Postoperative oncologic outcomes of curative resection after neoadjuvant chemotherapy were compared with those of upfront surgery. https://doi.org/10.1111/codi.13724. Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis The findings of this systematic review and meta-analysis suggest that TNT is a promising strategy in locally advanced rectal cancer, with superior rates of PCR compared with standard therapy. Tomasini R, Tsuchihara K, Tsuda C, Lau SK, Wilhelm M, Rufini A, Tsao MS, Iovanna JL, Jurisicova A, Melino G, Mak TW. Adjuvant therapy occurs after. Siragusa L, Sensi B, Vinci D, Franceschilli M, Pathirannehalage Don C, Bagaglini G, Bellato V, Campanelli M, Sica GS. A random-effects model with inverse-variance method was used for the meta-analysis. Significant correlation between glucose metabolism status and acute radiation enteritis resulting from concurrent chemoradiotherapy in rectal cancer. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Front Immunol. Article J Clin Oncol. Total neoadjuvant therapy: Fact, fantasy, or fallacy? Disease-free survival was also improved at 75.7% vs 68.5%, although the noted difference in this study compared with the previous studies is the inclusion of 3 months of adjuvant therapy. Rectal Cancer, Version 2.2018 NCCN clinical practice guidelines in oncology. None of the trials reported an increased tumor progression, despite the time to operative therapy being delayed by administration of neoadjuvant systemic chemotherapy. Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: Induction PubMedGoogle Scholar. It improves disease-free survival (DFS) by decreasing pelvic recurrence but has short- and long-term toxicity. However, we addressed this issue by conducting separate analyses for randomized and nonrandomized studies and then pooling the results. The oncologic benefit of neoadjuvant chemotherapy in thymic malignancies remains unclear. Biochemistry. https://doi.org/10.1016/S1470-2045(21)00079-6. List of Ongoing/Recently Reported TNT Trials Other Than Those Included in the Meta-analysis, eFigure 1. https://doi.org/10.1200/JCO.2020.38.15_suppl.4008. Kim JK, Marco MR, Roxburgh CSD, Chen CT, Cercek A, Strombom P, Temple LKF, Nash GM, Guillem JG, Paty PB, Yaeger R, Stadler ZK, Gonen M, Segal NH, Reidy DL, Varghese A, Shia J, Vakiani E, Wu AJ, Romesser PB, Crane CH, Gollub MJ, Saltz L, Smith JJ, Weiser MR, Patil S, Garcia-Aguilar J. Oncologist. 8600 Rockville Pike Total neoadjuvant therapy (TNT) is the delivery of chemoradiotherapy (CRT) or short-course radiotherapy (SCRT) and chemotherapy before surgery (or as nonoperative management [NOM]) and has been increasingly adopted for multimodal rectal cancer treatment. Collected data show wild heterogeneity in terms of RT and CT regimens, CT agents, timing of CT administration and timing of surgery for both experimental TNT and standard therapy. The .gov means its official. We conducted this meta-analysis to assess such concerns. The Memorial Sloan Kettering Center study reported significant benefits such as earlier stoma closure (72% vs 9%) and a 25% higher rate of minimally invasive surgical procedures in TNT treated patients [28, 68]. preoperative treatment sequencing for BR/LA PDA is unknown. 2023 May 10;14:1105180. doi: 10.3389/fimmu.2023.1105180. Amelio I, Bertolo R, Bove P, Buonomo O, Candi E, et al. Cell Death Differ. References of the included studies were manually assessed in order to detect any missing studies. In a nutshell, these are therapies, like chemotherapy or hormone therapy, delivered before or after the primary treatment, to help increase the treatments chance of success and decrease the risk of recurrence. Cell Death Differ. https://doi.org/10.1016/S1470-2045(21)00013-9]. No significant difference was found in rates of sphincter-preserving surgery or ileostomy requirements between the 2 approaches. Total Neoadjuvant Therapy for Rectal Cancer | Roswell Park However, the 3-year overall survival was similar in each arm at 89%. demonstrated improved 5-years DFS and OS in patients reaching pCR compared to incomplete pCR/non-responders (86% and 88% vs 63% and 76%, respectively) [45]. However, its efficacy and safety remain controversial in randomized controlled trials (RCTs). 