PT  - JOURNAL ARTICLE
AU  - Johnson, Garrett G.R.J.
AU  - Park, Jason
AU  - Helewa, Ramzi M.
AU  - Goldenberg, Benjamin A.
AU  - Nashed, Maged
AU  - Hyun, Eric
TI  - Total neoadjuvant therapy for rectal cancer: a guide for surgeons
AID  - 10.1503/cjs.005822
DP  - 2023 Apr 21
TA  - Canadian Journal of Surgery
PG  - E196--E201
VI  - 66
IP  - 2
4099  - http://canjsurg.ca/content/66/2/E196.short
4100  - http://canjsurg.ca/content/66/2/E196.full
SO  - CAN J SURG2023 Apr 21; 66
AB  - The modern management of rectal cancers continues to evolve. With the release of data from new landmark randomized controlled trials (RAPIDO, PRODIGE-23), total neoadjuvant therapy (TNT) has moved to the forefront of locally advanced rectal cancer treatment and is considered a standard option in selected patients. Total neoadjuvant therapy promises enhanced systemic disease control, better treatment adherence and less time with an ostomy. However, TNT as currently described encompasses a number of different potential treatment options that differ significantly in terms of their radiation dosage, chemotherapy regimen and order of treatments administered. Being familiar with TNT regimens will be important for rectal cancer surgeons to appropriately advocate for their patients and optimize their outcomes. This article serves as a primer for the general surgeon and offers a pragmatic overview of the indications, realistic expected benefits and potential downsides of each TNT regimen.