Efficacy of Total Neoadjuvant Therapy (TNT) Versus Concurrent Neoadjuvant Chemoradiotherapy (CCRT) Alone for Locally Advanced Rectal Cancer in Rajavithi Hospital: A Retrospective Study
DOI:
https://doi.org/10.64387/tjs.2025.275196Keywords:
Total neoadjuvant chemotherapy (TNT), Concurrent chemoradiotherapy (CCRT), Locally advanced rectal cancer (LARC), Pathological complete response (PCR)Abstract
Background: Conventional therapy for locally advanced rectal cancer included concurrent chemoradiotherapy (CCRT) followed by surgery and adjuvant chemotherapy. An alternative strategy known as total neoadjuvant therapy (TNT) involves the administration of neoadjuvant chemotherapy plus CCRT before surgery. The studies before suggest that TNT is a promising strategy in locally advanced rectal cancer with a superior rate of PCR compared with conventional therapy. The purpose of this study is to compare the rate of PCR using these 2 approaches in patients at Rajavithi Hospital.
Objective: To determine the differences in rates of pathologic complete response (PCR), R0 resection, and 30-day mortality between patients receiving TNT vs conventional CCRT.
Materials and Methods: We performed a retrospective study of patients with clinical stage II/III rectal cancer within Rajavithi Hospital. All patients who received TNT and conventional CCRT were collected between 2019 and 2024, and the rates of pathological complete response (pCR) were compared between the two arms.
Results: Of the 135 patients in the cohort, 102 (76%) received conventional treatment and 33 (24%) received TNT. At baseline, patients in both groups were more likely to have clinical Stage 3 disease. There were 5 (15.2%) TNT patients who achieved pCR after surgery, compared to 8 (7.8%) conventional CCRT patients (P = 0.305), with no significant difference. There were no significant differences in the rate of positive margins after surgery (3% vs. 8.8%, P = 0.45). Only one patient in the standard arm has mortality within 30 days.
Conclusion: In the TNT group, PCR was found to be higher than the standard group (15.2% vs 7.8%, p = 0.305), although PCR was not significantly different, the real pCR rate was consistent with previous studies that suggest TNT is a promising strategy in locally advanced rectal cancer, with superior rates of PCR compared to standard CCRT.
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