A new study conducted at Uppsala University in Sweden has found that a new treatment for locally advanced rectal cancer (LARC) has proven successful enough to avoid surgery and reduce the risk of recurrence. This treatment, called Total Neoadjuvant Treatment (TNT), involves short bursts of radiotherapy followed by various rounds of chemotherapy. The researchers observed 273 high-risk LARC patients at 16 hospitals from July 2016 to June 2020, as well as an additional 189 patients at 18 hospitals during the same period. They found that the treatment doubled the rates of tumor disappearance compared to previous regimens, from 14% to 28%, with no increase in the rate of recurrence.
Rectal cancer is a common condition in Sweden, with about 2,000 new cases diagnosed every year, one-third of which are high-risk for recurrence. Current treatment options often involve extensive radiotherapy combined with chemotherapy, followed by invasive surgery to remove part of the bowel, which can result in complications such as bowel control issues and the need for a stoma. Dr. Bengt Glimelius, the lead author of the study and a professor of oncology at Uppsala University, highlighted the potential of TNT to eliminate or reduce the need for surgery by directly targeting tumors. The treatment can spare the rectum, thereby avoiding the need for a stoma and the associated side effects.
Dr. Anne Mongiu, co-director of the colorectal surgery program at Yale Cancer Center, explained that TNT represents a shift in the traditional order of treatment for rectal cancer. Typically, chemotherapy is administered after surgery to reduce the risk of metastatic disease. However, TNT involves providing a full regimen of chemotherapy and chemoradiotherapy prior to surgery, which has been shown to increase compliance with treatment and improve the chances of a complete pathologic response. This approach has been the subject of several trials since the 2010s and has demonstrated promising outcomes for patients with rectal cancer.
Dr. Nilesh Vora, a board-certified hematologist and medical oncologist at Long Beach Medical Center, described TNT as a novel approach that offers several advantages over historical therapies for rectal cancer. By delivering neoadjuvant therapy before surgery, TNT can improve compliance with treatment regimens and increase the likelihood of downstaging the tumor. Glimelius noted that this approach of administering all radiotherapy and chemotherapy before surgery, without additional treatment afterward, is gaining popularity worldwide. He emphasized that TNT has been found to be equally effective across different countries, with no significant differences observed in clinical outcomes.
While total neoadjuvant treatment is theoretically accessible to patients globally, economic disparities and healthcare infrastructure limitations may hinder its widespread availability. Mongiu pointed out that countries with well-established healthcare systems, such as the United States, Canada, Europe, and Australia, offer TNT as part of their standard treatment protocols. In contrast, lower-income countries or those with less stable infrastructure may struggle to implement TNT due to challenges in purchasing and maintaining specialized equipment and chemotherapy agents. Despite the potential benefits of TNT for patients with rectal cancer, disparities in healthcare resources may limit its accessibility in certain regions.
