[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-378811-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-378811-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","total-neoadjuvant-therapy-for-rectal-cancer-a-guide-for-surgeons","Total neoadjuvant therapy for rectal cancer - a guide for surgeons","","Total neoadjuvant therapy (TNT) has become a key strategy for locally advanced rectal cancer following data from landmark randomized trials. The text explains how TNT integrates both radiation and full systemic chemotherapy before surgery, aiming for improved systemic disease control, higher treatment adherence, and reduced ostomy time. It contrasts multiple TNT regimens that differ in radiation dosing, chemotherapy combinations, and sequencing, summarizing evidence, indications, expected benefits, and potential downsides for surgical decision-making.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/total-neoadjuvant-therapy-for-rectal-cancer-a-guide-for-surgeons/378811/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/total-neoadjuvant-therapy-for-rectal-cancer-a-guide-for-surgeons/378811.png","ImageObject",300,407,{"name":42,"@type":43},"Noah","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-24",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is total neoadjuvant therapy (TNT) for rectal cancer?","Question",{"text":63,"@type":64},"TNT is a treatment approach that gives both radiation and full systemic chemotherapy before surgical resection.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why do surgeons need to understand different TNT regimens?",{"text":68,"@type":64},"Regimens vary in radiation dosage, chemotherapy regimen, and treatment sequencing, which affects indications, benefits, and downsides for patients.",{"name":70,"@type":61,"acceptedAnswer":71},"What benefits have trials suggested for TNT compared with earlier traditional sequencing?",{"text":72,"@type":64},"Landmark prospective randomized trials show potential improvements in disease-free survival, higher pathologic complete response rates, and chemotherapy completion rates.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},378811,1790530880,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144},8796095462418,"https://ap-avatar.wpscdn.com/avatar/80000253c1241d02b47?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778826106357471780","DISCUSSIONS IN SURGERY • DISCUSSIONS EN CHIRURGIE  \nTotal neoadjuvant therapy for rectal cancer: a guide for surgeons  \nGarrett G. R.J. Johnson, MD Jason Park, MD, MEd  \nRamzi M. Helewa, MD, MSc Benjamin A. Goldenberg, MDMaged Nashed, PhD  \nEric Hyun, MD, PhD Accepted Oct. 25, 2022  \nCorrespondence to:  \nE. Hyun  \nZ3037-409 Taché Ave. Winnipeg MB R2H 2A6  \n[ehyun@sbgh.mb.ca](ehyun@sbgh.mb.ca)  \nCite as: Can J Surg 2023 April 21;66(2) .  \ndoi: 10.1503/cjs.005822  \nSummary  \nThe modern management of rectal cancers continues to evolve. With the release of data from new landmark randomized controlled trials (RAPIDO, PRODIGE-23), total neoadjuvant therapy (TNT) has moved to the forefront of locally advanced rectal cancer treatment and is considered a standard option in selected patients. Total neoadjuvant therapy promises enhanced systemic disease control, better treatment adherence and less time with an ostomy. However, TNT as currently described encompasses a number of different potential treatment options that differ significantly in terms of their radiation dosage, chemotherapy regimen and order of treatments administered. Being familiar with TNT regimens will be important for rectal cancer surgeons to appropriately advocate for their patients and optimize their outcomes. This article serves as a primer for the general surgeon and offers a pragmatic overview of the indications, realistic expected benefits and potential downsides of each TNT regimen.  \nF  \nor 15 years, the standard of care for locally advanced (clinical T3–4 or N-positive) rectal cancer in North America has consisted of neoadjuvant therapy (radiation or chemoradiotherapy) followed by total meso-  \nrectal excision, with systemic chemotherapy usually thereafter.1 The aim of preoperative therapy is to downstage or downsize tumours; it improves locoregional control, but distant metastases remain a concern. To address systemic relapse, several recent trials have been conducted in which systemic chemotherapy is applied earlier in the rectal cancer treatment sequence.  \nThe term “total neoadjuvant therapy” (TNT) was developed and applied to a number of new multimodal treatment strategies for locally advanced rectal cancer that administer both radiation and systemic therapy before surgical resection. These strategies can vary substantially in their radiation dosages and fractionations, chemotherapy options and sequencing of modalities, but what they have in common is the administration of both radiation and full systemic chemotherapy (as opposed to lower radiosensitizing chemotherapy doses) in the neoadjuvant setting, before surgery. Promising results released from recent landmark prospective randomized controlled trials (RCTs) show that TNT may improve disease-free survival (DFS), pathologic complete response (pCR) rates and chemotherapy completion rates. 1,2 However, definitive curative-intent treatment still depends on complete surgical resection as standard treatment. Therefore, it is paramount that surgeons possess a detailed understanding of these new approaches in order to recognize when to advocate for TNT, when it is not needed and when it may be inappropriate. This article serves as an overview of the latest trials in TNT for rectal cancer treatment, to help guide surgeons in these discussions.  \nEvidEncE for TnT  \nTable 1 lists RCTs that used TNT for rectal cancers, and their results. The Rectal Cancer and Preoperative Induction Therapy Followed by  \nE196 Can J Surg/J can chir 2023;66(2) © 2023 CMA Impact Inc. or its licensors  \n\n| Table 1. Landmark total neoadjuvant therapy randomized controlled trials |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Study (year) | Rectal cancers\u003Cbr>included | Treatment arms (no. of cycles) | N | Survival\u003Cbr>outcomes\u003Cbr>(%) | pCR\u003Cbr>(%) | Completed\u003Cbr>chemo\u003Cbr>therapy\u003Cbr>(%) | Received\u003Cbr>surgery\u003Cbr>(%) | R0\u003Cbr>resection\u003Cbr>(%) | Follow-up\u003Cbr>(mo) |\n| PRODIGE-23 (2020)1 | cT3 or cT","cbCaiqUmauM5my52","https://ap.wps.com/l/cbCaiqUmauM5my52","pdf",119022,"English","# Summary\n# Background and rationale for TNT\n# Evidence for TNT\n## Table 1. Landmark TNT randomized controlled trials","[{\"question\":\"What is total neoadjuvant therapy (TNT) for rectal cancer?\",\"answer\":\"TNT is a treatment approach that gives both radiation and full systemic chemotherapy before surgical resection.\"},{\"question\":\"Why do surgeons need to understand different TNT regimens?\",\"answer\":\"Regimens vary in radiation dosage, chemotherapy regimen, and treatment sequencing, which affects indications, benefits, and downsides for patients.\"},{\"question\":\"What benefits have trials suggested for TNT compared with earlier traditional sequencing?\",\"answer\":\"Landmark prospective randomized trials show potential improvements in disease-free survival, higher pathologic complete response rates, and chemotherapy completion rates.\"}]","Total neoadjuvant therapy for rectal cancer - a guide for surgeons | PDF",1790232531,15]