{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:29:21Z","timestamp":1788316161159,"version":"build-2803163510"},"reference-count":80,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,6,18]],"date-time":"2023-06-18T00:00:00Z","timestamp":1687046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>This study compared the advantages and disadvantages of total neoadjuvant therapy (TNT) strategies for patients with locally advanced rectal cancer, compared with the more traditional multimodal neoadjuvant management strategies of long-course chemoradiotherapy (LCRT) or short-course radiotherapy (SCRT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic review and network meta-analysis of exclusively RCTs was undertaken, comparing survival, recurrence, pathological, radiological, and oncological outcomes. The last date of the search was 14 December 2022.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 15 RCTs involving 4602 patients with locally advanced rectal cancer, conducted between 2004 and 2022, were included. TNT improved overall survival compared with LCRT (HR 0.73, 95 per cent credible interval 0.60 to 0.92) and SCRT (HR 0.67, 0.47 to 0.95). TNT also improved rates of distant metastasis compared with LCRT (HR 0.81, 0.69 to 0.97). Reduced overall recurrence was observed for TNT compared with LCRT (HR 0.87, 0.76 to 0.99). TNT showed an improved pCR compared with both LCRT (risk ratio (RR) 1.60, 1.36 to 1.90) and SCRT (RR 11.32, 5.00 to 30.73). TNT also showed an improvement in cCR compared with LCRT (RR 1.68, 1.08 to 2.64). There was no difference between treatments in disease-free survival, local recurrence, R0 resection, treatment toxicity or treatment compliance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study provides further evidence that TNT has improved survival and recurrence benefits compared with current standards of care, and may increase the number of patients suitable for organ preservation, without negatively influencing treatment toxicity or compliance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znad177","type":"journal-article","created":{"date-parts":[[2023,6,18]],"date-time":"2023-06-18T14:15:35Z","timestamp":1687097735000},"page":"1316-1330","source":"Crossref","is-referenced-by-count":48,"title":["Total neoadjuvant therapy <i>versus<\/i> standard neoadjuvant treatment strategies for the management of locally advanced rectal cancer: network meta-analysis of randomized clinical trials"],"prefix":"10.1093","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9824-3312","authenticated-orcid":false,"given":"Mark","family":"Donnelly","sequence":"first","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"},{"name":"School of Medicine, University College , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2750-4607","authenticated-orcid":false,"given":"Odhr\u00e1n K","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"},{"name":"School of Medicine, University College , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2609-0836","authenticated-orcid":false,"given":"\u00c9anna J","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-4810","authenticated-orcid":false,"given":"Ben","family":"Creavin","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Department of Oncology, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"McDermott","sequence":"additional","affiliation":[{"name":"School of Medicine, University College , Dublin , Ireland"},{"name":"Department of Oncology, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory","family":"Kennelly","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"},{"name":"Centre for Colorectal Disease, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Hanly","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"},{"name":"Centre for Colorectal Disease, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se\u00e1n T","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"},{"name":"Centre for Colorectal Disease, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Des C","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"},{"name":"School of Medicine, University College , Dublin , Ireland"},{"name":"Centre for Colorectal Disease, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,18]]},"reference":[{"key":"2023090600092973500_znad177-B1","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1200\/JCO.2011.40.1836","article-title":"Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO\/ARO\/AIO-94 randomized phase III trial after a median follow-up of 11 years","volume":"30","author":"Sauer","year":"2012","journal-title":"J Clin 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