Dear Editor, We read with great interest the prospective study by Kumari et al.,1 evaluating total neoadjuvant therapy (TNT) with short-course radiotherapy (SCRT) for locally advanced rectal cancer (LARC). The authors are to be commended for conducting a prospective interventional study in a resource-constrained setting. Validating the feasibility of SCRT followed by consolidation chemotherapy (CT) is crucial for reducing patient burden in low- and middle-income countries (LMICs). However, we wish to address three points regarding the data interpretation and reporting. First, there appears to be a numerical discrepancy in the reported results. The abstract and results section state that “six (30%) out of 12 patients undergoing surgery achieved pCR.” However, the CONSORT diagram and the text in the “surgery characteristics” section indicate that 20 patients underwent definitive surgery. If 20 patients were operated on, 6 pCRs would indeed correspond to the reported 30%. The reference to “12 patients” in the text seems to be an error that necessitates a formal corrigendum, as it creates confusion regarding whether the pCR rate was 30% (6/20) or 50% (6/12). Second, while the reported per-protocol pCR rate of 30% is promising and comparable to the RAPIDO (28%),2 and STELLAR (26%)3 trials, it is vital to consider the intent-to-treat (ITT) population. Of the 25 enrolled patients, 5 (20%) did not reach the surgical endpoint due to default, disease progression, or refusal. In a real-world neoadjuvant setting, these attritions are part of the treatment strategy‘s failure rate. An ITT analysis would place the pCR rate at 24% (6/25). Highlighting this figure is essential for oncologists to provide realistic counseling to patients regarding the likelihood of achieving a complete response at the initiation of therapy. Finally, the conclusion that the regimen demonstrates “excellent short-term locoregional control” should be interpreted with caution. The median follow-up was only 15.5 months. In LARC, the risk of local recurrence persists well beyond this period, often peaking between 12 and 24 months.4 With two locoregional failures already observed within this short window, describing the control rates as “preliminary” rather than “excellent” would be more scientifically appropriate until longer follow-up data are available. We congratulate the authors on this valuable contribution and hope these clarifications will further strengthen the utility of their findings for the oncology community. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Rashad Ismayilov (Thu,) studied this question.