Recent findings from a systematic review and network meta-analysis highlight the potential benefits of total neoadjuvant therapy (TNT) for patients with locally advanced rectal cancer (LARC). The study, which included 27 randomized clinical trials with over 13,000 participants, demonstrated that TNT regimens, particularly long-course chemoradiotherapy (L-CRT) plus consolidation chemotherapy, significantly improve pathological complete response (pCR) rates compared to standard L-CRT.
Key findings include:
Higher pCR rates: L-CRT plus consolidation chemotherapy showed the highest improvement in pCR rates, with a relative risk (RR) of 1.96 compared to standard L-CRT.
Treatment adherence: TNT protocols may enhance adherence to preoperative chemotherapy and radiotherapy, potentially leading to better management of micrometastases.
Long-term outcomes: While TNT regimens improve pCR rates, further research is needed to assess their impact on long-term survival and recurrence rates.
Given these insights, TNT protocols should be considered as a first-line treatment option for increasing pCR rates in LARC. However, careful evaluation of long-term outcomes and patient-specific factors is crucial to optimizing treatment strategies.
URL: 10.1001/jamanetworkopen.2024.14702
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