Deciphering the Dilemma: Choosing the Optimal Total Neoadjuvant Treatment Strategy for Locally Advanced Rectal Cancer
Abstract
:1. Introduction
2. A Long Ride
3. Time to Make a Change
4. Total Neoadjuvant Therapy
5. LCRT-Based TNT
6. SCRT-Based TNT
7. Neoadjuvant Chemotherapy
8. Non-Operative Management (NOM)
9. Microsatellite Instability-High (MSI-H) / Deficient Mismatch Repair (dMMR) in LARC Patients
10. Which Neoadjuvant Treatment Is the Best?
Author Contributions
Funding
Conflicts of Interest
Abbreviation/Glossary List
cCR | Complete Clinical Response |
CRC | Colorectal Cancer |
CRM | Circumferential Resection Margin |
CRT | Chemoradiotherapy |
CT | Chemotherapy |
DFS | Disease-free Survival |
EMVI | Extramural Vascular Invasion |
LARC | Locally Advanced Rectal Cancer |
LCRT | Long Course Chemoradiotherapy |
LR | Local Recurrence |
MFS | Metastasis-free Survival |
MRF | Mesorectal Fascia |
NAT | Neoadjuvant Therapy |
OS | Overall Survival |
pCR | Pathological Complete Response |
RCT | Randomized Controlled Trial |
RT | Radiotherapy |
SCRT | Short Course Radiotherapy |
TME | Total Mesorectal Excision |
TNT | Total Neoadjuvant Therapy |
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Trial | Regimen | Main outcome | Secondary | Outcomes | ||
---|---|---|---|---|---|---|
3y DFS * | 3y MFS * | 3y OS | pCR * | 3y LRR | ||
PRODIGE 23 | CT → LCRT → TME → CT | 76% | 79% | 91% | 28% | 4% |
N = 461 | LCRT → TME → CT | 69% | 72% | 88% | 12% | 6% |
pCR | 3y DFS | 3y OS | 3y DM | 3y LRR | ||
CAO/ARO/AIO 12 | CT → LCRT → TME | 17% | 73% | 92% | 18% | 6% |
N = 306 | LCRT → CT → TME | 25% * | 73% | 92% | 16% | 5% |
5y DFS | 5y MFS | 5y OS | 5y OP * | 5y LRFS | ||
OPRA | CT → LCRT → TME or WW | 71% | 80% | 88% | 39% | 94% |
N = 324 | LCRT → CT → TME or WW | 69% | 78% | 85% | 54% | 90% |
5y DrTF * | 5y DM * | 5y OS | pCR * | 5y LRR * | ||
RAPIDO | SCRT → CT → TME | 27.8% | 23% | 81.7% | 28% | 10.2% |
N = 920 | LCRT → TME → CT | 34% | 30.4% | 80.2% | 14% | 6.1% |
3y DFS | 3y DM | 3y OS * | pCR+cCR * | 3y LRR | ||
STELLAR | SCRT → CT → TME → CT | 64.5% (non inferior) | 22% | 86% | 21.8% | 8.4% |
N = 591 | LCRT → TME → CT | 62.3% | 24% | 75% | 12.3% | 11% |
5y DFS | 5y OS | pCR | 5y LRR | |||
PROSPECT | CT → Selective LCRT → TME ± CT | 80.8% (non inferior) | - | 89.5% | 21.9% | 1.8% |
N = 1128 | LCRT → TME ± CT | 78.6% | - | 90.2% | 24.3% | 1.6% |
3y DFS | 3y OS | pCR | 3y LRR | |||
FOWARC | LCRT → TME → 5FU | 72.9% | - | 91.3% | 14% | 8% |
N = 495 | LCRT + CT → TME → CT | 77.2% | - | 89.1% | 27.5% | 7% |
CT → TME → CT | 73.5% | - | 90.7% | 6.5% | 8.3% |
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Manriquez, E.; Solé, S.; Silva, J.; Hermosilla, J.P.; Romero, R.; Quezada-Diaz, F. Deciphering the Dilemma: Choosing the Optimal Total Neoadjuvant Treatment Strategy for Locally Advanced Rectal Cancer. Curr. Oncol. 2024, 31, 4292-4304. https://doi.org/10.3390/curroncol31080320
Manriquez E, Solé S, Silva J, Hermosilla JP, Romero R, Quezada-Diaz F. Deciphering the Dilemma: Choosing the Optimal Total Neoadjuvant Treatment Strategy for Locally Advanced Rectal Cancer. Current Oncology. 2024; 31(8):4292-4304. https://doi.org/10.3390/curroncol31080320
Chicago/Turabian StyleManriquez, Erik, Sebastián Solé, Javiera Silva, Juan Pablo Hermosilla, Rubén Romero, and Felipe Quezada-Diaz. 2024. "Deciphering the Dilemma: Choosing the Optimal Total Neoadjuvant Treatment Strategy for Locally Advanced Rectal Cancer" Current Oncology 31, no. 8: 4292-4304. https://doi.org/10.3390/curroncol31080320