Evaluation of efficacy and safety between neoadjuvant short-course radiotherapy followed by chemotherapy versus concomitant chemoradiation in locally advanced rectal carcinoma
Firdoushi Khatun, Linkon Biswas, Arpan KhatuaAbstract
Background:
Total neoadjuvant therapy (TNT) has emerged as a promising treatment strategy for locally advanced rectal carcinoma. This study aimed to compare TNT with standard long-course chemoradiotherapy (CTRT) in terms of efficacy and toxicity.
Materials and Methods:
A total of 92 patients were randomized into two groups. Patients in the control arm received preoperative long-course CTRT (50.4 Gy in 28 fractions over 5.5 weeks), followed by radical surgery 4–6 weeks later. Postoperatively, all patients received eight cycles of adjuvant chemotherapy. In the study arm (TNT), patients received neoadjuvant short-course radiotherapy (RT; 25 Gy in 5 fractions over 1 week), followed by six cycles of chemotherapy. Radical surgery was performed 4 weeks after completion of chemotherapy. Outcomes assessed included pathological response, margin-negative resection rates, and treatment-related toxicities.
Results:
The rate of complete pathological response was significantly higher in the TNT arm than in the control arm (53.3% vs. 31.9%,
Conclusion:
TNT appears to be an effective alternative to standard long-course CTRT, offering improved pathological response and a favorable margin-negative resection rate, with an acceptable toxicity profile. However, a longer follow-up is needed to confirm these findings.