Background: Total neoadjuvant therapy (TNT) has emerged as a promising strategy for locally advanced rectal cancer (LARC). By administering both chemoradiotherapy (CRT) and systemic chemotherapy (CHT) pre-surgery, TNT is associated with improved disease-free survival (DFS), reduced distant metastases, and higher pathological complete response (pCR) rates.Materials and Methods: This study included patients with LARC who received various TNT schedules: induction chemotherapy (iCHT), consolidation chemotherapy (cCHT), or a combination of both (sandwichCHT). We analyzed treatment adherence, toxicity, and pathological response. Local and distant disease recurrence, as well as survival outcomes, were also evaluated.Results: Between May 2021 and January 2025, 70 patients received TNT. Treatment included iCHT (41%), sandwichCHT (49%), and cCHT (10%). Most patients (94%) received long-course radiotherapy (LCRT). Overall, TNT was well tolerated, with grade 2 gastrointestinal toxicity during CRT being the most common frequent adverse event (33%). Disease progression during TNT was noted in five patients (7%); three of these patients were receiving chemotherapy, while two underwent surgical resection of the primary tumor. A watch-and-wait strategy was adopted for five patients (7%) following TNT. Surgical procedures performed included anterior resection (92%), abdominoperineal resection (7%), and local excision (1%). Pathological assessment revealed an overall pCR rate of 30%. With a median follow-up of 17 months, no patients experienced local recurrence. Post-surgery, 10 patients (17%) developed disease progression. The median DFS was 14.7 months. Five patients (7%) died during the follow-up period, with only one death attributed to causes other than disease progression.Conclusions:In this cohort of LARC patients, TNT demonstrated favorable tolerability and encouraging short-term efficacy.
背景：全术前新辅助治疗（TNT）已成为局部进展期直肠癌（LARC）的一种前景广阔的治疗策略。通过在术前联合应用放化疗（CRT）和全身化疗（CHT），TNT与改善的无病生存期（DFS）、减少远处转移以及更高的病理完全缓解（pCR）率相关。 材料与方法：本研究纳入了接受不同TNT方案的LARC患者，包括诱导化疗（iCHT）、巩固化疗（cCHT）或两者联合（sandwichCHT）。我们分析了治疗依从性、毒性和病理反应，并评估了局部和远处疾病复发以及生存结局。 结果：2021年5月至2025年1月期间，共有70例患者接受了TNT。治疗方案包括iCHT（41%）、sandwichCHT（49%）和cCHT（10%）。大多数患者（94%）接受了长程放疗（LCRT）。总体而言，TNT耐受性良好，最常见的频繁不良事件是CRT期间的2级胃肠道毒性（33%）。5例患者（7%）在TNT期间出现疾病进展，其中3例正在接受化疗，2例接受了原发肿瘤的手术切除。另有5例患者（7%）在TNT后采取了观察等待策略。实施的手术方式包括前切除术（92%）、腹会阴联合切除术（7%）和局部切除术（1%）。病理评估显示总体pCR率为30%。中位随访时间为17个月，期间无患者出现局部复发。术后有10例患者（17%）出现疾病进展。中位DFS为14.7个月。随访期间有5例患者（7%）死亡，其中仅1例死亡原因与疾病进展无关。 结论：在这组LARC患者队列中，TNT显示出良好的耐受性和令人鼓舞的短期疗效。
肿瘤(癌症)患者之家