Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort
Background: Rectal cancer poses a significant global health burden. Conventional neoadjuvant chemoradiotherapy (nCRT) demonstrates limited efficacy in achieving disease-free survival (DFS) and organ preservation. Total neoadjuvant therapy (TNT), an emerging paradigm integrating systemic chemotherapy...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-05-01
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| Series: | Therapeutic Advances in Medical Oncology |
| Online Access: | https://doi.org/10.1177/17588359251332466 |
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| author | Zhiyuan Zhang Ruiyan Wu Zhenyu Ke Fan Xia Guichao Li Juefeng Wan Hui Zhang Yujia Deng Zhen Zhang Yan Wang Lijun Shen |
| author_facet | Zhiyuan Zhang Ruiyan Wu Zhenyu Ke Fan Xia Guichao Li Juefeng Wan Hui Zhang Yujia Deng Zhen Zhang Yan Wang Lijun Shen |
| author_sort | Zhiyuan Zhang |
| collection | DOAJ |
| description | Background: Rectal cancer poses a significant global health burden. Conventional neoadjuvant chemoradiotherapy (nCRT) demonstrates limited efficacy in achieving disease-free survival (DFS) and organ preservation. Total neoadjuvant therapy (TNT), an emerging paradigm integrating systemic chemotherapy with radiotherapy, aims to address these limitations. Objectives: To evaluate the short- and long-term oncological outcomes and organ preservation feasibility of TNT in high-risk locally advanced rectal cancer (LARC) patients. Designs: A retrospective study was conducted to analyze the short-term and long-term results after total nCRT. Methods: This retrospective study involved 110 rectal cancer patients with high-risk features treated at the Fudan University Shanghai Cancer Center from 2008 to 2022. Patients underwent comprehensive staging and received nCRT followed by either total mesorectal excision (TME) or a watch and wait (W&W) strategy. The regimen included concurrent chemoradiotherapy with 50 Gy/25 fractions and at least six cycles of induction or consolidation chemotherapy. Both short-term and long-term outcomes were collected and analyzed. Results: Among the LARC patients, 73.6% were stage III, and 47.3% opted for the W&W strategy. The combined rate of clinical complete response or confirmed pathological complete response (pCR) reached 49.1%. During follow-up, 10% of patients experienced local regrowth. The 3-year DFS and overall survival (OS) rates were 75.7% and 92.4%, respectively. The W&W strategy could achieve superior outcomes than patients without pCR in DFS ( p = 0.021) and OS ( p = 0.006). Conclusion: TNT demonstrates durable survival outcomes and facilitates organ preservation in over 50% of high-risk LARC patients. Intensive surveillance is critical for the early detection of local regrowth. Trial registration: Our study is retrospective in nature, rather than a prospective clinical trial. Therefore, registration was not conducted, and the Clinical Trial Number is not applicable. |
| format | Article |
| id | doaj-art-9f13c073b0aa4e32bf5b52760ac412c7 |
| institution | DOAJ |
| issn | 1758-8359 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Medical Oncology |
| spelling | doaj-art-9f13c073b0aa4e32bf5b52760ac412c72025-08-20T03:09:31ZengSAGE PublishingTherapeutic Advances in Medical Oncology1758-83592025-05-011710.1177/17588359251332466Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohortZhiyuan ZhangRuiyan WuZhenyu KeFan XiaGuichao LiJuefeng WanHui ZhangYujia DengZhen ZhangYan WangLijun ShenBackground: Rectal cancer poses a significant global health burden. Conventional neoadjuvant chemoradiotherapy (nCRT) demonstrates limited efficacy in achieving disease-free survival (DFS) and organ preservation. Total neoadjuvant therapy (TNT), an emerging paradigm integrating systemic chemotherapy with radiotherapy, aims to address these limitations. Objectives: To evaluate the short- and long-term oncological outcomes and organ preservation feasibility of TNT in high-risk locally advanced rectal cancer (LARC) patients. Designs: A retrospective study was conducted to analyze the short-term and long-term results after total nCRT. Methods: This retrospective study involved 110 rectal cancer patients with high-risk features treated at the Fudan University Shanghai Cancer Center from 2008 to 2022. Patients underwent comprehensive staging and received nCRT followed by either total mesorectal excision (TME) or a watch and wait (W&W) strategy. The regimen included concurrent chemoradiotherapy with 50 Gy/25 fractions and at least six cycles of induction or consolidation chemotherapy. Both short-term and long-term outcomes were collected and analyzed. Results: Among the LARC patients, 73.6% were stage III, and 47.3% opted for the W&W strategy. The combined rate of clinical complete response or confirmed pathological complete response (pCR) reached 49.1%. During follow-up, 10% of patients experienced local regrowth. The 3-year DFS and overall survival (OS) rates were 75.7% and 92.4%, respectively. The W&W strategy could achieve superior outcomes than patients without pCR in DFS ( p = 0.021) and OS ( p = 0.006). Conclusion: TNT demonstrates durable survival outcomes and facilitates organ preservation in over 50% of high-risk LARC patients. Intensive surveillance is critical for the early detection of local regrowth. Trial registration: Our study is retrospective in nature, rather than a prospective clinical trial. Therefore, registration was not conducted, and the Clinical Trial Number is not applicable.https://doi.org/10.1177/17588359251332466 |
| spellingShingle | Zhiyuan Zhang Ruiyan Wu Zhenyu Ke Fan Xia Guichao Li Juefeng Wan Hui Zhang Yujia Deng Zhen Zhang Yan Wang Lijun Shen Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort Therapeutic Advances in Medical Oncology |
| title | Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort |
| title_full | Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort |
| title_fullStr | Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort |
| title_full_unstemmed | Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort |
| title_short | Total neoadjuvant therapy in high-risk rectal cancer: organ preservation and survival outcomes in a single-center retrospective cohort |
| title_sort | total neoadjuvant therapy in high risk rectal cancer organ preservation and survival outcomes in a single center retrospective cohort |
| url | https://doi.org/10.1177/17588359251332466 |
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