How We Treat Localized Rectal Cancer—An Institutional Paradigm for Total Neoadjuvant Therapy

Total neoadjuvant therapy (TNT)—the neoadjuvant employment of radiotherapy (RT) or chemoradiation (CRT) as well as chemotherapy (CHT) before surgery—may lead to increased pathological complete response (pCR) rates as well as a reduction in the risk of distant metastases in locally advanced rectal ca...

Full description

Saved in:
Bibliographic Details
Published inCancers Vol. 14; no. 22; p. 5709
Main Authors Roeder, Falk, Gerum, Sabine, Hecht, Stefan, Huemer, Florian, Jäger, Tarkan, Kaufmann, Reinhard, Klieser, Eckhard, Koch, Oliver Owen, Neureiter, Daniel, Emmanuel, Klaus, Sedlmayer, Felix, Greil, Richard, Weiss, Lukas
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 21.11.2022
MDPI
Subjects
Abdomen
Accuracy
Algorithms
Cancer
Cancer therapies
Care and treatment
Chemotherapy
Clinical trials
Colorectal cancer
Decision making
Endoscopy
Failure
Immunotherapy
Lymphatic system
Medical prognosis
Metastases
Metastasis
Methods
Microsatellite instability
Neoadjuvant therapy
Patients
Radiation therapy
Rectum
Remission (Medicine)
Review
Surgery
Tumors
Austria
total neoadjuvant therapy
microsatellite instability
mismatch-repair-deficiency
CRT
rectal cancer
radiotherapy
chemoradiotherapy
TNT
organ-sparing
Online AccessGet full text

Cover

More Information
Summary:Total neoadjuvant therapy (TNT)—the neoadjuvant employment of radiotherapy (RT) or chemoradiation (CRT) as well as chemotherapy (CHT) before surgery—may lead to increased pathological complete response (pCR) rates as well as a reduction in the risk of distant metastases in locally advanced rectal cancer. Furthermore, increased response rates may allow organ-sparing strategies in a growing number of patients with low rectal cancer and upfront immunotherapy has shown very promising early results in patients with microsatellite instability (MSI)-high/mismatch-repair-deficient (dMMR) tumors. Despite the lack of a generally accepted treatment standard, we strongly believe that existing data is sufficient to adopt the concept of TNT and immunotherapy in clinical practice. The treatment algorithm presented in the following is based on our interpretation of the current data and should serve as a practical guide for treating physicians—without any claim to general validity.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
ObjectType-Review-3
content type line 23
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers14225709