LARC. In TNT both systemic (whole body) chemotherapy and neoadjuvant CRT are given before surgery. However, there are few studies investigating the effectiveness and safety of TNT versus standard neoadjuvant CRT for the treatment of patients with LARC.

This study analyzed 8 studies involving a total of 2196 patients with LARC. Patients were divided into 2 groups, based on the treatment they received before surgery. Group 1 included 1113 patients who received TNT. Group 2 included 1083 patients who received standard neoadjuvant CRT.

Patients who received TNT were 1.77 times more likely to achieve pathological complete response (pCR; the absence of any cancer cells after surgery) than those who received standard CRT.

TNT treatment reduced the risk of death by 12% and the risk of disease worsening by 17% compared to standard CRT. TNT treatment also showed significant effectiveness in reducing the risk of distant metastasis by 19% compared to standard CRT.

Side effects were more common in the TNT treatment group (9%-41%) than in the standard CRT group (2%-29%). Diarrhea, nausea, low number of white blood cells, and fatigue were the most common chemoradiotherapy-related side effects.

This study concluded that TNT was associated with a significant improvement in the outcomes of patients with LARC compared with standard CRT.

This study analyzed studies with different protocols. Some data could not be compared. The sample size was very small.