Total neoadjuvant therapy (TNT, rectal cancer)
Giving all the chemotherapy and radiotherapy for rectal cancer before surgery rather than splitting it around the operation. It improves completion of chemotherapy, shrinks more tumours completely, and makes avoiding surgery possible for some patients.
Classic management was chemoradiation, surgery, then adjuvant FOLFOX, which many patients never completed. TNT (RAPIDO: short-course radiotherapy then FOLFOX/CAPOX; PRODIGE 23: FOLFIRINOX then chemoradiation) halved distant metastases and doubled pathological complete responses, and OPRA showed that with consolidation chemotherapy about half of patients can be managed by watch-and-wait without surgery. PROSPECT showed FOLFOX alone can replace radiotherapy in selected intermediate-risk tumours, and dMMR rectal cancer is now treated with dostarlimab alone. The optimal sequence and who can safely skip which component remain active questions.
Pages like this
not linked directly; found by shared links- TermAbdominoperineal resection
Shares Total mesorectal excision (TME), Chemoradiation (chemoradiotherapy, CRT), Colorectal cancer.
- TermColectomy
Shares Total mesorectal excision (TME), FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX, Colorectal cancer.
- TermIMRT / IGRT / VMAT (modern external beam radiotherapy)
Shares Hypofractionation (fewer, larger radiotherapy doses), Chemoradiation (chemoradiotherapy, CRT).
- TermStoma (colostomy, ileostomy, urostomy)
Shares Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Colorectal cancer.
- ProductOxaliplatin
Shares FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX, Colorectal cancer.
- ProductFluorouracil (5-FU)
Shares FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX, Colorectal cancer.
- ProductIrinotecan (and liposomal irinotecan)
Shares FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX, Colorectal cancer.