Is total neoadjuvant therapy (TNT) always the best approach for rectal cancer? This paper addresses the complexities of TNT, a treatment paradigm rapidly gaining popularity. While TNT involves chemotherapy *before* surgery, its widespread adoption, even for less advanced cancers, raises concerns about increased toxicity and healthcare service burdens. The authors emphasize the importance of tailoring treatment to individual patients, considering both tumor characteristics and patient-specific goals. They caution against the assumption that all patients are suitable for organ preservation strategies. Furthermore, the authors challenge the perception that TNT universally provides substantial survival benefits. The paper suggests treatment with total neoadjuvant therapy (TNT) needs to be carefully assessed for each patient in order to avoid treatmentārelated toxicity. In conclusion, this perspective advocates for a nuanced approach to rectal cancer management, emphasizing individualized treatment plans and a clear understanding of TNT's potential benefits and drawbacks. It calls for a critical reevaluation of current practices to ensure the best possible outcomes for patients.
Published in Colorectal Disease, this paper directly addresses a central debate within the journal's scope. By questioning the blanket application of total neoadjuvant therapy for rectal cancer, the article stimulates discussion about optimal treatment strategies and personalized medicine. Its focus on patient-centered care and minimizing treatment-related toxicity aligns with the journal's commitment to improving outcomes in colorectal disease management.