关键词: 局部进展期直肠癌, 全程新辅助治疗, 病理完全缓解, 远处转移, 器官保留

Abstract: The standard treatment for locally advanced rectal cancer, involved either neoadjuvant chemoradiotherapy or short-course radiotherapy, followed by total mesorectal resection and postoperative adjuvant chemotherapy, which could significantly reduce local recurrence rate, but overall survival is not improved. Total neoadjuvant therapy (TNT), delivering the full course of radiotherapy and chemotherapy before surgery, has been demonstrated by several landmark randomized controlled trials to significantly enhance pathologic complete response rates and reduce distant metastasis rates, thereby prolonging disease-free survival and overall survival. For low rectal cancer, patients with a complete clinical response following TNT even have the opportunity to adapt watch and wait surveillance and achieve organ preservation of the rectum. However, there are still obstacles and challenges for TNT, such as suitable population, the optimal radiotherapy and chemotherapy regimens, as well as their sequence and the choice of adjuvant chemotherapy. A stratified approach based on high-resolution MR results may be a preferred regimen.

Key words: locally advanced rectal cancer, total neoadjuvant therapy, pathological complete response, distant metastasis, organ preservation