Total Neoadjuvant Therapy Versus Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer, Who will Gain Maximum Benefit? A Prospective Randomized Study

• Shorouk G. Badr

  Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt

• Hesham Tawfik

  Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt

• Mohammad Hamdy Abo-Ryia

  Department of General Surgery, GIT & Laparoscopic surgery unit, Faculty of Medicine, Tanta University, Tanta, Egypt

• Ayman Mohamed El Saqa

  Department of Histopathology, Faculty of Medicine, Tanta University, Tanta, Egypt

• Fatma Gharib

  Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt

Colorectal cancer (CRC) is a global health problem as it is a common and lethal disease. Neoadjuvant treatment improves anal sphincter preservation, resectability, and local control. Total neoadjuvant therapy (TNT) [that incorporates chemotherapy with chemoradiotherapy before surgery has been assumed to offer advantages such as enhanced compliance with planned therapy, tumor downstaging, early eradication of occult micrometastases and assessment of chemosensitivity. This prospective phase II randomized study included 70 locally advanced rectal cancer (LARC) patients treated in Tanta University Hospitals throughout the period from January 2022 to April 2025. Thirty-two patients received CRT (Arm A) and 38 patients received TNT (Arm B). The aim was comparison of outcomes and toxicities in stage II and III rectal cancer cases receiving standard neoadjuvant chemoradiation (nCRT) and TNT. The pathological complete response rate was 19.4% in TNT versus 12.5% in CRT and this was statistically insignificant. R0 resection rate was 93.5% versus 87.5% in TNT and CRT respectively. Disease free survival was 54% versus 50% and overall survival (OS) was 86% versus 73% in TNT and CRT respectively with statistically insignificant difference. Toxicity also was comparable between 2 groups and most of reported toxicity was grade 1 and 2 which is easily manageable. TNT resulted in a trend towards improvement in pathologic complete response (PCR), disease free survival (DFS) and OS with comparable manageable toxicity.

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