Jabbar SAA, Choo ALE, Wong NW, Ngu JCY, Teo NZ. Comparing early surgical outcomes between total neoadjuvant therapy and standard long course chemoradiotherapy for rectal cancer. World J Gastrointest Oncol 2025; 17(11): 111250 [PMID: 41281487 DOI: 10.4251/wjgo.v17.i11.111250]
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00735730
Submitted on:
November 23, 2025, 11:17
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Reader Comments:
This article presents an interesting retrospective study involving a substantial cohort of patients, highlighting the role of total neoadjuvant therapy (TNT), specifically the RAPIDO protocol, compared to conventional long-course chemoradiotherapy (LCCRT) in the management of locally advanced rectal cancer (LARC). The study focuses on early surgical outcomes, a topic of significant clinical relevance.
The cornerstone of LARC treatment remains optimal surgical resection via total mesorectal excision (TME). To reduce locoregional failure, preoperative concurrent chemoradiotherapy has long been the standard of care. However, as noted in the article and supported by prior evidence (e.g., Fokas et al.), the efficacy of this approach is primarily confined to local control, while distant metastases continue to be a major cause of treatment failure and compromised survival.
The intensification of neoadjuvant therapy through TNT addresses this limitation by achieving early systemic control, significant tumor downstaging, and higher rates of pathological complete response, all without compromising early surgical outcomes compared to LCCRT, as demonstrated in this study. Moreover, the authors report that TNT is associated with a shorter total stoma duration and a lower permanent stoma rate, which are meaningful benefits for patients' quality of life.
Recent landmark trials, such as RAPIDO and PRODIGE 23, have provided robust evidence supporting the use of TNT, showing improved pathological complete response, better treatment compliance, and reduced distant metastases compared to LCCRT. This study adds valuable real-world data to the growing body of literature affirming the safety and feasibility of TNT from a surgical perspective.
We commend the authors for their contribution and agree that further prospective studies with longer follow-up are warranted to evaluate long-term oncological outcomes.
(By Prof Sanaa El Majjaoui and Pr Nabil Ismaili)