Tailored total neoadjuvant therapy for locally advanced rectal cancer: One size may not fit for all!

Ozer L., Yıldız İ., Bayoglu V., Bozkurt M., Esen E., Remzi F. H., ...Daha Fazla

COLORECTAL DISEASE, cilt.23, sa.7, ss.1662-1669, 2021 (SCI-Expanded) identifier identifier

  • Yayın Türü: Makale / Editöre Mektup
  • Cilt numarası: 23 Sayı: 7
  • Basım Tarihi: 2021
  • Doi Numarası: 10.1111/codi.15669
  • Dergi Adı: COLORECTAL DISEASE
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.1662-1669
  • Anahtar Kelimeler: algorithm, locally advanced, rectal cancer, total neoadjuvant treatment, TOTAL MESORECTAL EXCISION, PHASE-III TRIAL, ADJUVANT CHEMOTHERAPY, POSTOPERATIVE CHEMORADIOTHERAPY, PREOPERATIVE CHEMORADIOTHERAPY, COLORECTAL-CANCER, OPEN-LABEL, RADIOTHERAPY, SURGERY, CHEMORADIATION
  • Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet

Özet

While current neoadjuvant protocols have proven benefits on local control for majority of patients with locally advanced rectal cancer, there are certain clinical conditions that require future advances for improving the outcomes. Total neoadjuvant therapy incorporates systemic chemotherapy planned within standard neoadjuvant protocols either before or after radiotherapy for locally advanced rectal cancer as a whole. Enhanced compliance with planned oncological therapy, tumour downstaging, administration of chemotherapy at the earliest time in the disease course to help assessing chemosensitivity are the proposed benefits of total neoadjuvant therapy in patients with locally advanced rectal cancer. Patient selection criteria for administration of total neoadjuvant therapy in the recent guidelines are unclear. Since current literature is inconclusive for the optimal sequence and type of radiotherapy and chemotherapy, premature incorporation of total neoadjuvant therapy for all locally advanced rectal cancers may result in overtreatment and subsequently toxicity. This article aims to discuss the current literature and to propose a future perspective by considering real-life scenarios reflecting patients' needs for treatment of locally advanced rectal cancer.