Total neoadjuvant therapy for rectal cancer: a guide for surgeons

The modern management of rectal cancers continues to evolve. With the release of data from new landmark randomized controlled trials (RAPIDO, PRODIGE-23), total neoadjuvant therapy (TNT) has moved to the forefront of locally advanced rectal cancer treatment and is considered a standard option in selected patients. Total neoadjuvant therapy promises enhanced systemic disease control, better treatment adherence and less time with an ostomy. However, TNT as currently described encompasses a number of different potential treatment options that differ significantly in terms of their radiation dosage, chemotherapy regimen and order of treatments administered. Being familiar with TNT regimens will be important for rectal cancer surgeons to appropriately advocate for their patients and optimize their outcomes. This article serves as a primer for the general surgeon and offers a pragmatic overview of the indications, realistic expected benefits and potential downsides of each TNT regimen.

Automated summary

With the release of data from new landmark randomized controlled trials, total neoadjuvant therapy (TNT) has become a standard option for locally advanced rectal cancer treatment. However, the current description of TNT includes different treatment options with significant differences in radiation dosage, chemotherapy regimen, and treatment order. It is important for rectal cancer surgeons to be familiar with TNT regimens in order to advocate for their patients and optimize outcomes. This article provides a primer and pragmatic overview of the indications, benefits, and downsides of each TNT regimen.