A new treatment for locally advanced rectal cancer (LARC) known as Total neoadjuvant treatment (TNT) has been successful in avoiding surgery and reducing the risk of recurrence, according to a study conducted at Uppsala University in Sweden. The treatment involves short-course radiotherapy followed by rounds of chemotherapy and has shown twice the effectiveness in reducing tumor existence compared to previous approaches. With a high risk of recurrence in one-third of rectal cancer patients, this new treatment could potentially reduce the need for complicated bowel surgery and the subsequent complications that follow.
Sweden, with approximately 2,000 new cases of rectal cancer diagnosed each year, has seen positive results in the use of TNT for high risk LARC patients. Dr. Bengt Glimelius, the lead author of the study, highlights that the ability of TNT to directly target tumors may eliminate the need for invasive surgery in cases where the tumor disappears completely during treatment. This not only preserves the rectum but also eliminates the need for a stoma and a new rectum, reducing the occurrence of bowel control problems in patients post-surgery.
Total Neoadjuvant Therapy (TNT) has been considered a breakthrough in rectal cancer treatment, shifting the order of treatment modalities to maximize efficiency and compliance with chemotherapy. Dr. Anne Mongiu mentions that historically, chemotherapy was often given post-surgery but moving it to a neoadjuvant setting has shown an increase in complete pathologic response (pCR) with no residual tumor found post-surgery. This innovative approach has been well-received in the medical community as a way to reduce tumor size before surgery.
Dr. Nilesh Vora, a board-certified hematologist and medical oncologist, emphasizes the novel approach of TNT in rectal cancer treatment, pointing out the potential benefits of downstaging the tumor before surgery and ensuring better compliance with intended therapies. Despite global acceptance of TNT as an effective treatment option for rectal cancer, economic disparities may hinder its accessibility in lower income countries or those with unstable healthcare infrastructure. The specialized equipment and trained multidisciplinary teams required for TNT implementation may be lacking in certain regions.
Researchers, including Dr. Bengt Glimelius, who led the TNT study, believe that this treatment approach can have a worldwide impact, with consistent effectiveness across different countries. In previous randomized trials involving seven countries, including the U.S., there were no significant differences in outcomes, suggesting that TNT could be implemented globally. Despite the potential benefits of TNT being accessible worldwide, economic disparities and healthcare infrastructure challenges may limit its availability in certain regions, highlighting the need for continued efforts to make innovative treatments accessible to all patients.
