The outcomes of induction chemotherapy, followed by neoadjuvant chemoradiotherapy and surgery, in locally advanced rectal cancer, single institute experience

Background & objectives: Total neoadjuvant therapy (TNT) is currently the standard of care in the treatment of locally advanced rectal cancer. We conducted this study to investigate the therapeutic implications of induction chemotherapy followed by neoadjuvant chemoradiotherapy & surgery in locally advanced rectal cancer, in terms of response & toxicity. Methods: This retrospective study analyzed data from 40 rectal cancer patients treated between 2018 & 2023 at Rizgary Medical Oncology Center in Hawler, KRG, Iraq. Patients received induction chemotherapy, and after 3-4 weeks, re-staging was done to exclude metastases. Subsequently, neoadjuvant chemo-radiotherapy was administered, followed by another evaluation 3-4 weeks later to exclude metastases and assess treatment response. Finally, Total Mesorectal Excision (TME) was performed. The study looked at outcomes like downstaging, pCR, R0, DFS, and OS, as well as side effects related to the treatment. Results: The average age of the patients was 50.5 years, ranging from 28 to 81 years. After receiving the treatment, TNM staging showed a 50% reduction in tumor size, and 12.5% of our patients achieved pCR. While 75% of the cases studied showed R0, which was significantly associated with tumor relapse (p-value = 0.009). With a median follow-up of 23.5 months, survival outcomes revealed that the 3-year DFS was 50%, and the 3-year OS was 90%. Treatment-related toxicities varied from 2% to 12%, mostly in grades 2 and 3, and were appropriately managed. Conclusions: Induction chemotherapy followed by neoadjuvant chemoradiotherapy, and surgery could be an effective and safe approach for locally advanced rectal cancer.