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The effects of total neoadjuvant therapy compared with traditional therapy in rectal cancer.
Yasmeen Z. Qwaider, Swati Sonal, Chloe Boudreau, Robert Goldstone, Rocco Ricciardi, Liliana G. Bordeianou, Hiroko Kunitake, David L. Berger
General/Gastrointestinal Surgery, Massachussetts General Hospital, Boston, Massachusetts, United States

Objective Total neoadjuvant therapy (TNT) has slowly replaced traditional treatment (ChemoXRT, surgical resection, and adjuvant chemotherapy) in patients with rectal cancer treated with surgical resection for curative intent. Our objective is to compare these treatment groups in patients who underwent surgical resections for their tumors. Design Retrospective extraction and analysis of data from an IRB-approved database of all surgically resected colorectal cancers at a tertiary care institution. Setting Patients with rectal cancer treated with neoadjuvant chemoradiotherapy at a tertiary institutional setting between 2004 and 2018 with an average follow-up duration of 47.5 months Patients A total of 362 patients were included in this analysis. We included all patients with rectal cancer treated with neoadjuvant chemoradiation and surgical resection, either with TNT or traditional adjuvant chemotherapy. Patients with the complete clinical response with a "watch-and-wait" approach were not included. Interventions N/A Outcome measures Pathological complete response, tumor downstaging, recurrence rates, overall and disease-free survival. Results Of all patients with rectal cancer who underwent surgical resection and had at least neoadjuvant chemoradiation, 36 patients had TNT (10%) and 326 had traditional therapy (90%). All patients who had TNT completed their treatment (100%) while 7 patients from the traditional group were non-compliant with adjuvant chemotherapy guidelines (2%). On univariate analysis, there were no significant differences in pathological complete response rates, readmission rates, or intraoperative complications rates between both groups (p>0.05). Multivariate Cox regression models show that TNT and traditional therapy had no effect on overall or disease-free survival on patients who went on to have surgical resection of their tumors. Conclusions There appears to be no difference between patients treated with TNT or traditional therapy in patients with rectal cancer who underwent resection. There might still be differences in clinical complete response rates although we have not included these in our analysis.


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