Impact of Professional Seniority on Total Neoadjuvant Treatment Approach for Locally Advanced Rectal Cancer

Total neoadjuvant therapy (TNT) integrates planned systemic chemotherapy (ChT) before or after radiotherapy (RT) for locally advanced rectal cancer (LARC). 1 Increased compliance with planned oncological therapy, tumor down-staging, ChT administration at the earliest stage, and evaluating tumor chemosensitivity are the proposed benefits of TNT.Because randomized trials evaluating proper TNT sequence and practice are limited, physicians hesitate to implement this strategy. 2,3Although TNT has been used in different forms in the last decade, it has been recently offered as one of the treatment approaches for LARC. 4 The optimal sequence for ChT or RT and the type of systemic treatment and RT are not clarified in the guidelines. 5e patient selection criteria for TNT use in rectal cancer are unclear. 6Moreover, decision-making in oncology requires a plethora of different criteria.Generally, only 6% of the National Comprehensive Cancer Network (NCCN) recommendations were based on high-level evidence.Sometimes, lower levels of evidence or expert opinions were used to select the best treatment option.