Predictive Biomarkers and Models for Response to Total Neoadjuvant Therapy in Rectal Cancer: A Comprehensive Review | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 143, Volume 100, Issue 1, July 2025, Page 3538-3540 PDF (214.46 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2025.446805 | ||||
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| Abstract | ||||
| Background: The treatment of locally advanced rectal cancer (LARC) has been transformed by the implementation of Total Neoadjuvant Therapy (TNT), an intensive preoperative regimen that administers all planned chemotherapy and radiotherapy before surgery is considered. This approach has significantly raised the rates of pathological complete response (pCR), enabling organ preservation through a “watch-and-wait” (W&W) strategy for certain patients. The effectiveness of W & W critically depends on accurately identifying those who have achieved pCR without invasive procedures. Objective: This review summarizes the latest evidence on predictive markers for response to TNT, examining both established and new methods such as clinical evaluations, advanced imaging techniques (including morphological and functional MRI, PET/CT), endoscopic assessments, and emerging molecular biomarkers like circulating tumor DNA (ctDNA) and genomic signatures from tissue samples. Methods: We searched PubMed, Google Scholar, and Science Direct for Rectal cancer, Total neoadjuvant therapy, Pathological complete response, Watch-and-Wait, Predictive biomarkers, MRI AND Circulating tumor DNA. Only the most recent or thorough investigation, from 2004 to 2025 was taken into account. The writers evaluated relevant literature references as well. Documents written in languages other than English have been ignored. Papers that were not regarded as significant scientific research included dissertations, oral presentations, conference abstracts, and unpublished manuscripts were excluded. Conclusion: Combining imaging, molecular diagnostics, and potentially artificial intelligence provides the most promising approach for selecting rectal cancer patients suitable for organ-preserving treatments, allowing for more tailored and effective care. | ||||
| Keywords | ||||
| Rectal cancer; Total neoadjuvant therapy; Pathological complete response; Watch-and-Wait; Predictive biomarkers; MRI; Circulating tumor DNA | ||||
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