Onkologie. 2023:17(1):35-39 | DOI: 10.36290/xon.2023.009

Are we in the era of total neoadjuvant treatment in rectal cancer?

Marián Liberko1, 2, Renata Soumarová1, 2
1 Onkologická klinika 3. LF UK a FNKV, Praha
2 3. lékařská fakulta Univerzity Karlovy, Praha

Long term standard for treatment of locally advanced rectal cancer was neoadjuvant chemoradiotherapy followed by radical surgery and eventually adjuvant chemotherapy in selected patients. Stagnation of oncological outcomes of clasical approach lead to a new concept called total neoadjuvant treatment (TNT). This article offers review of most recent TNT studies and their significance for clinical pratice.

Keywords: locally advanced rectal cancer, neoadjuvant chemoradiotherapy, total neoadjuvant treatment.

Accepted: February 22, 2023; Published: March 1, 2023  Show citation

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Liberko M, Soumarová R. Are we in the era of total neoadjuvant treatment in rectal cancer? Onkologie. 2023;17(1):35-39. doi: 10.36290/xon.2023.009.
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References

  1. Glynne-Jones R, Wyrwicz L, Tiret E, et al. ESMO Guidelines Committee. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl_4):iv22-iv40. doi: 10.1093/annonc/mdx224. Erratum in: Ann Oncol. 2018;29(Suppl 4):iv263. PMID: 28881920. Go to original source... Go to PubMed...
  2. Sauer R, Becker H, Hohenberger W, et al. German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731-40. doi: 10.1056/NEJMoa040694. PMID: 15496622. Go to original source... Go to PubMed...
  3. Cedermark B, Dahlberg M, Glimelius B, et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997 Apr 3;336(14):980-7. doi: 10.1056/NEJM199704033361402. Erratum in: N Engl J Med 1997;336(21):1539. PMID: 9091798. Go to original source... Go to PubMed...
  4. Folkesson J, Birgisson H, Pahlman L, et al. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23(24):5644-50. doi: 10.1200/JCO.2005.08.144. PMID: 16110023. Go to original source... Go to PubMed...
  5. Erlandsson J, Holm T, Pettersson D, et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol. 2017;18(3):336-346. doi: 10.1016/S1470-2045(17)30086-4. Epub 2017 Feb 10. PMID: 28190762. Go to original source... Go to PubMed...
  6. Petersen SH, Harling H, Kirkeby LT, et al. Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev. 2012;2012(3):CD004078. doi: 10.1002/14651858.CD004078.pub2. PMID: 22419291; PMCID: PMC6599875. Go to original source... Go to PubMed...
  7. Zhao L, Liu R, Zhang Z, et al. Oxaliplatin/fluorouracil-based adjuvant chemotherapy for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and surgery: a systematic review and meta-analysis of randomized controlled trials. Colorectal Dis. 2016;18(8):763-72. doi: 10.1111/codi.13381. PMID: 27169752. Go to original source... Go to PubMed...
  8. Hong YS, Kim SY, Lee JS, et al. Oxaliplatin-Based Adjuvant Chemotherapy for Rectal Cancer After Preoperative Chemoradiotherapy (ADORE): Long-Term Results of a Randomized Controlled Trial. J Clin Oncol. 2019;37(33):3111-3123. doi: 10.1200/JCO.19.00016. Epub 2019 Oct 8. PMID: 31593484. Go to original source... Go to PubMed...
  9. Denost Q, Fleming CA, Burghgraef T, et al. MIRECA Collaborative Group (Pubmed Citable). An International Multicenter Prospective Study Evaluating the Long-term Oncological Impact of Adjuvant Chemotherapy in ypN+ Rectal Cancer. Ann Surg. 2022 Oct 28. doi: 10.1097/SLA.0000000000005742. Epub ahead of print. PMID: 36305301. Go to original source... Go to PubMed...
