Abstract 267P
Background
Since 2021, total neoadjuvant therapy (TNT) has become the standard treatment for locally advanced rectal adenocarcinoma. This TNT strategy has led to a decrease in the risk of metastatic recurrence and an improvement in patient survival.
Methods
A prospective observational monocentric study including patients treated at the Medical Oncology Department of Beni Messous University Hospital Center for stage II and III rectal adenocarcinoma, who were treated according to PRODIGE 23 TNT protocol. The AIM of this study is to evaluate the feasibility and effectiveness of this strategy in our population.
Results
From January 2022 to March 2023,101 patients were included(M/F=62/39),with a mean age of 54.59(25-74 years). All patients had rectal adenocarcinoma. Regarding tumor location, there were 71 mid-rectum, 44 low-rectum including 14 patients with both mid and low rectum. Sphincter involvement was found in 29 patients. The stage of the disease was stage III in 95% and II in 5%. Patients received neoadjuvant chemotherapy FOLFIRINOX, with an average number of cycles of 5.76 (1-6 cycles), with 21% of patients experiencing grade 3 or higher toxicities, including 6 deaths. Clinical response was found in 89% of patients, with objective response rate of 56.43% according to RECIST and 63.36% according to mrTRG. Patients had radiotherapy (CAP50). After the end of radiotherapy, 2 patients had metastases on imaging and did not undergo surgery, as did 8 other patients: 3 discovered metastases intraoperatively, 3 refused mutilating surgery, and 2 patients had complete radiological responses and had a Watch and Wait strategy. 85 patients underwent surgery with sphincter preservation in 11 patients, including 3 with organ preservation; The rate of complete pathological response was 18.82% with 43.52% of therapeutic responses classified as RCRG1 and 28.23% with NAR score <8. After an average follow-up of 18.5 months (27-13 months), the disease-free survival rate is estimated at 70.59%, with a rate of 74.21% for metastasis-free survival.
Conclusions
TNT for rectal cancer is a feasible and effective strategy in our population. Further studies are needed to personalize rectal cancer management by identifying the best responders to this strategy.
Legal entity responsible for the study
D. Belabdi.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.