EP981 - Outcomes of locally advanced rectal cancer patients who underwent total neoadjuvant therapy (TNT) in a tertiary government hospital

Image or Table (Do Not add text here):

Purpose/Background: Neoadjuvant therapy has been proven to be effective in improving locoregional control for locally advanced rectal cancer patients. Standard of care includes pre-operative chemoradiotherapy followed by resection within the principles of total mesorectal excision. The aim is mostly for tumor downstaging to be able to achieve an optimal local clearance, thereby improving surgical outcomes. Chemotherapy after surgery may also be given depending on the presence of high-risk features. The goal, at this point, is now geared towards improving systemic control. However, this strategy seems to be not as successful in preventing systemic failure. Issues on compliance to adjuvant treatment became a factor as well. These apparent gaps were addressed by total neoadjuvant therapy (TNT) with the full course of systemic chemotherapy being given prior to surgery. Induction or consolidation chemotherapy was perceived to achieve long-term disease control without sacrificing locoregional control. One particular approach by Bahadoer et al is the Rectal cancer and Preoperative Induction therapy followed by Dedicated Operation (RAPIDO) protocol, which has gained traction due to its promising initial results in terms of disease-related treatment failure (including locoregional failure, distant metastasis, new primary colorectal tumor, or treatment-related death) relative to the standard regimen.

Methods/Interventions: This is a descriptive study done via chart review among locally advanced rectal cancer patients in Jose R. Reyes Memorial Medical Center (JRRMMC) who were enrolled in the RAPIDO protocol since its adaptation in the institution in 2021. The decision was based upon the consensus of a multidisciplinary team (MDT) comprised of the colorectal surgeon, radiation oncologist and medical oncologist among others. Eligible patients received short course radiotherapy (5 x 5 Gy) followed by consolidation chemotherapy (CAPOX) before subjecting them to surgery.

Results/Outcomes: Of the 19 patients enrolled in the protocol, the majority (57%) were male, within the age group of 59 years and below (63%). Three patients (15%) underwent definitive surgery. Three other patients (15%) are still for surgery. Seven patients (35%) underwent diversion (either open or laparoscopic), of which four of them had tumor progression. There were two mortalities (one had definite surgery), which were both due to complications secondary to tumor progression. Seven other patients (35%) were lost to follow up.

Conclusion/Discussion: While most of the patients included had treatment failure, the results of this study might not be reflective of the treatment effect of the RAPIDO protocol. The limitations of this study includes the small patient pool, the patients’ socioeconomic profile and the inherent limitations of the institution. A prospective cohort study to determine other disease-related treatment failure might be in order moving forward. Follow up has become an issue as well for the subset of patients in this institution. A coordinator might be of value to be able to improve compliance and avoid delays in management to potentially decrease the incidence of treatment failure.