Dados do Trabalho

Título

EFFICACY AND SAFETY OF TOTAL NEOADJUVANT THERAPY (TNT) REGIMENS IN PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER (LARC) TREATED IN SALVADOR-BA: A RETROSPECTIVE COHORT STUDY.

Introdução

Based on OPRA and RAPIDO trials, Total Neoadjuvant Therapy (TNT) has become an option in the treatment of locally advanced rectal cancer (LARC).

Objetivo

To evaluate the efficacy and safety of TNT regimens in a population with LARC treated in the community.

Método

Between May 2020 and May 2021 we performed a retrospective cohort study, including data from medical records of all consecutive patients with LARC treated with TNT in two health institutions in Salvador, Bahia, Brazil. Primary endpoint was the rate of radiological response after TNT, measured through the magnetic resonance tumor regression grade (mrTRG), using a 5-point grading system. Secondary outcomes were: rate of clinical and hematological toxicities ≥ G3, rate of delay and/or reduction in the dose of chemotherapy and rate of hospitalization.

Resultado

A total of N=8 patients were included. Median age was 60 years (range: 46-74) and N=6(75%) were male. All patients were staged with pelvic-MRI. According to 8th AJCC, all were stage III, with N=4(50%) IIIB and N=3(37.5%) IIIC. In addition, N=6(75%) were cT3, N=1(12.5%) was cT4, N=5(62.5%) were cN1 and N=3(37.5%) were cN2. Regarding the distance from the tumor to the anal border (AB): N=2(25%) were <5cm from AB and N=6(75%) were between 5-10cm from AB. In addition, N=5(62.5%) patients were submitted to the OPRA protocol (consolidation chemotherapy arm) and N=3(37.5%) to the RAPIDO protocol. After a median follow-up of 7.21 months (range: 0.1-9.8), N=4/8 patients had completed TNT and were included in the analysis of the primary outcome. Among these, N=2(50%) showed a complete radiological response: mrTRG1 and the other two (50%) presented a good radiological response: mrTRG2. Patients who had mrTRG1 had low rectal tumors, were treated with the OPRA protocol and underwent an active surveillance protocol. All 8 patients were included in the secondary analyzes. The rates of clinical and hematological toxicities≥ G3 were 12.5% and 37.5%, respectively, and 62.5% of the patients needed to undergo delay or chemotherapy dose reduction. No patient had clinical or hematological toxicities≥ G4. The hospital admission rate was 12.5%.

Conclusão

Preliminary data suggest that TNT is an active and safe strategy in the treatment of patients with LARC treated in the community. However, it is important to wait for the consolidated data from the increase in the number of treated patients and the increase in the follow-up time.

Palavras-chave

rectal cancer, Total Neoadjuvant Therapy