scholarly journals Retrospective study of total neoadjuvant therapy for locally advanced rectal cancer

2021 ◽  
Author(s):  
Yutian Zhao ◽  
Jiahao Zhu ◽  
Bo Yang ◽  
Qizhong Gao ◽  
Yu Xu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Standard Treatment ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Sphincter Preservation ◽  
Total Neoadjuvant Therapy

Aim: To compare treatment outcomes of total neoadjuvant therapy (TNT) and the standard treatment for locally advanced rectal cancer (LARC). Materials & methods: Patients with LARC (cT2-4 and/or cN1-2) who were treated with preoperative chemoradiotherapy plus induction and consolidation chemotherapy followed by surgery or the standard treatment were recruited. Pathologic complete response (pCR) rate, overall survival, disease-free survival and the sphincter preservation rate as well as safety were evaluated. Results: 49 cases were treated with TNT and 71 cases received the standard treatment. Multivariate analysis demonstrated that TNT and tumor size were independent risk factors for pCR. Grade 3 chemoradiotherapy toxicity and postoperative complications were similar between the two groups. Conclusion: TNT improved the pCR rate for patients with LARC, with tolerable toxicities.

Total neoadjuvant therapy compared with standard therapy in locally advanced rectal cancer: A systematic review and meta-analysis.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 709-709 ◽  
Author(s):  
Sashidhar Manthravadi ◽  
Weijing Sun ◽  
Anwaar Saeed ◽  
Joaquina Celebre Baranda ◽  
Anup Kasi
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Neoadjuvant Therapy ◽  
Standard Therapy ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Total Neoadjuvant Therapy

709 Background: Standard therapy of locally advanced rectal cancer (LARC) includes concurrent chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy (CT). An alternative strategy known as Total Neoadjuvant Therapy (TNT) involves administration of CRT and CT prior to surgery with the goal of delivering uninterrupted systemic therapy to eradicate micrometastases. A comparison of these two approaches has not been reviewed previously. Methods: Following PRISMA guidelines, a systematic review of PubMed and Web of Science was performed from inception through September 2018 to identify studies which compared TNT with CRT in LARC. The outcomes of interest were pathologic complete response rates (PCR), sphincter-preserving surgery rates, ileostomy rates, disease-free survival (DFS) and overall survival (OS). Summary hazard ratios (HR) with 95% confidence intervals (CI) were estimated using a random effects model and heterogeneity was estimated using the inconsistency index (I2). Results: After reviewing 2,163 reports, 5 studies which compared CRT and TNT were selected for inclusion. These were reported from Europe and the United States and included a total of 1,134 patients of whom 552 received TNT. The pooled prevalence of PCR was 32.4% (range 17-28%) in the TNT group and 22.3% (range 4-21%) in the CRT group. In a meta-analysis of five studies, TNT was associated with a higher chance of achieving a pathologic complete response (OR 1.92; 95% CI 1.44- 2.57, I2= 22%). Recipients of TNT also had higher odds of receiving sphincter-sparing surgery (5 studies, OR 1.92; 95% CI 1.44- 2.57, I2= 0%) and lower odds of requiring an ileostomy (2 studies, OR 0.72; 95% CI 0.54- 0.96, I2= 0%). Only one study presented data on DFS and noted improved DFS in patients who received TNT (OR 0.72; 95% CI 0.54- 0.96). The impact of TNT relative to standard therapy on overall survival was not reported. Conclusions: Total Neoadjuvant Therapy is a promising strategy in locally advanced rectal cancer, with superior PCR rates compared to standard therapy. However, the long term impact on disease recurrence and overall survival remain unclear. These are best be studied in a prospective randomized clinical trial.

Intensification of neoadjuvant therapy in patients with locally advanced rectal cancer

2021 ◽  
Vol 11 (2) ◽  
pp. 19-28
Author(s):  
Z. Z. Mamedli ◽  
A. V. Polynovskiy ◽  
D. V. Kuzmichev ◽  
S. I. Tkachev ◽  
A. A. Aniskin
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Free Survival ◽  
Disease Free

The aim of the study: to increase the frequency of achieving pathologic complete response and increase disease-free survival in the investigational group of patients with locally advanced rectal cancer T3(MRF+)–4N0–2M0 by developing a new strategy for neoadjuvant therapy.Materials and methods. In total, 414 patients were assigned to treatment. Control group I included 89 patients who underwent radiotherapy (RT) 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week. Control group II included 160 patients who underwent RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and oxaliplatin once a week, during the course of RT. Study group III consisted of 165 patients. This group combined RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and additional consecutive CapOx cycles. This group was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating chemotherapy (after CRT); subgroup IIIb included 59 patients who underwent “sandwich” treatment. Therapy consisted of conducting from 1 to 2 cycles of induction CapOx (up to CRT) and from 1 to 2 cycles of consolidating CapOx with an interval of 7 days. In the interval between the courses of drug therapy, RT 52–56 Gy/26–28 fractions was performed. According to the results of the control examination, further treatment tactics were determined. The primary end points were 5-year disease-free survival and the achievement of a pathologic complete response.Results. Pathologic complete response was significantly more often recorded in patients in the investigational group III (17.48 %; p = 0.021) compared with control groups (7.95 % in the I group and 8.28 % in the II group). 5-year disease-free survival in patients in the study groups was: 71.5 % in the III group, 65.6 % in the II group and 56.9 % in the I group.Conclusion. The shift in emphasis on strengthening the neoadjuvant effect on the tumor and improving approaches to drug therapy regimens have significantly improved disease-free survival of patients with locally advanced rectal cancer.

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