Preliminary results of total neoadjuvant therapy in patients with locally advanced rectal cancer
Main Article Content
Abstract
A prospective study was conducted on 36 patients diagnosed with locally invasive rectal adenocarcinoma, treated with total neoadjuvant therapy (TNT) combined with surgery. The TNT regimen included six cycles of FOLFIRINOX chemotherapy, followed by concurrent chemoradiotherapy, surgery, and adjuvant chemotherapy. Results showed that 19.4% of patients achieved a pathological complete response (pCR), and 8.4% had a near-complete response. The majority of patients (72.2%) showed partial response or stable disease. Hematological toxicities included anemia in 52.7% and thrombocytopenia in 41.6% of patients. Common non-hematological toxicities included mucositis (55.6%) and mild diarrhea (50%). Severe toxicities were rare, with no grade 4 toxicities reported. These preliminary findings suggest that TNT is a feasible and safe treatment option for patients with advanced rectal cancer, offering favorable pathological response rates and well-managed toxicities.
Article Details
Keywords
Rectal cancer, total neoadjuvant therapy, FOLFIRINOX, pathological complete response
References
2. Keller DS, Berho M, Perez RO, Wexner SD, Chand M. The multidisciplinary management of rectal cancer. Nature Reviews Gastroenterology & Hepatology. 2020; 17(7): 414-429. doi:10.1038/s41575-020-0275-y.
3. Lee SH. Total neoadjuvant therapy for rectal cancer: evidence and challenge. Ann Coloproctol. 2023; 39(4): 301-306. doi:10.3393/ac.2023.00269.0038.
4. Dijkstra EA, Nilsson PJ, Hospers GAP, et al. Locoregional Failure During and After Short-course Radiotherapy Followed by Chemotherapy and Surgery Compared With Long-course Chemoradiotherapy and Surgery. Ann Surg. 2023; 278(4): e766-e772. doi:10.1097/SLA.0000000000005799.
5. Conroy T, Castan F, Etienne PL, et al. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiotherapy in patients with locally advanced rectal cancer: long-term results of the UNICANCER-PRODIGE 23 trial. Ann Oncol. 2024; 35(10): 873-881. doi:10.1016/j.annonc.2024.06.019.
6. Virostko J, Capasso A, Yankeelov TE, Goodgame B. Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004-2015. Cancer. 2019; 125(21): 3828-3835. doi:10.1002/cncr.32347.
7. Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020; 70(3): 145-164. doi:10.3322/caac.21601.
8. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014; 383(9927): 1490-1502. doi:10.1016/S0140-6736(13)61649-9.
9. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017; 66(4): 683-691. doi:10.1136/gutjnl-2015-310912.
10. Ruo L, Guillem JG. Major 20th-century advancements in the management of rectal cancer. Dis Colon Rectum. 1999; 42(5): 563-578. doi:10.1007/BF02234129.
11. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010; 11(9): 835-844. doi:10.1016/S1470-2045(10)70172-8.
12. Fokas E, Schlenska-Lange A, Polat B, et al. Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Patients With Locally Advanced Rectal Cancer: Long-term Results of the CAO/ARO/AIO-12 Randomized Clinical Trial. JAMA Oncol. 2022; 8(1): e215445. doi:10.1001/jamaoncol.2021.5445.
13. Sakr A, Elsherbeiny M, Moneim RA, Shaaban S, Aldaly M. Neoadjuvant FOLFIRINOX followed by Chemoradiotherapy for Middle and Lower Rectal Cancer. Asian Pac J Cancer Prev. 2020; 21(6): 1717-1723. doi:10.31557/APJCP.2020.21.6.1717.
14. Habr-Gama A, São Julião GP, Perez RO. Nonoperative management of rectal cancer: identifying the ideal patients. Hematol Oncol Clin North Am. 2015; 29(1): 135-151. doi:10.1016/j.hoc.2014.09.004.