{"entity":{"id":"total-neoadjuvant-therapy","kind":"term","name":"Total neoadjuvant therapy (TNT, rectal cancer)","aka":["total neoadjuvant therapy","total neoadjuvant treatment","TNT approach","short-course radiotherapy then chemotherapy","consolidation chemotherapy","induction TNT","consolidation TNT","RAPIDO","PRODIGE 23","OPRA"],"tldr":"Giving all the chemotherapy and radiotherapy for rectal cancer before surgery rather than splitting it around the operation. It improves completion of chemotherapy, shrinks more tumours completely, and makes avoiding surgery possible for some patients.","summary":"Classic management was chemoradiation, surgery, then adjuvant FOLFOX, which a large share of patients never completed. TNT (RAPIDO: short-course radiotherapy then FOLFOX/CAPOX; PRODIGE 23: FOLFIRINOX then chemoradiation) halved distant metastases and doubled pathological complete responses, and OPRA showed that with consolidation chemotherapy about half of patients can be managed by watch-and-wait without surgery. PROSPECT showed FOLFOX alone can replace radiotherapy in selected intermediate-risk tumours, and dMMR rectal cancer is now treated with dostarlimab alone. The optimal sequence and who can safely skip which component remain active questions.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Colorectal_cancer#Rectal_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Colorectal_cancer#Rectal_cancer"},{"label":"NICE NG151: colorectal cancer, recommendations","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations"},{"label":"Macmillan: chemoradiation for rectal cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/chemoradiation-for-rectal-cancer"}],"tags":[],"related":["organ-preservation","total-mesorectal-excision","chemoradiation","hypofractionation","folfox-family"],"cancers":["colorectal","rectal-cancer"],"sections":["radiation","chemotherapy"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Rectal cancer: NICE NG151 says to offer preoperative radiotherapy or chemoradiotherapy to people with rectal cancer that is cT1 to T2 with node involvement, or cT3 to T4 with any node status, and not to offer preoperative radiotherapy for early rectal cancer (cT1 to T2, cN0, M0) outside a clinical trial. Macmillan explains chemoradiation for rectal cancer as radiotherapy with chemotherapy tablets or a drip to make the radiotherapy work better."],"category":"Treatment jargon"},"route":"/terms/total-neoadjuvant-therapy/","neighbours":{"term":[{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"},{"id":"circumferential-resection-margin","kind":"term","name":"Circumferential resection margin (rectal cancer)","route":"/terms/circumferential-resection-margin/"},{"id":"colorectal-trials-open-today","kind":"term","name":"Colorectal cancer trials open today (registry snapshot)","route":"/terms/colorectal-trials-open-today/"},{"id":"folfox-family","kind":"term","name":"FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX","route":"/terms/folfox-family/"},{"id":"hypofractionation","kind":"term","name":"Hypofractionation (fewer, larger radiotherapy doses)","route":"/terms/hypofractionation/"},{"id":"organ-preservation","kind":"term","name":"Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)","route":"/terms/organ-preservation/"},{"id":"total-mesorectal-excision","kind":"term","name":"Total mesorectal excision (TME)","route":"/terms/total-mesorectal-excision/"},{"id":"watch-and-wait-rectal-cancer","kind":"term","name":"Watch and wait after chemoradiotherapy for rectal cancer","route":"/terms/watch-and-wait-rectal-cancer/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"rectal-cancer","kind":"cancer","name":"Rectal cancer","route":"/cancers/rectal-cancer/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"paper":[{"id":"paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021","kind":"paper","name":"Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23)","route":"/key-papers/paper-conroy-prodige-23-neoadjuvant-folfirinox-rectal-lancet-oncol-2021/"},{"id":"paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025","kind":"paper","name":"Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial","route":"/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/"},{"id":"paper-garcia-aguilar-opra-organ-preservation-jco-2022","kind":"paper","name":"Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA)","route":"/key-papers/paper-garcia-aguilar-opra-organ-preservation-jco-2022/"},{"id":"paper-sauer-preoperative-chemoradiotherapy-rectal-nejm-2004","kind":"paper","name":"Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94)","route":"/key-papers/paper-sauer-preoperative-chemoradiotherapy-rectal-nejm-2004/"},{"id":"paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021","kind":"paper","name":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO)","route":"/key-papers/paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"},{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}],"idea":[{"id":"idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease","kind":"idea","name":"Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed","route":"/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/"},{"id":"idea-crc-organ-preservation-randomised-in-pmmr-rectal","kind":"idea","name":"Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint","route":"/ideas/idea-crc-organ-preservation-randomised-in-pmmr-rectal/"}],"trial":[{"id":"opra","kind":"trial","name":"OPRA","route":"/trials/opra/"}]}}