Rectal cancer & total neoadjuvant therapy - RAPIDO trial, POLISH 2 and OPRA trial, PRODIGE 23 trial

Total neoadjuvant therapy (TNT) is an approach to treating rectal cancer that involves giving chemotherapy and radiation therapy before surgery. The aim of TNT is to shrink the tumor, making it easier to remove during surgery, and potentially reducing the risk of the cancer coming back.
A lot of trials happened in this area in the last 4-5 years and this video summarizes the evidence in a very simplified and practical manner including the Polish 2 trial, RAPIDO trial, OPRA trial, and PRODIGE 23 trial.

TNT typically involves a combination of chemotherapy and radiation therapy given over a period of several weeks. The chemotherapy drugs used are often fluoropyrimidines, such as capecitabine or 5-fluorouracil (5-FU). Radiation therapy is usually given in daily fractions over a period of 5 to 6 weeks, with a total dose of around 45 to 50 Gy.

After completing TNT, patients undergo surgery to remove the remaining tumor. This is usually followed by additional chemotherapy, called adjuvant chemotherapy, to further reduce the risk of cancer returning.

TNT has been shown to improve outcomes for patients with locally advanced rectal cancer, particularly in terms of reducing the risk of local recurrence. However, it may not be suitable for all patients, and the decision to use TNT should be made on a case-by-case basis by a team of experienced healthcare professionals.

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