  10. Morris MC, Winer LK, Lee TC, et al. Omission of Adjuvant Chemotherapy in Rectal Cancer Patients with Pathologic Complete Response: a National Analysis. J Gastrointest Surg. 2021;25(7):1857-1865. doi: 10.1007/s11605-020-04749-6. Epub 2020 Jul 29. PMID: 32728821; PMCID: PMC7388436. Go to original source... Go to PubMed...
  11. Breugom AJ, Swets M, Bosset JF, et al. Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data. Lancet Oncol. 2015;16(2):200-7. doi: 10.1016/S1470-2045(14)71199-4. Epub 2015 Jan 12. PMID: 25589192. Go to original source... Go to PubMed...
  12. Breugom AJ, van Gijn W, Muller EW, et al. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015;26(4):696-701. doi: 10.1093/annonc/mdu560. Epub 2014 Dec 5. PMID: 25480874. Go to original source... Go to PubMed...
  13. Bujko K, Glimelius B, Valentini V, et al. Postoperative chemotherapy in patients with rectal cancer receiving preoperative radio(chemo)therapy: A meta-analysis of randomized trials comparing surgery ± a fluoropyrimidine and surgery + a fluoropyrimidine ± oxaliplatin. Eur J Surg Oncol. 2015;41(6):713-23. doi: 10.1016/j.ejso.2015.03.233. Epub 2015 Apr 13. PMID: 25911110. Go to original source... Go to PubMed...
  14. Bujko K, Glynne-Jones R, Bujko M. Does adjuvant fluoropyrimidine-based chemotherapy provide a benefit for patients with resected rectal cancer who have already received neoadjuvant radiochemotherapy? A systematic review of randomised trials. Ann Oncol. 2010;21(9):1743-1750. doi: 10.1093/annonc/mdq054. Epub 2010 Mar 15. PMID: 20231300. Go to original source... Go to PubMed...
  15. Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. doi: 10.1016/S1470-2045(20)30555-6. Epub 2020 Dec 7. Erratum in: Lancet Oncol. 2021;22(2):e42. PMID: 33301740. Go to original source... Go to PubMed...
  16. Jin J, Tang Y, Hu C, et al. Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR). J Clin Oncol. 2022;40(15):1681-1692. doi: 10.1200/JCO.21.01667. Epub 2022 Mar 9. PMID: 35263150; PMCID: PMC9113208. Go to original source... Go to PubMed...
  17. Bujko K, Wyrwicz L, Rutkowski A, et al. 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. Ann Oncol. 2016;27(5):834-842. doi: 10.1093/annonc/mdw062. Epub 2016 Feb 15. PMID: 26884592. Go to original source... Go to PubMed...
  18. Ciseł B, Pietrzak L, Michalski W, et al. Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol. 2019;30(8):1298-1303. doi: 10.1093/annonc/mdz186. PMID: 31192355. Go to original source... Go to PubMed...
  19. Conroy T, Bosset JF, Etienne PL, et al. 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. Lancet Oncol. 2021;22(5):702-715. doi: 10.1016/S1470-2045(21)00079-6. Epub 2021 Apr 13. PMID: 33862000. Go to original source... Go to PubMed...
  20. Fokas E, Allgäuer M, Polat B, et al. Randomized Phase II Trial of Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: CAO/ARO/AIO-12. J Clin Oncol. 2019;37(34):3212-3222. doi: 10.1200/JCO.19.00308. Epub 2019 May 31. PMID: 31150315. Go to original source... Go to PubMed...
  21. Fokas E, Schlenska-Lange A, Polat B, et al. Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Patients With Locally Advanced Rectal Cancer: Long-term Results of the CAO/ARO/AIO-12 Randomized Clinical Trial. JAMA Oncol. 2022;8(1):e215445. doi: 10.1001/jamaoncol.2021.5445. Epub 2022 Jan 20. PMID: 34792531; PMCID: PMC8603234. Go to original source... Go to PubMed...
  22. Garcia-Aguilar J, Patil S, Gollub MJ, et al. Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy. J Clin Oncol. 2022;40(23):2546-2556. doi: 10.1200/JCO.22.00032. Epub 2022 Apr 28. PMID: 35483010; PMCID: PMC9362876. Go to original source... Go to PubMed...




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