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Total neoadjuvant therapy vs standard therapy of locally advanced rectal cancer with high-risk factors for failure

World Journal of Gastrointestinal Oncology 2021年第2期13卷 119-130页

作者： Mojca Tuta Nina Boc erik brecelj Monika Peternel Vaneja Velenik Division of Radiology Institute of OncologyLjubljana 1000Slovenia Faculty of Medicine University of LjubljanaLjubljana 1000Slovenia Division of Surgery Institute of OncologyLjubljana 1000Slovenia Division of Radiotherapy Institute of OncologyLjubljana 1000Slovenia

BACKGROUND For locally advanced rectal cancer(LARC),standard therapy[consisting of neoadjuvant chemoradiotherapy(CRT),surgery,and adjuvant chemotherapy(ChT)]achieves excellent local ***,survival is still poor due to distant metastases,which remains the leading cause of death among these *** recent years,the concept of total neoadjuvant treatment(TNT)has been developed,whereby all systemic ChT-mainly affecting micrometastases-is applied prior to *** To compare standard therapy and total neoadjuvant therapy for LARC patients with high-risk factors for *** In a retrospective study,we compared LARC patients with high-risk factors for failure who were treated with standard therapy or with ***-risk for failure was defined according to the presence of at least one of the following factors:T4 stage;N2 stage;positive mesorectal fascia;extramural vascular invasion;positive lateral lymph *** consisted of 12 wk of induction ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin,CRT with capecitabine,and 6-8 wk of consolidation ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin prior to *** primary endpoint was pathological complete response(pCR).In total,72 patients treated with standard therapy and 89 patients treated with TNT were included in the *** Compared to standard therapy,TNT showed a higher proportion of pCR(23%vs 7%;P=0.01),a lower neoadjuvant rectal score(median:8.43 vs 14.98;P<0.05),higher T-and N-downstaging(70%and 94%vs 51%and 86%),equivalent R0 resection(95%vs 93%),shorter time to stoma closure(mean:20 vs 33 wk;P<0.05),higher compliance during systemic ChT(completed all cycles 87%vs 76%;P<0.05),lower proportion of acute toxicity grade≥3 during ChT(3%vs 14%,P<0.05),and equivalent acute toxicity and compliance during CRT and in the postoperative *** pCR rate in patients treated with TNT was significantly higher in patients

关键词： Locally advanced rectal cancer Total neoadjuvant therapy Pathological complete response Neoadjuvant rectal cancer score

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