2021;28(12):327081. Search for Similar Articles A total of 7 studies including 2416 patients, of whom 1206 received total neoadjuvant therapy, were selected. Total neoadjuvant therapy is a viable treatment strategy for patients with locally advanced rectal cancer and is associated with improved delivery of planned therapy, increased downstaging, earlier introduction of optimal systemic chemotherapy to address micrometastases, and the potential to sidestep any surgical treatment at all. https://doi.org/10.1093/annonc/mdv223. Results: ; Collaborative investigators . Short-term results of CAO/ARO/AIO-12 and OPRA trials showed improved pCR and cCR, improved compliance to CRT and grade 3 to 4 toxicity rate reduction, when comparing consolidation and induction TNT [38, 39]. The https:// ensures that you are connecting to the Two meta-analysis confirmed no statistically significant differences in TNT and standard arm for what concern the rate of negative resection margins [32, 46]. 2021;26(9):e155566. Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta-analysis. Currently, Locally Advanced Rectal Cancer (LARC) patients undergo a combined treatment of chemotherapy and radiotherapy, followed by surgery. TAp73 regulates the spindle assembly checkpoint by modulating BubR1 activity. 2022;40(23):2546-2556. Total Neoadjuvant Therapy (TNT) is an emerging approach aimed to reduce distant metastases and improve local control. A practical framework for the targeted use of total neoadjuvant therapy Because a considerable reduction in the bulk of the tumor with a TNT approach might result in more and more patients adopting a nonoperative watch-and-wait strategy in the future, accurate determination of CCR in addition to PCR is imperative. Long-course oxaliplatin-based preoperative chemoradiation versus 5 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. (A): Pathologic complete response with total neoadjuvant, Forest plots for survival endpoints. Rdel C, Martus P, Papadoupolos T, et al.. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. OConnell E, Reynolds IS, McNamara DA, Prehn JHM, Burke JP. Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Wu X, Peng J, Ren D, Wang J. Neoadjuvant modified FOLFOX6 with or without radiation versus fluorouracil plus radiation for locally advanced rectal cancer: final results of the Chinese FOWARC trial. 2018;4(6):e180071. Total neoadjuvant therapy (TNT) is one such therapeutic strategy that incorporates chemotherapy with chemoradiotherapy antecedent to surgery.4 Total neoadjuvant therapy as an alternative treatment for LARC is now supported by the National Comprehensive Cancer Network.5 It has been postulated to offer advantages such as enhanced compliance with planned therapy, reduction in the tumor stage, and exposure to chemotherapy sooner in the disease course that targets occult micrometastases and can help assess chemosensitivity. Article Inclusion in an NLM database does not imply endorsement of, or agreement with, official website and that any information you provide is encrypted Herein, we performed a systematic review and meta-analysis to compare the incidence of pathologic complete response (PCR), surgical organ preservation, and disease-free survival between the traditional concurrent chemoradiotherapy plus neoadjuvant chemotherapy (CRT plus A) approach vs TNT. Total neoadjuvant therapy versus standard therapy in locally advanced rectal cancer: A systematic review and meta-analysis of 15 trials. Although our meta-analysis does not highlight any specific surgical advantages in the TNT cohort, the Memorial Sloan Kettering Cancer Center study reported significant findings, such as earlier stoma closure (72% vs 9%) and a 25% higher rate of minimally invasive surgery in the TNT subset.8 Apprehensions regarding the safety of postponing surgery beyond 2 months after CRT were allayed by the TIMING (Timing of Rectal Cancer Response to Chemoradiotherapy Trial) trial.9 Although the rates of development of pelvic fibrosis were higher in the groups with a longer gap from CRT to surgery, they did not translate into an increased technical difficulty or postoperative complications. Lancet Oncol. Trends Biochem Sci. Front Surg. Ann Oncol. 