In a recent prospective observational cohort study published in eClinicalMedicine , researchers evaluated a modified regimen of total neoadjuvant treatment (TNT) in high-risk locally advanced rectal cancer (LARC) patients in Sweden. They found that the modified TNT regime achieved similar complete response (CR) rates and lower neurotoxicity compared to the RAPIDO trial, despite treating older patients with more advanced tumors. Study: Total neoadjuvant treatment using short-course radiotherapy and four CAPOX cycles in locally advanced rectal cancer with high-risk criteria for recurrence: a Swedish nationwide cohort study (LARCT-US) .
Image Credit: New Africa/Shutterstock.com Background Preoperative chemoradiotherapy (CRT) is the standard treatment for LARC, often followed by adjuvant chemotherapy. However, while CRT effectively reduces locoregional recurrences, it has limited impact on distant metastases and overall survival.
This led to interest in TNT, which involves delivering systemic treatment before surgery. The RAPIDO (short for Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation) trial compared CRT with a TNT regimen of short-course radiotherapy (scRT) followed by preoperative chemotherapy (CAPOX or FOLFOX), showing improved outcomes. The Uppsala recruiting center, a key participant in RAPIDO, observed positive results with TNT, particularly due to the reduced radiation burden and better response rates.
Consequently, they introduced a modi.