对于局部晚期直肠癌（LARC）的治疗，主要国际临床指南认为，对选定的患者进行新辅助放化疗初始治疗，然后进行手术和化疗是推荐的选择之一。尽管如此，在最终治疗（全新辅助治疗或 TNT）之前进行所有化疗是一种最佳选择，越来越多的证据必须在多学科委员会中进行评估。本综述总结了这种情况下的可用数据和争议。我们分析了主要已发表研究的特征，这些研究评估了 TNT 在 LARC 患者中的使用，评估了其纳入标准并区分了所采用的放射治疗分割、全身性药物、时间、以及这些治疗对手术和长期肿瘤学结果的影响。我们的目的是描述支持在日常临床实践中使用特定方案的证据。有确凿的证据表明在 LARC 患者中使用 TNT。没有数据表明某一特定 TNT 方案在所有现有方案中具有优越性。国际临床指南为根据每位患者的临床和病理特征选择最合适的治疗方法敞开了大门。这篇综述展示了 TNT 的不同方法，并根据临床证据评估了最佳选择。 Karger AG，巴塞尔。

for the management of locally advanced rectal cancer (LARC), initial treatment with neoadjuvant chemoradiotherapy followed by surgery and chemotherapy in selected patients is considered one of the recommended options by the main international clinical guidelines. Nonetheless, the administration of all chemotherapy before definitive treatment (total neoadjuvant therapy or TNT) is an optimal alternative with a growing level of evidence that must be evaluated in multidisciplinary boards. This review summarizes the available data and controversies in this scenario.we have analyzed the characteristics of the main published studies that assess the use of TNT in patients with LARC, evaluating their inclusion criteria and distinguishing between the employed radiotherapy fractionations, systemic agents, timing, and the implications of these treatments in regard to surgery and long-term oncological results. Our aim is to describe the evidence that supports the use of a specific regime in everyday clinical practice.there is solid evidence for the use of TNT in patients with LARC. There is no data indicating the superiority of one specific TNT scheme among all the existing options. International clinical guidelines leave the door open to choose the most adequate treatment based on the clinical and pathological characteristics of each patient. This review shows the different approaches to TNT and assesses the best options based on clinical evidence.S. Karger AG, Basel.