Total Neoadjuvant Treatment for Locally Advanced Rectal Cancer Patients: Where Do We Stand?
Valentina Daprà, Marco Airoldi, Michela Bartolini, Roberta Fazio, Giuseppe Mondello, Maria Chiara Tronconi, Maria Giuseppina Prete, Giuseppe Roberto D’Agostino, Caterina Foppa, Antonino Spinelli, Alberto Puccini, Armando Santoro
Abstract
The therapeutic landscape in locally advanced rectal cancer (LARC) has undergone a significant paradigm shift in recent years with the rising adoption of total neoadjuvant treatment (TNT). This comprehensive approach entails administering chemotherapy and radiation therapy before surgery, followed by optional adjuvant chemotherapy. To establish and deliver the optimal tailored treatment regimen to the patient, it is crucial to foster collaboration among a multidisciplinary team comprising healthcare professionals from various specialties, including medical oncology, radiation oncology, surgical oncology, radiology, and pathology. This review aims to provide insights into the current state of TNT for LARC and new emerging strategies to identify potential directions for future research and clinical practice, such as circulating tumor-DNA, immunotherapy in mismatch-repair-deficient tumors, and nonoperative management.