Initial results of total neoadjunctive therapy on patients with stages II - III rectal cancer
Main Article Content
Abstract
Rectal cancer is one of the common cancers in Vietnam. Currently, total neoadjuvant therapy is recommended for the treatment of advanced rectal cancer. This therapy reduces the rate of metastatic recurrence, bringing about effective disease-free survival time. A case series study on 33 advanced rectal cancer patients at Vietnam national cancer hospital was conducted from October 2022 to June 2024 to evaluate the initial results of total neo-adjuvant therapy. The study showed significant improvement in functional and systemic symptoms in patients after treatment. The average CEA value after treatment decreased from 6.45 ng/ml to 3.28 ng/ml. The rate of pathological complete response (pCR) was 21.2%, non-response was 9.1%. The number of patients with stage III reduction after surgery was 22 patients. The overall sphincter preservation rate was 72.7%. Adverse effects of chemicals were graded from stage I to II with 30.3%.
Article Details
Keywords
Rectal cancer, stage II - III, total neoadjuvant therapy
References
2. Benson AB, Venook AP, Al-Hawary MM, et al. Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network: JNCCN. Oct 2022;20(10):1139-1167. doi:10.6004/jnccn.2022.0051.
3. Ochiai K, Bhutiani N, Ikeda A, et al. Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?. Cancer. 2024;16(11):2093.
4. Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. The Lancet Oncology. May 2021;22(5):702-715. doi:10.1016/s1470-2045(21)00079-6.
5. Petrelli F, Trevisan F, Cabiddu M, et al. Total Neoadjuvant Therapy in Rectal Cancer: A Systematic Review and Meta-analysis of Treatment Outcomes. Annals of surgery. Mar 2020;271(3):440-448. doi:10.1097/sla.0000000000003471.
6. Weiser MR. AJCC 8th Edition: Colorectal Cancer. Annals of surgical oncology. Jun 2018;25(6):1454-1455. doi:10.1245/s10434-018-6462-1.
7. Thu Hiền Trương, Văn Ba N, Văn Thái P, và cs. Đánh giá hiệu quả hoá xạ trị đồng thời trước phẫu thuật trong điều trị ung thư trực tràng giai đoạn II, III . Tạp chí Y học Việt Nam. 07/21 2021;501(2). doi:10.51298/vmj.v501i2.481.
8. Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. Journal of clinical oncology. 2005;23(34):8688-8696.
9. Dhadda AS, Dickinson P, Zaitoun AM, et al. Prognostic importance of Mandard tumour regression grade following pre-operative chemo/radiotherapy for locally advanced rectal cancer. European journal of cancer (Oxford, England : 1990). May 2011;47(8):1138-45. doi:10.1016/j.ejca.2010.12.006.
10. Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. The Lancet Oncology. 2021;22(1):29-42.
11. Ludmila B, Alena N, Jaromir S, et al. Total neoadjuvant therapy in rectal cancer: the evidence and expectations. Critical Reviews in Oncology/Hematology. 2023;2023:104196.
12. Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging–detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. Journal of Clinical Oncology. 2011;29(28):3753-3760.
13. Arslan A, Turk G, Karagoz Eren S, et al. Compatibility of MRI and Pathological Tumor Regression Grading in Patients with Locally Advanced Rectal Cancer After Undergoing Neoadjuvant Chemoradiotherapy. Turkish Journal of Oncology/Türk Onkoloji Dergisi. 2021;36(4).
14. Wang M, Gwee YX, Lin Z, et al. Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC): Real-world experience from a tertiary Asian cancer center. American Society of Clinical Oncology; 2024.
15. Hà Nguyễn Thị, Kiên NX, Châu NĐ, et al. Kết quả bước đầu của điều trị tân bổ trợ toàn diện trước phẫu thuật ở bệnh nhân ung thư trực tràng giai đoạn II, III tại Bệnh viện Trung ương Quân đội 108. Tạp chí Y Dược học lâm sàng 108. 2023;
16. Hiếu NV, Quảng LV, Toàn BC, và cs. Đánh giá kết quả hóa xạ trị tiền phẫu trong ung thư trực tràng giai đoạn xâm lấn. Bản B của Tạp chí Khoa học và Công nghệ Việt Nam. 01/25 2018;60(2).
17. Giunta EF, Bregni G, Pretta A, et al. Total neoadjuvant therapy for rectal cancer: Making sense of the results from the RAPIDO and PRODIGE 23 trials. Cancer treatment reviews. 2021;96:102177.