The following is a summary of the “Total Neoadjuvant Therapy Significantly Increases Complete Clinical Response,” published in the March 2023 issue of Gastroenterology by Luke, et al.
As comprehensive neoadjuvant therapy for rectal cancer has been used for longer, it has been shown to result in larger tumour shrinkage and a higher rate of full clinical response, as judged by both pathological and clinical criteria. The purpose of this study was to compare the effectiveness of comprehensive neoadjuvant therapy vs conventional neoadjuvant chemoradiation in treating patients with locally advanced rectal cancer. The data in this study were collected in a cohort fashion and analysed retrospectively. Patients diagnosed with rectal cancer in a large integrated healthcare system between 2015 and 2019 were analysed. There was no discernible difference in clinical stage or patient characteristics between the 2 groups, as shown by their demographics.
Total neoadjuvant therapy was administered to 66 patients and standard neoadjuvant chemoradiation was administered to 399. Consolidation chemotherapy was given to 56 individuals, whereas induction chemotherapy was given to 10. The primary indicators of success were rates of complete clinical response, disease-free survival, proctectomy-free survival, and organ preservation. Results showed that the comprehensive neoadjuvant therapy group had a higher rate of complete clinical response (58.1% vs 14.8%, p 0.001) with 36 patients. Both groups had similar three-year overall survival rates (85.6% for conventional neoadjuvant chemoradiation and 86.0% for comprehensive neoadjuvant therapy). Compared to the standard neoadjuvant chemoradiation group, which had a 77.7% three-year distant metastasis-free survival rate, the entire neoadjuvant therapy group had a 67.4 percent rate.
Proctectomy-free survival at three years was 44% in the entire neoadjuvant therapy group and 6% in the standard neoadjuvant chemoradiotherapy group. Twenty-two patients in the standard neoadjuvant chemoradiation group (37.3% of complete clinical responders) and thirty-one patients in the comprehensive neoadjuvant therapy group (86.1% of complete clinical responders) opted to pursue organ preservation. The study’s shorter follow-up period of 3 years and retrospective design are its main limitations. Complete clinical response was greatly enhanced by using whole neoadjuvant therapy for rectal cancer. This allows for more organ preservation in patients without negatively impacting their overall survival or ability to keep their condition under control.
