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Total neoadjuvant therapy: A new standard of care for locally advanced rectal cancer?

dc.contributor.authorLeite, J
dc.contributor.authorMartins, S
dc.date.accessioned2024-07-05T15:46:03Z
dc.date.available2024-07-05T15:46:03Z
dc.date.issued2024
dc.description.abstractDelivering chemotherapy before surgery is a newer treatment approach called total neoadjuvant therapy (TNT), and the National Comprehensive Cancer Network guidelines recommend it for locally advanced rectal cancer (LARC) with cT3 / cN+ / cT4, in contrast with the European Society for Medical Oncology guidelines, in which most rectal cancers can be treated with surgery alone if good quality mesorectal resection is assured. Neoadjuvant or adjuvant treatments are reserved for patients with high-risk tumours, including cT3c/d or cT4, or that threaten the mesorectal fascia. The favourable outcomes in the RAPIDO trial for high-risk rectal cancers with a lower incidence of distant metastasis in the TNT group were observed but with an unexpected increase in the local recurrence with more extended follow-up. This suggests early surgery for nonresponding tumours. The TNT approach was also evaluated in the OPRA trial with long-course chemoradiotherapy and induction versus consolidation chemotherapy. Half the patients presented complete clinical responses and were enrolled in the watch-and-wait (WW) approach. Given the high number of trials and guidelines in this subject, the multidisciplinary team's decision-making process in rectal cancer management is complex. Looking at the actual data, it was concluded that TNT is not for all patients with LARC and is an option if organ preservation is a priority, although with a high regrowth rate in a WW strategy and increasing risk of distant metastasis, questioning the deleterious effect of deferral of surgery.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationMedical Research Archives. 2024;12(4)pt_PT
dc.identifier.doi10.18103/mra.v12i4.5254pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.4/2366
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectNeoplasias do Rectopt_PT
dc.subjectTerapia Neoadjuvantept_PT
dc.titleTotal neoadjuvant therapy: A new standard of care for locally advanced rectal cancer?pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue4pt_PT
oaire.citation.titleMedical Research Archivespt_PT
oaire.citation.volume12pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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