Ye Qing, Chen Changjiang, Liu Shengyuan, Li Yangming, Jian Jinliang, Huang Feng
Department of Colorectal Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, NO. 420 Fuma Road, Fuzhou, 350014, Fujian Province, China.
Sci Rep. 2025 Jul 25;15(1):27068. doi: 10.1038/s41598-025-12416-6.
Various studies have confirmed the benefits of total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC). Nevertheless, preoperative intensive treatment and a long waiting period can lead to significant side effects. This may result in surgical difficulties and a higher complication rate. The individualized modified TNT (mTNT) model might lessen the side effects without influencing the curative effect. The clinical data of LARC with short-course neoadjuvant radiotherapy and chemotherapy in the same attending group of colorectal surgery at Fujian Cancer Hospital were retrospectively examined from January 2017 to October 2023. An analysis was carried out on aspects such as the adverse reaction of chemoradiotherapy, postoperative complications, pathological withdrawal, and long-term outcomes of the data. 62 cases were enrolled, including 16 cases of induction chemotherapy mode (IC group), 20 cases of consolidation chemotherapy mode (CC group), and 26 cases of induction + consolidation chemotherapy sandwich mode (IC + CC group). In all three groups, the neoadjuvant therapy compliance rate reached 100%. No grade 4-5 toxicity was found, and the perioperative complication rate of 12.90% was within an acceptable range, including major complications, 4 cases of anastomotic leakage and one case of abdominal bleeding. Delayed complications including ileus and rectovaginal fistula occured in 5 patients, all of whom received consolidation chemotherapy and had BMI less than 21. There was a total pathological complete remission (pCR) rate of 24.19%, including IC group 18.75%, CC group 25.00%, and IC + CC group 26.92%. The downstaging rate of IC + CC group was significantly higher than that of IC group and CC group (P = 0.037). In comparison with those in the CC or IC + CC group, patients in the IC group, had lower Locoregional relapse-free survival (LRFS) rate (81.3%vs.82.5% and 92.9%, respectively, P = 0.292), and higher Distant metastasis-free survival (DMFS) rate (93.8% vs.73.1% and 82.4%, respectively, P = 0.365), however, these variances were not of significance. The initial outcomes of the individualized modified TNT model are promising. Sequencing adjusted according to the disease risk upon presentation might be the best way to balance local and distant disease control and treatment toxicity.
多项研究证实了全新辅助治疗（TNT）对局部晚期直肠癌（LARC）的益处。然而，术前强化治疗和较长的等待期可能会导致显著的副作用。这可能会导致手术困难和更高的并发症发生率。个体化改良TNT（mTNT）模型可能会减少副作用，同时不影响治疗效果。回顾性分析了2017年1月至2023年10月福建医科大学附属肿瘤医院结直肠外科同一治疗组中接受短程新辅助放疗和化疗的LARC患者的临床资料。对化疗放疗的不良反应、术后并发症、病理退缩和数据的长期结果等方面进行了分析。共纳入62例患者，包括诱导化疗模式16例（IC组）、巩固化疗模式20例（CC组）和诱导+巩固化疗夹心模式26例（IC+CC组）。三组新辅助治疗的依从率均达到100%。未发现4-5级毒性反应，围手术期并发症发生率为12.90%，在可接受范围内，包括严重并发症4例吻合口漏和1例腹腔出血。5例患者出现包括肠梗阻和直肠阴道瘘在内的延迟并发症，这些患者均接受了巩固化疗且BMI小于21。总病理完全缓解（pCR）率为24.19%，其中IC组为18.75%，CC组为25.00%，IC+CC组为26.92%。IC+CC组的降期率显著高于IC组和CC组（P=0.037）。与CC组或IC+CC组相比，IC组患者的局部区域无复发生存率（LRFS）较低（分别为81.3% vs. 82.5%和92.9%，P=0.292），远处无转移生存率（DMFS）较高（分别为93.8% vs. 73.1%和82.4%，P=0.365），然而，这些差异无统计学意义。个体化改良TNT模型的初步结果令人鼓舞。根据就诊时的疾病风险调整治疗顺序可能是平衡局部和远处疾病控制及治疗毒性的最佳方法。
