A new study conducted at Uppsala University in Sweden has found that a new treatment for locally advanced rectal cancer (LARC) has been successful in avoiding surgery and reducing the risk of recurrence. This treatment, known as Total Neoadjuvant Treatment (TNT), involves short-course radiotherapy followed by rounds of chemotherapy. The researchers followed 273 patients with high-risk LARC at 16 hospitals from July 2016 to June 2020. The rates of tumor disappearance doubled from previous treatment regimens, from 14% to 28%, and there was no increase in the rate of recurrence. Sweden sees about 2,000 rectal cancer diagnoses each year, with one-third of those at high risk of recurrence.
The new treatment has been credited with reducing the need for complicated bowel surgery, which can lead to subsequent complications. Dr. Bengt Glimelius, the lead author of the study and a professor of oncology in Sweden, stated that if the tumor completely disappears during treatment, surgery may not be required, allowing the rectum to be preserved and eliminating the need for a stoma and a new rectum. The study found that the treatment can directly attack tumors, providing relief from invasive surgery and side effects such as bowel control issues. As rectal cancer treatment continues to evolve, the TNT approach shifts the entire treatment regimen before surgery, changing the order in which treatment is administered.
Total Neoadjuvant Therapy (TNT) refers to giving a full regimen of chemotherapy and chemoradiotherapy prior to surgery in the treatment of rectal cancer. Dr. Anne Mongiu, co-director of the colorectal surgery program at Yale Cancer Center, explained that this approach increases overall compliance with chemotherapy and has shown an increase in complete pathologic response, leading to no residual tumor in post-surgical pathology specimens. Dr. Nilesh Vora, the medical director of the MemorialCare Todd Cancer Institute, noted that TNT is a novel approach to treating rectal cancer, with the idea of downstaging the tumor before surgery. This new method of treatment has been shown to be equally effective worldwide.
While total neoadjuvant treatment is theoretically accessible to people around the world, there are economic disparities that may hinder access to this treatment. Dr. Mongiu explained that the healthcare infrastructure in each country impacts the availability of TNT. First-world countries like the United States, Canada, Europe, and Australia offer TNT as evidenced by their participation in large randomized clinical trials. However, lower-income countries and those with unstable infrastructure may struggle to obtain the specialized equipment and trained multidisciplinary teams needed to administer TNT. Despite these potential barriers, the researchers involved in the study believe that TNT could provide a new and effective treatment option for patients with locally advanced rectal cancer.
