Future direction of total neoadjuvant therapy for locally advanced rectal cancer.
Nat Rev Gastroenterol Hepatol
; 21(6): 444-455, 2024 Jun.
Article
in En
| MEDLINE
| ID: mdl-38485756
ABSTRACT
Despite therapeutic advancements, disease-free survival and overall survival of patients with locally advanced rectal cancer have not improved in most trials as a result of distant metastases. For treatment decision-making, both long-term oncologic outcomes and impact on quality-of-life indices should be considered (for example, bowel function). Total neoadjuvant therapy (TNT), comprised of chemotherapy and radiotherapy or chemoradiotherapy, is now a standard treatment approach in patients with features of high-risk disease to prevent local recurrence and distant metastases. In selected patients who have a clinical complete response, subsequent surgery might be avoided through non-operative management, but patients who do not respond to TNT have a poor prognosis. Refined molecular characterization might help to predict which patients would benefit from TNT and non-operative management. Specifically, integrated analysis of spatiotemporal multi-omics using artificial intelligence and machine learning is promising. Three prospective trials of TNT and non-operative management in Japan, the USA and Germany are collaborating to better understand drivers of response to TNT. Here, we address the future direction for TNT.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rectal Neoplasms
/
Neoadjuvant Therapy
Limits:
Humans
Language:
En
Journal:
Nat Rev Gastroenterol Hepatol
/
Nat. rev. gastroenterol. hepatol
/
Nature reviews. Gastroenterology & hepatology (Print)
Journal subject:
GASTROENTEROLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Japón
Country of publication:
Reino Unido