2006;355(11):111423. Implications for practice: https://doi.org/10.1016/j.tibs.2015.04.007. For example, an individual may have surgery to remove a tumor, followed by adjuvant chemotherapy. PLoS One. The total neoadjuvant therapy (TNT) and chemoradiotherapy followed by surgery and adjuvant chemotherapy (CRT plus A) groups were compared. Core tip: Given the enormous amount of scientific information published every year, systematic reviews and meta-analyses have become indispensable methods for the evaluation of medical treatments and the delivery of the best evidence-based practice. Cite this article. van der Valk MJM, Marijnen CAM, van Etten B, et al. The search terms were as follows: anal/anorectal neoplasms OR anal/anorectal cancer AND total neoadjuvant treatment OR total neoadjuvant therapy. They may then follow this with adjuvant therapy to destroy any remaining cancer cells, reducing the risk of recurrence. The p53 family member p73 in the regulation of cell stress response. Ankylosing Spondylitis Pain: Fact or Fiction, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/adjuvant-therapy, https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html, https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/chemotherapy-side-effects.html, https://academic.oup.com/jncimono/article/2015/51/36/945910, https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/hormone-therapy.html, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/neoadjuvant-therapy, https://academic.oup.com/jncics/article/1/1/pkx004/4210673, https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/effects-on-different-parts-of-body.html, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299787/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/, https://jamanetwork.com/journals/jamaoncology/fullarticle/2330620, https://onlinelibrary.wiley.com/doi/abs/10.1002/jso.26305, Dementia: Olive oil could boost brain health, according to new study, 2 glasses of 'non-alcoholic' wine a day may help improve aging skin. Total neoadjuvant therapy enhances ones chances of attaining a PCR, which traditionally has been shown to correspond to higher overall and disease-free survival. 2018;20(8):O21525. It seems therefore, important to identify factors predictive of a good response to TNT. The meta-analysis by Liu et al., which included 8 RCTs, showed an overall improved pCR. https://doi.org/10.1056/NEJM199704033361402. Conroy T, Lamfichekh N, Etienne P-L, et al.. Total neoadjuvant therapy with mFOLFIRINOX versus preoperative chemoradiation in patients with locally advanced rectal cancer: final results of PRODIGE 23 phase III trial, a UNICANCER GI trial. https://doi.org/10.1016/s0167-4838(99)00036-9. Furthermore, non-responders could be at risk of both local and distant progression while waiting for surgery. PubMed Central One of the most discussed clinical points is whether to administer TNT before or after neoadjuvant RT. reported an 18% reduction in risk of recurrence (p=0.01) and a 19% reduction in mortality at 3years (p=0.04) [46]. The good results of the RAPIDO trial, in particular for what concerned the resection margins, suggest that longer intervals, whilst beneficial in terms of pCR, will not jeopardize surgical outcomes [30]. Google Scholar. An article in JAMA Oncology describes when such cases arise: Recommendations for adjuvant therapy may be based on response to neoadjuvant therapy. eCollection 2022. In this national cohort, TNT was not associated with better survival and/or CRM negative status in comparison with nCRT, despite numerically higher downstaging rates. Mauretti A, Neri A, Kossover O, Seliktar D, Nardo PD, Melino S. Design of a novel composite H2 S-releasing hydrogel for cardiac tissue repair. Phase II study of durvalumab plus total neoadjuvant therapy (TNT) in locally advanced rectal cancer: the GEMCAD-1703 DUREC trial, Short-term results of VOLTAGE-A: nivolumab monotherapy and subsequent radical surgery following preoperative chemoradiotherapy in patients with microsatellite stable and microsatellite instability-high locally advanced rectal cancer. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial, Improved metastasis- and disease-free survival with preoperative sequential short-course radiation therapy and FOLFOX chemotherapy for rectal cancer compared with neoadjuvant long-course chemoradiotherapy: results of a matched pair analysis. Before Most often, neoadjuvant and adjuvant therapies are recommended when a patient with early-stage cancer undergoes surgery or radiation therapy and the oncologist believes he or she may benefit from additional systemic treatmentsor treatments that affect the entire body, Dr. Alawin says. Perioperative versus total neoadjuvant chemotherapy in gastric - PubMed Int J Immunopathol Pharmacol. modify the keyword list to augment your search. Disc Onc. BAX mitochondrial integration is regulated allosterically by its 1-2 loop. https://doi.org/10.1002/onco.13824. 2012;279(1):15467. Several ongoing studies are analyzing whether this new approach could improve oncological outcomes. Biol Direct. Bellomaria A, Barbato G, Melino G, Paci M, Melino S. Recognition of p63 by the E3 ligase ITCH: effect of an ectodermal dysplasia mutant. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R9001 randomized trial. A growing body of evidence26,27 suggests that surgery delayed for 3 or more months after radiotherapy is associated with a higher response rate compared with surgery performed within 12 weeks of radiation. All rights reserved. Dossa F, Chesney TR, Acuna SA, Baxter NN. Amelio I, Melino G. The p53 family and the hypoxia-inducible factors (HIFs): determinants of cancer progression. J Clin Oncol. The watch-and-wait approach may be deemed preferable because surgery can lead to bowel or bladder incontinence and sexual impairment as well as a short-term or permanent ostomy. In Europe, the gold standard for the treatment of locally advanced rectal cancer (LARC) consists in a multidisciplinary approach based on the administration of either preoperative long-course chemoradiotherapy (CRT) or short-course radiotherapy (SCRT), followed by surgery and adjuvant chemotherapy [7,8,9,10]. Two-sided P<.05 indicated significance. Multiple ongoing TNT trials are now including the neoadjuvant rectal score as a primary or secondary end point.32,37 In the CAO/ARO/AIO-04 trial,41 the neoadjuvant rectal score was found to be an independent predictor for disease-free, overall, and distant metastasisfree survival as well as local recurrence; however, a recent Netherlands Cancer Registrybased study including more than 6500 patients42 found the neoadjuvant rectal score to be poorly concordant with the true end point when compared with a simple Cox proportional hazards regression model using the same 3 criteria included in the neoadjuvant rectal score formula. Riesco-Martinez MC, Fernandez-Martos C, Gravalos-Castro C, Espinosa-Olarte P, La Salvia A, Robles-Diaz L, Modrego-Sanchez A, Garcia-Carbonero R. Impact of total neoadjuvant therapy vs. standard chemoradiotherapy in locally advanced rectal cancer: a systematic review and meta-analysis of randomized trials. 2022 Nov 4;17(11):e0276599. However, sub-analysis of induction TNT had demonstrated that this strategy decreases likelihood of residual nodal disease [27]. Are we already in the era of total neoadjuvant treatment for rectal Radioimmunotherapy in colorectal cancer treatment: present and future. and transmitted securely. It is not clear whether consolidation TNT or lengthening the chemoradiation-to-surgery interval led to pCR improvement [44]. Supplemental digital content is available for this article. Please enable it to take advantage of the complete set of features! Abbreviation: RCT, randomized control, Forest plots for pathologic complete response. 2021;28(12):328296. The landscape of total neoadjuvant therapy for locally advanced rectal cancers looks promising, and the RAPIDO protocol is likely to be the new standard of care, especially in resource-limited settings and the current climate of the COVID-19 pandemic, when fewer visits to health-care centres are desirable. Only two randomized phase III studies provided SCRT in the experimental arm, before the administration of consolidation CT [13, 30]. Please try again soon. Conditions that impact someones recommendation for adjuvant or neoadjuvant therapy may include: Both therapies offer various benefits to people living with cancer. Most of these studies were single institutional and retrospective [2]. 2000;926:90100. Local recurrence rate is the main long-term endpoint. Yu H, Huang Y, Ge Y, Hong X, Lin X, Tang K, Wang Q, Yang Y, Sun W, Huang Y, Luo H. Selenite-induced ROS/AMPK/FoxO3a/GABARAPL-1 signaling pathway modulates autophagy that antagonize apoptosis in colorectal cancer cells. Treatment protocols show high heterogeneity. Adjuvant therapy follows the primary treatment and helps reduce the risk of cancer recurring. Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Adjuvant therapy can improve a persons long-term outcomes. This is the first systematic review and meta-analysis, to our knowledge, to compare the efficacy of TNT with that of conventional CRT plus A for LARC. LBA2 Background: Radiation with sensitizing fluoropyrimidine (5FUCRT) is a standard curative intent treatment for LARC. Sibio S, Di Giorgio A, DUgo S, Palmieri G, Cinelli L, Formica V, Sensi B, Bagaglini G, Di Carlo S, Bellato V, Sica GS. The outcome of PCR was reported in all 7 studies. Seven RCTs reported on pCR, including over 3000 patients. https://doi.org/10.1177/039463200501800111. 2017;96(13):e6487. 1. Does a longer waiting period after neoadjuvant radio-chemotherapy improve the oncological prognosis of rectal cancer? Would you like email updates of new search results? The following Medical Subject Headings (MeSH) terms were used: total neoadjuvant therapy OR total neoadjuvant treatment OR neoadjuvant AND rectal cancer OR locally advanced rectal cancer. Furthermore, differences can be found within the same study, due to the different chemo-radio therapeutic regimens employed for the two arms. 2013;13(Suppl 2):S57. Xiong K, Bao T, Cao Y, Hu W, Deng J, Chen J, Xiao T. Int J Colorectal Dis. https://doi.org/10.1001/jamaoncol.2021.5445. Additional factors independently associated with lower OS included male gender, uninsured status, low income status, high comorbidity score, poorly differentiated tumors, abdominoperineal resection, and positive surgical margins (all P <0.01). official website and that any information you provide is encrypted Cell Death Differ. A recently published systemic review and meta-analysis [1] identified 7 unique studies with 1206 patients receiving total neoadjuvant terapy (TNT) and surgery and 1210 patients treated with chemoradiotherapy (CRT), surgery, and adjuvant chemotherapy (CRT plus A). 5FU/Folinic Acid, Irinotecan and Oxaliplatin, Near-Complete Pathological Complete Response. eTable 1. BMC Surg. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. In all these studies CRT agents were the same for both the experimental and standard arm, except for the RAPIDO trial, which compared capecitabine-based CRT in the control arm to SCRT in the experimental arm [30]. Preoperative chemoradiotherapy has primarily been proven to be effective in local disease control but is not as successful in preventing distant metastasis, which has emerged as the primary mode of recurrence in rectal cancer. Investigating the power of music for dementia. Article Total neoadjuvant therapy was associated with a higher chance of achieving a PCR (odds ratio [OR], 2.44; 95% CI, 1.99-2.98). Glynne-Jones R. Interpreting the RAPIDO trial: factors to consider. The overall pCR rate may be improved with TNT compared with standard treatment. Received 2020 Jul 15; Accepted 2020 Oct 25. Preferred reporting items for systematic reviews and metaanalysis flowchart. Taking into account the outcomes from these studies (Garcia-Aguilar et al9 described a 5-year disease-free survival whereas Markovina et al10 and Conroy et al12 reported a 3-year disease-free survival) generated an OR of 2.07 (95% CI, 1.20-3.56; I2=49%) (Figure 5) favoring improved disease-free survival among those who received TNT.7,8,10. Gallo M, Paludi D, Cicero DO, Chiovitti K, Millo E, Salis A, Damonte G, Corsaro A, Thellung S, Schettini G, Melino S, Florio T, Paci M, Aceto A. Although reported in only 3 studies,9,10,12 TNT was associated with a significantly longer disease-free survival. 2016;16(6):84758. Data regarding the first author, publication year, location, sample size (including numbers of patients who received standard therapy and TNT), and rates of PCR, sphincter-preserving surgery, ileostomy, and disease-free and overall survival were extracted. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. Several evidences suggest a lack of benefits of aCT in patients who have already received nCT [22,23,24,25,26]. The median age for the patients receiving TNT ranged from 57 to 69 years, with 58% to 73% being male. The most common AEs included diarrhea, nausea, neutropenia and fatigue [28, 32]. CRT seems to be the preferable option in case of high-risk local recurrence cancers. Kim SY, Joo J, Kim TW, Hong YS, Kim JE, Hwang IG, Kim BG, Lee KW, Kim JW, Oh HS, Ahn JB, Zang DY, Kim DY, Oh JH, Baek JY. 2020 Kasi A et al. Data on overall survival were not consistently reported. Combined chemotherapy and chemoradiation, referred to as total neoadjuvant therapy (TNT), is used worldwide, and several high-quality trials showed that TNT improves oncological outcomes in two aspects ( 8 - 11 ). Kasi A, Abbasi S, Handa S, Al-Rajabi R, Saeed A, Baranda J, Sun W. Total neoadjuvant therapy vs standard therapy in locally advanced rectal cancer: a systematic review and meta-analysis. Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy. https://clinicaltrials.gov/ct2/show/NCT04246684#contacts ClinicalTrials.gov Identifier: NCT04246684. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Deng et al. 1999;17:2396. Goffredo, Paolo MD*; Khan, Adil MD; Mott, Sarah L. MS; Jensen, Christine C. MD, MPH*; Madoff, Robert D. MD*; Gaertner, Wolfgang B. MD*; You, Y. Nancy MD; Hassan, Imran MD, *Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, Department of Surgery, Raleigh General Hospital, Beckley, WV, Holden Comprehensive Cancer Center, University of iowa Hospitals & Clinics, Iowa City, IA. In multivariable analysis, as compared to nCRT, TNT demonstrated numerically higher pCR rates (P = 0.05) but had similar incidence of positive CRM (P = 0.11). Cookies policy. Neoadjuvant-Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Abbreviations: CI, confidence interval; OR, odds ratio; TNT, total neoadjuvant therapy. Data supporting consolidation TNT are reported in two RCTs testing the optimal timing of TNT. JAMA Oncol. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Adjuvant chemotherapy refers to chemotherapy that people receive after another cancer treatment, such as surgery. 2018 Mar;17 (1):1-12. doi: 10.1016/j.clcc.2017.06.008. Roede C. Short-course Radiotherapy Versus Chemoradiotherapy, Followed by Consolidation Chemotherapy, and Selective Organ Preservation for MRI-defined Intermediate and High-risk Rectal Cancer Patients. How many different models of cell death? Another limitation is that the studies incorporated in our analysis were a mix of randomized and nonrandomized trials. Only Moore et al. 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. Predictive CRM [35, 36] and lateral nodes involvement [30, 36] were described by two RCTs. We avoid using tertiary references. In their UNICANCER-PRODIGE-23 phase 3 randomised, controlled trial (n=461), total neoadjuvant treatment (neoadjuvant chemotherapy consisting of oxaliplatin, irinotecan, leucovorin, and fluorouracil given for 3 months followed by chemoradiotherapy) combined with surgery and adjuvant chemotherapy given for 3 months was compared with standard-of-ca. Neoadjuvant chemotherapy with or without anthracyclines in - PubMed and transmitted securely. ; EORTC Radiation Oncology Group . Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. 2020;12(12):3655. https://doi.org/10.3390/cancers12123655. CRT was based on single agent administration (5FU or capecitabine) in 6 out of 8 studies [30, 31, 33,34,35,36]. Cell Death Differ. The study was conducted in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. National Library of Medicine For example, when doctors use adjuvant therapy to treat people with cancer, it reduces the risk of cancer returning. Bookshelf The https:// ensures that you are connecting to the The French Research Group of Rectal Cancer Surgery (GRECCAR). Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer: results of the international randomized RAPIDO-trial, Prognostic significance of tumor regression in locally advanced rectal cancer after preoperative radiochemotherapy. A further search was performed in clinicaltrial.gov using the terms total neoadjuvant therapy and rectal cancer. Neoadjuvant chemotherapy is when a person has chemotherapy as their main. Recently, total neoadjuvant therapy (TNT) has shown greater efficacy in terms of increasing the rate of complete pathological response (pCR) and . All rights reserved. Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced

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