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%,p< 0.001) and lower lymphatic (26.3% vs. 42.6%,p= 0.009), vascular (15.8% vs. 32.7%,p= 0.002), and perineural invasion rates (20.3% vs. 37.6%,p= 0.003). Furthermore, 16.9% of TNT patients opted for non-operative management (NOM), compared to 0.9% in the CRT group (p< 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,p< 0.001). The 3-year EFS was 58.3% for CRT and 71.1% for TNT (p= 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.
全疗程新辅助治疗（TNT）已成为局部进展期直肠癌（LARC）管理中一种前景广阔的治疗策略，旨在提高肿瘤可切除性、增加病理完全缓解（pCR）率、改善治疗依从性、生存率及肛门括约肌保留率。本研究比较了采用诱导或巩固化疗模式的TNT与标准放化疗（CRT）的临床疗效。这项回顾性多中心研究分析了2021年至2024年间来自七家肿瘤中心的II-III期LARC患者接受CRT或TNT治疗的情况。根据化疗与放疗的时序，TNT组被分为诱导组和巩固组。研究分析了临床病理资料及治疗结局，包括pCR率、无事件生存期（EFS）和总生存期（OS）。在276例患者中，105例接受CRT，171例接受TNT。TNT组显示出显著更高的pCR率（21.8% vs. 2.9%，p<0.001）和更低的淋巴管侵犯率（26.3% vs. 42.6%，p=0.009）、血管侵犯率（15.8% vs. 32.7%，p=0.002）及神经侵犯率（20.3% vs. 37.6%，p=0.003）。此外，16.9%的TNT患者选择了非手术治疗（NOM），而CRT组仅为0.9%（p<0.001）。TNT组放疗结束至手术的中位间隔时间更长（17.6周 vs. 8.8周，p<0.001）。CRT组3年EFS为58.3%，TNT组为71.1%（p=0.06）。与CRT相比，TNT具有更高的pCR率、更低的淋巴血管侵犯率及更高的NOM实施率。这支持将TNT作为LARC的可行治疗策略，为患者生活质量带来潜在获益。
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