Total Neoadjuvant Therapy (TNT) in Rectal Cancer
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Purpose of Review
This 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 randomized trials evaluating TNT show improved rates of pathologic complete response and patient treatment tolerance with this approach.
The 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.
KeywordsRectal cancer Total neoadjuvant therapy TNT Total mesorectal excision TME Chemoradiation Neoadjuvant Organ preservation
Compliance with Ethical Standards
Conflict of Interest
Sarah J. Stephens declares that she has no conflict of interest.
Christopher G. Willett declares that he has no conflict of interest.
Manisha Palta has received research support from Merck, honoraria from Oakstone CME and UpToDate, and has received compensation from Navigant for service as a consultant.
Brian G. Czito declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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