From the Guidelines
Total neoadjuvant therapy (TNT) for rectal cancer should be given as an initial treatment, including chemoradiation and chemotherapy, with the preferred timing for chemotherapy being after radiation, as recommended by the most recent guidelines 1. The standard approach for TNT typically involves a combination of fluoropyrimidine-based chemotherapy with radiation therapy for 5-6 weeks, followed by additional chemotherapy.
- The radiation component usually delivers 45-50 Gy in 25-28 fractions to the pelvis.
- Some protocols may administer systemic chemotherapy first, followed by chemoradiation.
- TNT aims to reduce tumor size before surgery, eliminate micrometastases early, improve sphincter preservation rates, and potentially achieve complete pathological response in some patients. This approach has shown benefits in local control and disease-free survival compared to traditional approaches where adjuvant chemotherapy follows surgery, as supported by recent phase III trial data 1. Patients typically undergo surgery about 8-12 weeks after completing the neoadjuvant regimen, allowing time for maximal tumor response while monitoring for treatment-related toxicities throughout the process. Key considerations for TNT include the patient's tumor location, risk factors for local and distant metastases, and the potential for non-operative management if a clinical complete response is achieved.
From the Research
Administration of TNT for Rectal Cancer
- The provided studies do not specifically mention the administration of TNT (Trinitrotoluene) for rectal cancer.
- However, the studies discuss various chemoradiation regimens for the treatment of rectal cancer, including 5-fluorouracil (5-FU), capecitabine, oxaliplatin, and irinotecan 2, 3, 4, 5, 6.
- These regimens are typically administered orally or intravenously, often in combination with radiation therapy.
- The studies suggest that the choice of chemoradiation regimen depends on various factors, including the stage and location of the tumor, as well as the patient's overall health and preferences 3, 6.
Chemoradiation Regimens
- Neoadjuvant chemoradiation with 5-FU or capecitabine, with or without oxaliplatin, is a common approach for the treatment of rectal cancer 2, 4, 5.
- The addition of oxaliplatin to 5-FU or capecitabine-based chemoradiation has been shown to increase toxicity, but its effectiveness in improving outcomes is still debated 4, 6.
- Other regimens, such as short-course radiation therapy followed by consolidation neoadjuvant chemotherapy, have also been investigated 3.
Conclusion Not Applicable
As per the provided guidelines, a conclusion section is not applicable. The information provided is based on the available evidence and is intended to inform and educate.