Total neoadjuvant therapy for the treatment of locally advanced rectal cancer: a systematic minireview

• Published in: Biology direct Vol. 17; no. 1; pp. 16 - 14
• Main Authors: Guida, Andrea M., Sensi, Bruno, Formica, Vincenzo, D’Angelillo, Rolando M., Roselli, Mario, Del Vecchio Blanco, Giovanna, Rossi, Piero, Capolupo, Gabriella T., Caricato, Marco, Sica, Giuseppe S.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.06.2022; BioMed Central; BMC
• Subjects: Adjuvant treatment; Analysis; Cancer; Cancer therapies; Care and treatment; Chemoradiotherapy - methods; Chemotherapy; Chemotherapy, Adjuvant - methods; Clinical trials; Colorectal cancer; Colorectal carcinoma; Combined treatment; Diagnosis; Disease control; Evidence-based medicine; Health services; Heterogeneity; Humans; Locally Advanced Rectal Cancer (LARC); Metastases; Metastasis; Methods; Neoadjuvant chemoradiotherapy; Neoadjuvant Therapy - methods; Neoplasm Staging; Pathological Complete Response (pCR); Patients; Radiation therapy; Rectal cancer; Rectal Neoplasms - drug therapy; Rectal Neoplasms - pathology; Rectum; Review; Risk factors; Surgery; Surgical outcomes; Systemic diseases; Total Neoadjuvant Therapy (TNT); Tumor Regression Grade (TRG); Tumor suppressor genes; Tumors; Italy; Total Neoadjuvant Therapy (TNT); Locally Advanced Rectal Cancer (LARC); Pathological Complete Response (pCR); Rectal cancer; Tumor Regression Grade (TRG); Neoadjuvant chemoradiotherapy
• ISSN: 1745-6150; 1745-6150
• DOI: 10.1186/s13062-022-00329-7

Colorectal carcinoma is the second leading cause of cancer-related deaths, and indeed, rectal cancer accounting for approximately one third of newly diagnosed patients. Gold standard in the treatment of rectal cancer is a multimodality approach, aiming at a good control of the local disease. Distant recurrences are the major cause of mortality. Currently, Locally Advanced Rectal Cancer (LARC) patients undergo a combined treatment of chemotherapy and radiotherapy, followed by surgery. Eventually, more chemotherapy, namely adjuvant chemotherapy (aCT), may be necessary. Total Neoadjuvant Therapy (TNT) is an emerging approach aimed to reduce distant metastases and improve local control. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Published results were encouraging, but the heterogeneity of protocols in use, makes the comparison and interpretation of data rather complex. One of the major concerns regarding TNT administration is related to its effect on larger and more advanced cancers that might not undergo similar down-staging as smaller, early-stage tumors. This minireview, based on a systematic literature search of randomized clinical trials and meta-analysis, summarizes current knowledge on TNT. The aim was to confirm or refute whether or not current practice of TNT is based on relevant evidence, to establish the quality of that evidence, and to address any uncertainty or variation in practice that may be occurring. A tentative grouping of general study characteristics, clinical features and treatments characteristics has been undertaken to evaluate if the reported studies are sufficiently homogeneous in terms of subjects involved, interventions, and outcomes to provide a meaningful idea of which patients are more likely to gain from this treatment.