Total Neoadjuvant Therapy in Rectal Cancer: Single Institution Experience
Author : Dr. Syed Faizan, Dr. Giridhar CM and Dr. MS Ganesh
Abstract :
Total neoadjuvant treatment (TNT) is a more recent development in the treatment of rectal cancer. With new information on its effectiveness, the concept of delivering complete chemotherapy regimens that include capecitabine and oxaliplatin (CAPEOX) or modified 5 fluorouracil and oxaliplatin (mFOLFOX6) upfront with radiation in the preoperative setting is becoming more and more common. The main goal of this study was to determine the complete pathological response.
Materials and Methods: The present Retrospective study was conducted at a tertiary care centre between January 2022 to June 2024, among 50 Patients who were diagnosed with locally advanced (Ct3/4 or Ct2- N +) Rectal Cancer. The Patients Received 6 Cycles of Capeox Or 6-8 Cycles of Folfox followed by a Short Course of Radiation Therapy or Long Course Radiation Therapy and then surgery.
Results: A total of 50 patients were included for the study. About 25(50%) patients were in T3 stage and 33(66%) patients were in N1 stage. About 41(82%) patients received full dose TNT regimen CAPEOX. The majority of patients 29(58%) received Short Course Radiotherapy (SCRT). About 35(70%) patients underwent surgery between 1-2 months post radiotherapy and Laparoscopic Abdominoperineal resection was the commonest surgery performed among 28(56%) patients. About 18(36%) patients didn’t complete TNT regimen due to various reasons like diarrhoea, bleeding, non-responsive to chemotherapy, and vomiting. Pathological complete response was observed among 18(36%) patients and Lymphovascular invasion (LVI) was positive among 08(16%) patients.
Conclusion: TNT represents a transformative approach in rectal cancer management, offering improved systemic control, higher compliance, and potential for organ preservation. While challenges remain, ongoing research and advancements in precision oncology hold promise for further refining TNT and expanding its benefits to a broader patient population.
Keywords :
Total neoadjuvant treatment (TNT), rectal cancer, chemotherapy etc.
