From the Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Man. (Johnson, Helewa, Hyun); the Clinician Investigator Program, University of Manitoba, Winnipeg Man. (Johnson); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Park); the Section of Medical Oncology and Haematology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Goldenberg); the Radiation Oncology, CancerCare Manitoba, Winnipeg, Man. (Nashed).
From the Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Man. (Johnson, Helewa, Hyun); the Clinician Investigator Program, University of Manitoba, Winnipeg Man. (Johnson); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Park); the Section of Medical Oncology and Haematology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man. (Goldenberg); the Radiation Oncology, CancerCare Manitoba, Winnipeg, Man. (Nashed)
Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. Print 2023 Mar-Apr.
The modern management of rectal cancers continues to evolve. With the release of data from new landmark randomized controlled trials (RAPIDO, PRODIGE-23), total neoadjuvant therapy (TNT) has moved to the forefront of locally advanced rectal cancer treatment and is considered a standard option in selected patients. Total neoadjuvant therapy promises enhanced systemic disease control, better treatment adherence and less time with an ostomy. However, TNT as currently described encompasses a number of different potential treatment options that differ significantly in terms of their radiation dosage, chemotherapy regimen and order of treatments administered. Being familiar with TNT regimens will be important for rectal cancer surgeons to appropriately advocate for their patients and optimize their outcomes. This article serves as a primer for the general surgeon and offers a pragmatic overview of the indications, realistic expected benefits and potential downsides of each TNT regimen.
直肠癌的现代治疗方法在不断发展。随着新的具有里程碑意义的随机对照试验（RAPIDO、PRODIGE-23）数据的发布，全新辅助治疗（TNT）已成为局部晚期直肠癌治疗的前沿方法，并且在一些特定患者中被视为标准选择。TNT 有望增强全身疾病控制，提高治疗依从性，并减少造口时间。然而，目前描述的 TNT 包括许多不同的潜在治疗方案，这些方案在辐射剂量、化疗方案和治疗顺序方面存在显著差异。了解 TNT 方案对于直肠肿瘤外科医生为患者提供适当的治疗方案并优化治疗结果非常重要。本文旨在为普通外科医生提供基础知识，并对每种 TNT 方案的适应证、实际预期益处和潜在缺点进行实用概述。
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