New and evolving research in locally advanced rectal cancer suggests that selective use of treatments in some patients can achieve outcomes similar to those of standard regimens, according to the chair of the Department of Radiation Oncology at Duke University School of Medicine, Durham, North Carolina.
However,"these patients require close surveillance post treatment to identify any recurrence that may require salvage treatment," he added. FOLFOX chemotherapy alone .Although the data were ultimately inconclusive because of potential staging bias, the findings were"promising for recommending radiation omission in these patients," Dr Willett said.in 2023 was similarly encouraging, he said. In this trial, 1194 patients with locally advanced rectal cancer were randomized to FOLFOX or chemoradiation prior to sphincter-sparing surgery.
"There is a need for biomarkers such as circulating tumor DNA to further aid in selection and monitoring of patients with rectal cancer," Dr Willett said. "The location of the rectal tumor and clinical TNM stage also will inform the discussion as to which of the potential total neoadjuvant therapy regimens would be most optimal to reduce the risk of local recurrence and maintain long-term quality of life for the individual patient," explained Dr Benson, professor of medicine at Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago.
The treatment of locally advanced rectal cancer continues to evolve, but there is no question that TNT has transformed patient outcomes, including the ability to deintensify treatment for select patients, Dr Benson said.