Total Neoadjuvant Therapy (TNT) in Rectal Cancer

AbstractPurpose of ReviewThis review summarizes the relevant literature on the use of total neoadjuvant therapy (TNT) for patients with locally advanced rectal cancer. It highlights the most notable literature published and briefly discusses future directions.Recent FindingsRecent randomized trials evaluating TNT show improved rates of pathologic complete response and patient treatment tolerance with this approach.SummaryThe rationale for TNT includes the poor patient tolerance of adjuvant chemotherapy and the persistent risk of distant disease in patients with locally advanced rectal cancer, despite improvements in local control. Randomized trials have focused on short-term pathologic endpoints. Ongoing phase 3 trials are evaluating long-term disease-related outcomes, allowing for a more thorough evaluation of this treatment paradigm. TNT may also facilitate organ preservation in appropriately selected patients.
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research

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Conclusion: Extending the waiting period by 4 weeks following RCT has no influence on the oncological outcomes of T3/T4 rectal cancers.
Source: Annals of Surgery - Category: Surgery Tags: ESA-RANDOMIZED CONTROLLED TRIALS Source Type: research
Authors: Kye BH, Lee SH, Jeong WK, Yu CS, Park IJ, Kim HR, Kim J, Lee IK, Park KJ, Choi HJ, Kim HY, Baek JH, Lee YS Abstract Purpose: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. Methods: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent...
Source: Annals of Surgical Treatment and Research - Category: Surgery Tags: Ann Surg Treat Res Source Type: research
In vitro and in vivo studies on the association of long non‑coding RNAs H19 and urothelial cancer associated 1 with the susceptibility to 5‑fluorouracil in rectal cancer. Int J Oncol. 2019 Oct 04;: Authors: Yokoyama Y, Sakatani T, Wada R, Ishino K, Kudo M, Koizumi M, Yamada T, Yoshida H, Naito Z Abstract There is no predictive biomarker for response to 5‑fluorouracil (5FU)‑based neoadjuvant chemotherapy (NAC) in rectal cancer. In the present study, we examined potential long non‑coding RNAs (lncRNAs) linked to the susceptibility to 5FU in cultured colorectal cancer cells, and in bi...
Source: International Journal of Oncology - Category: Cancer & Oncology Authors: Tags: Int J Oncol Source Type: research
Abstract Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone o...
Source: World Journal of Gastroenterology - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
ConclusionsDue to the proximity of the tumor to the pelvic viscera, especially the ectopic kidney, the probability of inadequate abscission of the lesion in surgery and radiotherapy, as well as complications and localized relapse were increased so that the kidney could be maintained. Carrying out careful pre-treatment examinations can result in maintaining an ectopic kidney and its daily conditioned function dependent on the status of the patient, including the proximity of the ectopic kidney to the tumor, anatomical position, and prior damage. The lesson learned from the present case is that radiotherapy and surgery are p...
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Background: Perineural invasion (PNI) and lymphovascular invasion (LVI) are associated with poor prognosis in colorectal cancer, but their clinical significance is still controversial for patients with locally advanced rectal cancer (LARC) who had received neoadjuvant chemoradiotherapy (nCRT) and surgical resection. The aim of this study was to confirm the correlation between PNI and/or LVI and clinical prognosis and to further confirm whether PNI and/or LVI can be used as potential prognostic indicators of adjuvant chemotherapy after nCRT and surgery in LARC.Methods: From February 2002 to December 2012, a total of 181 pat...
Source: Journal of Cancer - Category: Cancer & Oncology Authors: Tags: Research Paper Source Type: research
CONCLUSIONS: Assessment at 10 to 16 weeks may detect a minority of patients who achieve complete clinical response without additional recurrence after neoadjuvant chemoradiation. Patients suspected for a complete clinical response should be considered for reassessment beyond 16 weeks before definitive management when considered for a watch and wait strategy. See Video Abstract at http://links.lww.com/DCR/A901.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contribution: Colorectal Cancer Source Type: research
AbstractBackgroundC-reactive protein (CRP) has been suggested as a satisfactory early marker of postoperative complications after colorectal surgery. The aim of this study was to assess the impact of a CRP monitoring-driven discharge strategy, after stoma reversal following laparoscopic sphincter-saving surgery for rectal cancer.MethodsEighty-eight patients who had stoma reversal between June 2016 and April 2018 had CRP serum level monitoring on postoperative day (POD) 3 and, if necessary, on POD5. Patients were discharged on POD4 if the CRP level was  
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
AbstractRectal cancer accounts for one-third of newly diagnosed colorectal cancer cases. Given its anatomical location and risk for local recurrence, a multidisciplinary treatment program including surgery, radiation therapy, and chemotherapy has demonstrated improved outcomes in localized disease. Genetic analysis has become part of the standard approach for management of advanced disease and new trials are considering tailored therapies for locally advanced disease. This review describes molecular subsets of colorectal cancer; implications for clinical management, including patterns of metastatic spread and response to t...
Source: Abdominal Imaging - Category: Radiology Source Type: research
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