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Total Neoadjuvant Therapy (TNT) in Rectal Cancer

  • Radiation Therapy and Radiation Therapy Innovations in Colorectal Cancer (JY Wo, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

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 Findings

Recent randomized trials evaluating TNT show improved rates of pathologic complete response and patient treatment tolerance with this approach.

Summary

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Radiation Oncology, Duke Cancer Center, Medicine Circle, PO Box 3085, Durham, NC, 27710, USA

    Sarah J. Stephens, Christopher G. Willett, Manisha Palta & Brian G. Czito

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  1. Sarah J. Stephens
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  2. Christopher G. Willett
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Correspondence to Brian G. Czito.

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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.

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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).

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This article is part of the Topical Collection on Radiation Therapy and Radiation Therapy Innovations in Colorectal Cancer

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Stephens, S.J., Willett, C.G., Palta, M. et al. Total Neoadjuvant Therapy (TNT) in Rectal Cancer. Curr Colorectal Cancer Rep 14, 199–206 (2018). https://doi.org/10.1007/s11888-018-0415-8

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