Locally advanced rectal cancer: total neoadjuvant treatment

摘要

Pre-operative radiochemotherapy followed by surgery with total mesorectal excision (TME) has been the standard for treatment of Grade mill rectal cancers for some time. The year 2020 has marked a turning point in the management of these locally advanced rectal cancers, with the simultaneous presentation, at the American Society of Clinical Oncology (ASCO) congress, of two Phase III studies evaluating a total neoadjuvant therapy (TNT) strategy. This TNT strategy consists of radiotherapy or radiochemotherapy before surgery, with multidrug therapy delivered before (so-called "induction" strategy) or after radiotherapy (so-called "consolidation" strategy). In these two studies, compliance was excellent. A significant increase in recurrence-free survival and metastasis-free survival at three years was demonstrated for the experimental arms in each of these two studies with a gain in the order of 7-8%, although not in terms of overall survival. The rate of sterilization of the operative parts was also significantly higher in the experimental arms (28% versus 12%). These two Phase III studies produced similar results. However, at present, choosing the treatment regimen, in the absence of a direct comparison between the two regimens, remains challenging.