Şenocak Taşçı Elif, Mutlu Arda Ulaş, Saylık Onur, Ölmez Ömer Fatih, Bilici Ahmet, Sünger Erdem, Sütçüoğlu Osman, Çakmak Öksüzoğlu Ömür Berna, Özdemir Nuriye, Akdoğan Orhun, Bayoğlu İbrahim Vedat, Majidova Nargiz, Güren Ali Kaan, Özen Engin Esra, Hacıbekiroğlu İlhan, Er Özlem, Dane Faysal, Bozkurt Mustafa, Turan Canbaz Esra, Erdamar Sibel, Aytaç Erman, Özer Leyla, Yıldız İbrahim
Department of Medical Oncology, Kanuni Sultan Süleyman Training and Research Hospital, 34295 Istanbul, Turkey.
Department of Medicine, Acıbadem MAA University, 34560 Istanbul, Turkey.
Cancers (Basel). 2024 Sep 21;16(18):3213. doi: 10.3390/cancers16183213.
Total neoadjuvant therapy (TNT) has emerged as a promising approach for managing locally advanced rectal cancer (LARC), aiming to enhance resectability, increase pathological complete response (pCR), improve treatment compliance, survival, and sphincter preservation. This study compares the clinical outcomes of TNT, with either induction or consolidation chemotherapy, to those of the standard chemoradiotherapy (CRT). In this retrospective multi-institutional study, patients with stage II-III LARC who underwent CRT or TNT from seven oncology centers between 2021 and 2024 were retrospectively analyzed. The TNT group was categorized into induction or consolidation groups based on the sequence of chemotherapy and radiotherapy. Clinical and pathological data and treatment outcomes, including pCR, event-free survival (EFS), and overall survival (OS), were analyzed. Among the 276 patients, 105 received CRT and 171 underwent TNT. The TNT group showed significantly higher pCR (21.8% vs. 2.9%, < 0.001) and lower lymphatic (26.3% vs. 42.6%, = 0.009), vascular (15.8% vs. 32.7%, = 0.002), and perineural invasion rates (20.3% vs. 37.6%, = 0.003). Furthermore, 16.9% of TNT patients opted for non-operative management (NOM), compared to 0.9% in the CRT group ( < 0.001). The median interval between the end of radiotherapy and surgery was longer in the TNT group (17.6 weeks vs. 8.8 weeks, < 0.001). The 3-year EFS was 58.3% for CRT and 71.1% for TNT ( = 0.06). TNT is associated with higher pCR, lower lymphatic and vascular invasion rates, and higher rates of NOM compared to CRT. This supports the use of TNT as a viable treatment strategy for LARC, offering potential benefits in quality of life.
全新辅助治疗（TNT）已成为一种治疗局部晚期直肠癌（LARC）的有前景的方法，旨在提高可切除性、增加病理完全缓解（pCR）、改善治疗依从性、生存率和保留括约肌。本研究比较了采用诱导化疗或巩固化疗的TNT与标准放化疗（CRT）的临床结局。在这项回顾性多机构研究中，对2021年至2024年间在7个肿瘤中心接受CRT或TNT的II-III期LARC患者进行了回顾性分析。TNT组根据化疗和放疗的顺序分为诱导组或巩固组。分析了临床和病理数据以及治疗结局，包括pCR、无事件生存期（EFS）和总生存期（OS）。在276例患者中，105例接受了CRT，171例接受了TNT。TNT组的pCR显著更高（21.8%对2.9%，<0.001），而淋巴（26.3%对42.6%，=0.009）、血管（15.8%对32.7%，=0.002）和神经周围侵犯率更低（20.3%对37.6%，=0.003）。此外，16.9%的TNT患者选择了非手术治疗（NOM），而CRT组为0.9%（<0.001）。TNT组放疗结束至手术的中位间隔时间更长（17.6周对8.8周，<0.001）。CRT组的3年EFS为58.3%，TNT组为71.1%（=0.06）。与CRT相比，TNT与更高的pCR、更低的淋巴和血管侵犯率以及更高的NOM率相关。这支持将TNT作为LARC的一种可行治疗策略，在生活质量方面具有潜在益处。
