Department of Surgery, Minimally Invasive Unit, University of Rome Tor Vergata, 00133, Rome, Italy.
Department of Systems Medicine, Medical Oncology Unit, Policlinico Tor Vergata, Rome, Italy.
Biol Direct. 2022 Jun 13;17(1):16. 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.
结直肠癌是癌症相关死亡的第二大主要原因，事实上，直肠癌约占新诊断患者的三分之一。直肠癌的治疗金标准是多模式方法，旨在很好地控制局部疾病。远处复发是导致死亡的主要原因。目前，局部晚期直肠癌（LARC）患者接受化疗和放疗联合治疗，然后进行手术。最终，可能需要更多的化疗，即辅助化疗（aCT）。新辅助治疗（TNT）是一种新兴的方法，旨在减少远处转移并提高局部控制率。目前正在进行多项研究，以分析这种新方法是否能改善肿瘤学结果。已发表的结果令人鼓舞，但由于使用的方案存在异质性，使得数据的比较和解释变得相当复杂。关于 TNT 给药的主要关注点之一与它对较大和更晚期癌症的影响有关，这些癌症可能不会像较小的早期肿瘤那样经历类似的降级。这篇基于随机临床试验和荟萃分析的系统文献检索的小型综述总结了目前关于 TNT 的知识。目的是确认或反驳目前 TNT 的实践是否基于相关证据，确定证据的质量，并解决实践中可能存在的任何不确定性或差异。已经进行了一般研究特征、临床特征和治疗特征的试探性分组，以评估报告的研究在涉及的对象、干预措施和结果方面是否足够同质，从而提供一个有意义的想法，即哪些患者更有可能从这种治疗中获益。
