2Department of Radiation Oncology, İzmir City Hospital, Ministry of Health, İzmir-Türkiye
3Department of Public Health, Recep Tayyip Erdoğan University Faculty of Medicine, Rize-Türkiye DOI : 10.5505/tjo.2025.4681 OBJECTIVE
Rectal cancer is a leading cause of cancer-related deaths, with total neoadjuvant therapy (TNT) emerging as a key treatment for locally advanced rectal cancer (LARC). However, its clinical application varies due to differing protocols and physician preferences. This study explores physician perspectives on TNT in LARC management.
METHODS
An online survey was conducted among radiation oncologists, medical oncologists, and colorectal
surgeons in Türkiye. The questionnaire, consisting of 24 questions, addressed demographics, staging,
treatment sequencing, radiotherapy, chemotherapy regimens, and response evaluation. Responses were
analyzed using descriptive statistics, with comparisons made between specialties using chi-square or
Fisher"s exact test.
RESULTS
A total of 103 participants completed the survey, with 68.9% agreeing on the standardization of TNT as
the neoadjuvant treatment for LARC. While no statistically significant differences were observed across
specialties, medical oncologists more frequently supported TNT as the standard approach (81.8%)
compared to colorectal surgeons (70%) and radiation oncologists (60%). Factors influencing treatment
choices included tumor staging, with N stage being the most significant determinant (32%). Opinions
on treatment sequencing within TNT were split, with a nearly even distribution between chemotherapy-
first and radiotherapy-first approaches.
CONCLUSION
This nationwide survey indicates that, while many clinicians support TNT as a neoadjuvant treatment
for LARC, there remains considerable heterogeneity in clinical approaches, and full consensus among
specialties has not yet been achieved. Strengthening evidence-based guidelines and enhancing multidisciplinary
collaboration are needed to reduce practice variability and improve patient care.