A new treatment for locally advanced rectal cancer (LARC) that has been successful in avoiding surgery and reducing the risk of recurrence has been developed and tested in Sweden. The treatment, known as total neoadjuvant treatment (TNT), involves short-course radiotherapy followed by rounds of chemotherapy. Researchers at Uppsala University found that this treatment was twice as effective as previous methods in reducing the existence of tumors in patients with high-risk LARC. The study followed 273 patients at 16 hospitals and an additional 189 patients at 18 hospitals over a four-year period. The treatment was found to significantly reduce the need for complicated bowel surgery and the associated complications.
In Sweden, approximately 2,000 individuals are diagnosed with rectal cancer yearly, with one-third of them at high risk of recurrence. Standard treatment for rectal cancer typically involves radiotherapy or a combination of radiotherapy and chemotherapy followed by surgery to remove part of the bowel, leading to potential problems with bowel control and the need for a stoma. Lead author Dr. Bengt Glimelius of Uppsala University highlighted the benefit of TNT in directly attacking tumors, potentially eliminating the need for surgery altogether and preserving the rectum, thus avoiding bowel control issues. This shift in treatment order has shown promising results in reducing tumor size and the risk of recurrence.
Dr. Anne Mongiu, co-director of the colorectal surgery program at Yale Cancer Center, noted that rectal cancer treatment has been rapidly evolving since the 1980s, with TNT representing a significant change in the timing of treatment administration. Rather than the traditional approach of giving chemotherapy post-surgery, TNT delivers a full regimen of chemotherapy and chemoradiotherapy prior to surgery, increasing compliance and improving the likelihood of a complete pathologic response where no residual tumor is found. This novel approach has the potential to downstage tumors before surgery, leading to improved outcomes for patients with rectal cancer.
Dr. Nilesh Vora, medical director of the MemorialCare Todd Cancer Institute, echoed the sentiment that TNT offers a novel and effective approach to treating rectal cancer. By administering neoadjuvant therapy before surgery, there is a greater chance of reducing the size of the tumor and increasing compliance with treatment. Lead author Dr. Glimelius emphasized that TNT has shown consistent effectiveness across different countries, with no significant differences in outcomes observed. While theoretically accessible worldwide, economic disparities and healthcare infrastructure may impact the availability of TNT in various regions, particularly in lower-income countries where specialized equipment and trained multidisciplinary teams may be lacking.
Overall, the success of TNT in reducing tumor size, avoiding surgery, and minimizing the risk of recurrence represents a significant advancement in the treatment of locally advanced rectal cancer. The shift from traditional treatment protocols to a neoadjuvant approach has shown promising results in improving patient outcomes and reducing the need for invasive surgeries. While the accessibility of TNT may be limited by economic and infrastructural challenges in some regions, the potential benefits of this treatment approach are clear. Further research and clinical trials may help to solidify the role of TNT in the management of rectal cancer and expand its availability to patients worldwide.
