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Session: ePoster: Colon and Colorectal Cancer 22 (Sat315)

EP131 - Total Neoadjuvant Therapy improves oncological outcomes compared to neoadjuvant chemoradiotherapy for pathological non-responders

Saturday, May 10, 2025
3:58 PM – 4:03 PM PT
Location: Monitor 4, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • eq

    elchanan quint

    Colorectal fellow
    cleveland clinic ohio
    beachwood, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • LD

    Leonardo C. Duraes, MD, PhD

    Associate Staff Colorectal Surgery
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • Michael A. Valente, DO

    Associate Professor of Surgery
    Cleveland Clinic
    cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Ali Alipouriani, MD

    Clinical Research Fellow
    Colorectal Surgery Department, Digestive Disease Institute, Cleveland Clinic Foundation
    Department of colorectal surgery, Cleveland Clinic Foundation
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Scott R. Steele, MD, MBA

    President, Cleveland Clinic, Main Campus Submarket and Rupert B. Turnbull M.D., Endowed Chair in Colorectal Surgery
    Cleveland Clinic
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • David Liska, MD

    Associate Professor, Chair
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland Clinic, Cleveland, Ohio
    Cleveland, Ohio, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
elchanan quint, n/a: This individual has no financial relationships with ineligible companies.
Michael A. Valente, DO: This individual has no financial relationships with ineligible companies.
Ali Alipouriani, MD: This individual has no financial relationships with ineligible companies.
Scott R. Steele, MD, MBA: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Total Neoadjuvant Therapy (TNT) has demonstrated improved tumor response rates and improved oncologic outcomes. For reasons that are not yet fully understood, some patients have a poor response to TNT. Previous studies on neoadjuvant chemoradiotherapy (nCRT) have demonstrated that pathological non-responders tend to have poor long-term oncologic outcomes, especially when definitive surgical therapy is delayed. The aim of this study is to evaluate if patients with poor pathological response following TNT will have worse outcomes than poor responders treated with nCRT considering the increased delay to definitive surgical therapy inherent to TNT protocols.

Methods/Interventions: A prospective cancer registry at a quaternary referral center was retrospectively queried for all patients with locally advanced rectal adenocarcinoma who were treated with long course nCRT or TNT followed by proctectomy between 2009-2023. Patients found to have a poor treatment response as signified by an American Joint Committee on Cancer (AJCC) Tumor Regression Grade (TRG) 3 were included. Patients with stage 4 rectal cancer and patients who were treated with short course radiotherapy were excluded.

Results/Outcomes: Twenty-nine patients in the TNT group and twenty-seven patients in the nCRT group were identified with pathological TRG 3. Patients in the TNT group were younger (p=0.02) and underwent more laparoscopic and robotic surgeries (p < 0.01). The TNT group experienced a longer interval between diagnosis and surgery (p < 0.001), as well as between the completion of nCRT and surgery (p < 0. 001). No significant differences were observed between the groups in terms of gender (p=0.79), ASA score (p=0.1), BMI (p=0.08), type of procedure (LAR vs. APR) (p=0.14), clinical stage (p=0.28), tumor size (p=0.58), pathological differentiation (p=0.18), pathological stage (p=0.49), or follow-up period (p=0.12). TNT patients were found to have better disease-free survival (p=0.02) and overall survival (p=0.03). No significant differences were found in overall recurrence (p=0.13), local recurrence (p=0.25), or distant recurrence (p=0.24).

Conclusion/Discussion: Despite inherently longer time from diagnosis to definitive surgical therapy, patients pathologically resistant to neoadjuvant therapy treated with TNT demonstrated better oncologic outcomes when compared to patients treated with nCRT. These improved outcomes may be due to the effect of earlier administration of systemic chemotherapy included in TNT regimens on potential micrometastases. This study highlights that TNT is an effective treatment option, even in patients with a primary tumor demonstrating pathologic resistance to neoadjuvant treatment.