Total neoadjuvant therapy

In ancient times, the traditional treatment for rectal cancer relied heavily on surgery as the main approach, followed by chemotherapy and radiation therapy. This often led to severe side effects and the potential for complete loss of rectal function, significantly impacting the patient's quality of life.

With continuous advancements in imaging and diagnostic techniques, Total Neoadjuvant Therapy (TNT) has emerged as a groundbreaking approach that has revolutionized rectal cancer treatment. TNT involves administering full doses of chemotherapy and radiation therapy before surgery to shrink the tumor, increasing the likelihood of recovery without the need for major surgery. This method aims to preserve the rectum, reduce risks, and improve overall treatment outcomes.

What is Total Neoadjuvant Therapy?

Total Neoadjuvant Therapy is a treatment approach designed to deliver chemotherapy and radiotherapy in full before any surgical intervention. It is primarily used for patients with locally advanced rectal cancer to enhance treatment outcomes by shrinking the tumor and improving overall results before surgery.

However, TNT is not considered a cure for rectal cancer. Instead, it serves to reduce the risks associated with surgery. Surgeons must thoroughly understand these new approaches to determine the optimal timing for utilizing TNT.

Stages of Rectal Cancer Treatment

Comprehensive Assessment:

• A thorough examination of the patient's overall health and ability to tolerate treatment.

• Determination of the tumor's size and extent to develop an appropriate treatment plan.

Chemotherapy and Radiotherapy:

• Divided into short-term and long-term treatments. Short-term radiotherapy is typically administered before chemotherapy to alleviate symptoms and reduce risks.

• Long-term chemotherapy and radiotherapy are preferred by specialists due to higher response rates in treating rectal cancer.

• Chemotherapy uses powerful drugs like FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) to kill cancer cells, while radiotherapy employs high-energy rays to destroy the tumor.

• Combining chemotherapy and radiotherapy enhances the effectiveness of treatment.

Surgery:

• Performed after completing chemotherapy and radiotherapy to remove the remaining tumor.

• The decision to operate is based on an accurate diagnosis of the tumor's location and size post-therapy.

• Treatment duration varies according to the tumor type, stage, and patient condition, typically ranging from 3 to 6 months.

Goals of Total Neoadjuvant Therapy

• Reduce the Risk of Rectal Resection: Utilizing TNT before surgery lowers the likelihood of needing to remove the rectum.

• Shrink Tumor Size Before Surgery: Chemotherapy and radiation aim to reduce the tumor size or eliminate it completely.

• Decrease Relapse Rates: TNT lowers the risk of cancer recurrence and complications, increasing survival rates.

• Preserve Normal Rectal Functions: TNT helps maintain the rectum's functions and aesthetic appearance.

• Enhance Recovery Chances: Improves the patient's chances of recovery and protects healthy tissue from radiation damage.

Risks and Side Effects of Neoadjuvant Therapy

While there are some risks and complications during TNT, they vary based on the patient's condition and cancer stage. Generally, the risks are low. Common side effects of chemotherapy and radiotherapy include:

• Fatigue and physical stress

• Loss of appetite and weight loss

• Diarrhea, nausea, fever, and vomiting

• Cognitive function decline

• Hair loss

• Bleeding, tissue, and nerve damage

Role of Doctors

As specialists in rectal cancer surgery, our role is to stay informed on the latest treatment methods and strategies to help patients improve their health and minimize risks. Careful monitoring and follow-up are crucial after administering chemotherapy, radiotherapy, or performing surgery.

Signs of Success in Adjuvant Chemotherapy

Adjuvant chemotherapy is effective in eliminating tumors but can damage healthy tissues. The effectiveness is determined by the tumor's response to treatment, identified through:

• Clinical examination to compare tumor size before and after therapy.

• Imaging tests such as X-rays or CT scans.

• Blood tests to assess tumor markers.

In conclusion, Total Neoadjuvant Therapy represents a significant advancement in rectal cancer treatment, offering new hope for patients by reducing tumor size and improving survival rates. 

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