부산대학교 도서관

BACKGROUND:: Increased experience with total neoadjuvant therapy for rectal cancer suggests significantly more tumor regression and increased rates of complete clinical response, measured by pathologic complete response and clinical complete response. OBJECTIVE:: This study assessed outcomes following total neoadjuvant therapy versus standard neoadjuvant chemoradiotherapy for locally advanced rectal cancer patients. DESIGN:: This is a retrospective cohort study. SETTINGS:: A database of patients with rectal cancer from 2015 to 2019 at a large integrated healthcare system was reviewed. PATIENTS:: Demographics of the two groups reveal no significant difference in clinical stage or patient characteristics. Of 465 patients, 66 patients underwent total neoadjuvant therapy and 399 standard neoadjuvant chemoradiotherapy. Fifty-six underwent consolidation chemotherapy with 10 patients undergoing induction chemotherapy. MAIN OUTCOME MEASURES:: Complete clinical response, disease-free survival, proctectomy-free survival, and organ preservation rates were measured. RESULTS:: Complete clinical response was achieved in 36 patients (58.1%) versus 59 patients (14.8%) (p < 0.001) favoring the total neoadjuvant therapy group. Three-year overall survival was similar between groups (85.6% standard neoadjuvant chemoradiotherapy vs 86.0% total neoadjuvant therapy). Three-year distant metastasis-free survival was 67.4% in the total neoadjuvant therapy group and 77.7% in the standard neoadjuvant chemoradiotherapy group. Three-year proctectomy-free survival was 44% in the total neoadjuvant therapy group versus 6% in the standard neoadjuvant chemoradiotherapy group. Twenty-two (37.3% of complete clinical responders) patients in the standard neoadjuvant chemoradiotherapy group elected to pursue organ preservation, while 31 (86.1% of complete clinical responders) patients from the total neoadjuvant therapy group chose organ preservation. LIMITATIONS:: This study is a retrospective study with a shorter follow up of 3 years. CONCLUSIONS:: Total neoadjuvant therapy for rectal cancer significantly increased complete clinical response. This allowed patients to have greater organ preservation with no significant difference in overall survival or disease control. See Video Abstract at http://links.lww.com/DCR/B934.