Tuta M, Boc N, Brecelj E, Peternel M, Velenik V. Total neoadjuvant therapy vs standard therapy of locally advanced rectal cancer with high-risk factors for failure. World J Gastrointest Oncol 2021; 13(2): 119-130 [PMID: 33643528 DOI: 10.4251/wjgo.v13.i2.119]
Corresponding Author of This Article
Vaneja Velenik, MD, PhD, Associate Professor, Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2, Ljubljana 1000, Slovenia. vvelenik@onko-i.si
Research Domain of This Article
Oncology
Article-Type of This Article
Clinical and Translational Research
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Feb 15, 2021; 13(2): 119-130 Published online Feb 15, 2021. doi: 10.4251/wjgo.v13.i2.119
Total neoadjuvant therapy vs standard therapy of locally advanced rectal cancer with high-risk factors for failure
Mojca Tuta, Nina Boc, Erik Brecelj, Monika Peternel, Vaneja Velenik
Mojca Tuta, Nina Boc, Division of Radiology, Institute of Oncology, Ljubljana 1000, Slovenia
Mojca Tuta, Vaneja Velenik, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
Erik Brecelj, Division of Surgery, Institute of Oncology, Ljubljana 1000, Slovenia
Monika Peternel, Vaneja Velenik, Division of Radiotherapy, Institute of Oncology, Ljubljana 1000, Slovenia
Author contributions: Tuta M designed and performed the research, and wrote the paper; Velenik V designed and performed the research, and supervised the report; Boc N and Peternel M designed the research and contributed to the analysis; Brecelj E designed the research and provided clinical advice.
Institutional review board statement: The study was reviewed and approved by the institutional review boards and the National Medical Ethics Committee of Slovenia (No. 0120-298/2019/5).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymised clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vaneja Velenik, MD, PhD, Associate Professor, Division of Radiotherapy, Institute of Oncology, Zaloška cesta 2, Ljubljana 1000, Slovenia. vvelenik@onko-i.si
Received: September 27, 2020 Peer-review started: September 27, 2020 First decision: December 12, 2020 Revised: December 22, 2020 Accepted: January 7, 2021 Article in press: January 7, 2021 Published online: February 15, 2021
ARTICLE HIGHLIGHTS
Research background
Distant metastases remain the leading cause of death for patients with locally advanced rectal cancer. Systemic chemotherapy that mainly affects micrometastasis is administered with chemoradiotherapy prior to surgery in total neoadjuvant treatment.
Research motivation
Currently, it is unknown which treatment is better for patients with locally advanced rectal cancer and high-risk factors for treatment failure.
Research objectives
To compare the results of total neoadjuvant therapy and standard therapy in patients with locally advanced rectal cancer and high-risk factors for failure in the same time period.
Research methods
We selected patients with locally advanced rectal cancer and high-risk factors for failure who were treated with standard therapy or with total neoadjuvant therapy. High-risk for failure were defined by the presence of at least one of the following factors: T4 status; N2 status; positive mesorectal fascia; extramural vascular invasion; and/or positive lateral lymph node.
Research results
This retrospective study showed that total neoadjuvant therapy yielded a higher proportion of pathological complete response (pCR), lower neoadjuvant rectal score, higher T-and N-downstaging, equivalent R0 resection, shorter time to stoma closure, higher compliance during systemic chemotherapy, lower proportion of acute toxicity grades ≥ 3 during chemotherapy, and equivalent acute toxicity and compliance during chemoradiotherapy and in the postoperative period. With total neoadjuvant therapy, we achieved a statistically significantly higher rate of pCR with intensity-modulated radiotherapy/volumetric modulated arc therapy compared to the three-dimensional conformal radiation therapy technique.
Research conclusions
The outcome of total neoadjuvant therapy is better than that of standard treatment of locally advanced rectal cancer with high-risk factors for failure, in terms of the pCR rate and the neoadjuvant rectal prognostic score.
Research perspectives
Randomized studies are needed to more reliably assess the benefits of total neoadjuvant therapy for locally advanced rectal cancer with high-risk factors for failure.
