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<p>Total neoadjuvant therapy (TNT) refers to the addition of preoperative systemic therapy to preoperative radiotherapy (RT; 5 × 5 Gy) or chemoradiotherapy (ChRT) for rectal cancer. This can be administered either before RT/ChRT as induction therapy or after RT/ChRT as consolidation therapy. Randomized trials demonstrate improved tumor response (clinical or pathological complete remission) and a&#xa0;significant improvement in disease-free survival with TNT compared to neoadjuvant ChRT plus surgery with or without adjuvant chemotherapy. The updated S3&#xa0;guidelines therefore recommend TNT, particularly for patients high-risk factors defined with magnetic resonance imaging (MRI, cT4, cN2, mrCRM+, EMVI+, lateral lymph node involvement). Following achievement of complete clinical remission after TNT organ-preserving (watch and wait) strategies are increasingly being favored and are being further optimized in ongoing clinical trials (e.g., ACO/ARO/AIO 18.1, JANUS, STELLAR&#xa0;II).</p>

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Aktuelle Konzepte der totalen neoadjuvanten Therapie beim Rektumkarzinom

  • 期刊论文

  • 发表日期：

    2026年2月10日

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  • Claus Rödel,
  • Maximilian Fleischmann,
  • Markus Diefenhardt,
  • Emmanouil Fokas

摘要

Total neoadjuvant therapy (TNT) refers to the addition of preoperative systemic therapy to preoperative radiotherapy (RT; 5 × 5 Gy) or chemoradiotherapy (ChRT) for rectal cancer. This can be administered either before RT/ChRT as induction therapy or after RT/ChRT as consolidation therapy. Randomized trials demonstrate improved tumor response (clinical or pathological complete remission) and a significant improvement in disease-free survival with TNT compared to neoadjuvant ChRT plus surgery with or without adjuvant chemotherapy. The updated S3 guidelines therefore recommend TNT, particularly for patients high-risk factors defined with magnetic resonance imaging (MRI, cT4, cN2, mrCRM+, EMVI+, lateral lymph node involvement). Following achievement of complete clinical remission after TNT organ-preserving (watch and wait) strategies are increasingly being favored and are being further optimized in ongoing clinical trials (e.g., ACO/ARO/AIO 18.1, JANUS, STELLAR II).