目前局部晚期直肠癌的治疗取得了很高的治愈率，远处转移扩散是患者死亡的主要原因。完全新辅助治疗 (TNT) 在手术前采用（化学）放射治疗和联合化疗来改善治疗结果。 TNT 已被证明可以显着减少远处转移，使无病生存率在 3 年内提高 5 - 10%，并且最终还可以提高总生存率（约 7 年内提高 5%）。事实证明，它使病理完全缓解率提高了一倍，使其成为非手术治疗的一种有吸引力的策略，以避免远端肿瘤患者进行永久性结肠造口术。此外，由于更好的耐受性，它支持坚持治疗，并且有可能缩短其总持续时间。目前与 TNT 相关的许多问题仍未解决，包括适应症、首选放疗和化疗方案、顺序、手术时机以及辅助治疗的作用。分层方法可能是最佳方法。版权所有 © 2023 作者。由 Elsevier B.V. 出版。保留所有权利。

Current management of locally advanced rectal cancer achieves high cure rates, distant metastatic spread being the main cause of patients' death. Total neoadjuvant therapy (TNT) employs (chemo)radiotherapy and combined chemotherapy prior to surgery to improve the treatment outcomes. TNT has been shown to reduce significantly distant metastases, increase disease-free survival by 5 - 10% in 3 years, and finally also overall survival (≈ 5% in 7 years). It proved to double the rate of pathologic complete responses, making it an attractive strategy for non-operative management to avoid permanent colostomy in patients with distal tumors. In addition, it endorses adherence to the therapy due to better tolerance and, potentially, shortens its overall duration. A number of questions related to TNT remain currently unresolved including the indications, preferred radiotherapy and chemotherapy regimens, their sequence, timing of surgery, and role of adjuvant therapy. A stratified approach may be the optimal way to go.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.