Annals of Coloproctology

Review

Colorectal cancer

Total neoadjuvant therapy for rectal cancer: evidence and challenge: Suk-Hwan Lee; Ann Coloproctol. 2023;39(4):301-306. Published online August 29, 2023; DOI: https://doi.org/10.3393/ac.2023.00269.0038

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Recent advances in the management of rectal cancer have dramatically changed the clinical practice of colorectal surgeons because the main focus of rectal cancer treatment has changed from sphincter-saving to an organ-preserving strategies. Modifying the delivery of systemic chemotherapy to improve patients’ survival is another progress in colorectal cancer management, known as total neoadjuvant therapy (TNT). TNT is a new strategy used by colorectal surgeons to improve the quality of life and survival of patients after treatment. TNT poses limitations or obstacles, such as overtreatment issues in patients with stage I rectal cancer. However, considering the quality-of-life issues in patients with low-lying rectal cancer necessitating a permanent colostomy, the indication for TNT will be expanded. This review summarizes the recently conducted clinical trials and foresees future perspectives on TNT.

Citations

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Cirugía Española.2024; 102(11): 590. CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
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Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
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Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

Original Article

Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial: Hamid Nasrolahi, Sepideh Mirzaei, Mohammad Mohammadianpanah, Ali Mohammad Bananzadeh, Maral Mokhtari, Mohammad Reza Sasani, Ahmad Mosalaei, Shapour Omidvari, Mansour Ansari, Niloofar Ahmadloo, Seyed Hasan Hamedi, Nezhat Khanjani; Ann Coloproctol. 2019;35(5):242-248. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.09.06

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Abstract PDF

Purpose
Currently, neoadjuvant chemoradiation (CRT) followed by total mesorectal resection is considered the standard of care for treating locally advanced rectal cancer. This study aimed to investigate the efficacy and feasibility of adding induction chemotherapy to neoadjuvant CRT in locally advanced rectal cancer.
Methods
This phase-II clinical trial included 54 patients with newly diagnosed, locally advanced (clinical T3–4 and/or N1–2, M0) rectal cancer. All patients were treated with 3 cycles of preoperative chemotherapy using the XELOX (capecitabine + oxaliplatin) regimen before and after a concurrent standard long course of CRT (45–50.4 Gy) followed by standard radical surgery. Pathologic complete response (PCR) rate and toxicity were the primary and secondary endpoints, respectively.
Results
The study participants included 37 males and 17 females, with a median age of 59 years (range, 20–80 years). Twenty-nine patients (54%) had clinical stage-II disease, and 25 patients (46%) had clinical stage-III disease. Larger tumor size (P = 0.006) and distal rectal location (P = 0.009) showed lower PCR compared to smaller tumor size and upper rectal location. Pathologic examinations showed significant tumor regression (6.1 ± 2.7 cm vs. 1.9 ± 1.8 cm, P < 0.001) with 10 PCRs (18.5%) compared to before the intervention. The surgical margin was free of cancer in 52 patients (96.3%). Treatment-related toxicities were easily tolerated, and all patients completed their planned treatment without interruption. Grade III and IV toxicities were infrequent.
Conclusion
The addition of induction chemotherapy to neoadjuvant CRT is an effective and well-tolerated treatment approach in patients with rectal cancer.

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Efficacy and safety of sequential neoadjuvant chemotherapy and short-course radiation therapy followed by delayed surgery in locally advanced rectal cancer: a single-arm phase II clinical trial with subgroup analysis between the older and young patients
Alimohammad Bananzadeh, Ali Akbar Hafezi, NamPhong Nguyen, Shapour Omidvari, Ahmad Mosalaei, Niloofar Ahmadloo, Mansour Ansari, Mohammad Mohammadianpanah
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Review

Organ Preservation Strategies After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: Ri Na Yoo, Hyung Jin Kim; Ann Coloproctol. 2019;35(2):53-64. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.04.15.1

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Abstract PDF

Standard use of neoadjuvant chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemotherapy in locally advanced rectal cancer has tremendously improved oncologic outcomes over the past several decades. However, these improvements come with costs of significant morbidity and poor quality of life. Along with developments in imaging techniques, clinical experience and evidence have identified a certain subgroup of patients that have exceptionally good clinical outcomes while preserving quality of life. Driven by patient demand and interest in preserving quality of life, numerous organ preservation treatment strategies for managing rectal cancer are rapidly evolving. Herein, the flow of research in organ preservation strategies and counter arguments are discussed.

Citations

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Lateral pelvic lymph node dissection based on nodal response to neoadjuvant chemoradiotherapy in mid/low rectal cancer: a retrospective comparative cohort study
Tae-Gyun Lee, Duck-Woo Kim, Hong-min Ahn, Hye-Rim Shin, Mi Jeong Choi, Min Hyeong Jo, Heung-Kwon Oh, Sung-Bum Kang
Annals of Surgical Treatment and Research.2025; 108(6): 333. CrossRef
Efficacy and safety of MR-guided adaptive simultaneous integrated boost radiotherapy to primary lesions and positive lymph nodes in the neoadjuvant treatment of locally advanced rectal cancer: a randomized controlled phase III trial
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Organ preservation for early rectal cancer using preoperative chemoradiotherapy
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Komplette Response nach neoadjuvanter Therapie beim Rektumkarzinom: Implikationen für die Chirurgie
Carolin Kastner, Bernhard Petritsch, Joachim Reibetanz, Christoph-Thomas Germer, Armin Wiegering
Der Chirurg.2022; 93(2): 144. CrossRef
Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy
Ye Won Jeon, In Ja Park, Jeong Eun Kim, Jin-Hong Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim
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Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review
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Annals of Coloproctology.2021; 37(6): 382. CrossRef
The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer
Mayra Evelia Jiménez de los Santos, Juan Armando Reyes-Pérez, Rosa Martha Sandoval-Nava, José Luis Villalobos-Juárez, Yolanda Villaseñor-Navarro, Itzel Vela-Sarmiento, Isabel Sollozo-Dupont
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