Rectal Cancer: Completing the Treatment Cycle With Modern TNT Protocols

In Costa Rica, the management of rectal cancer has advanced significantly thanks to growing scientific evidence and the expertise of specialized centers. One of the most important developments is Total Neoadjuvant Therapy (TNT), a modern approach that combines chemotherapy, Radiation Oncology, and, when necessary, surgery. This strategy aims to improve disease control, increase the chances of cure, and, whenever possible, preserve rectal function.

Unlike traditional treatment—where radiotherapy was followed by surgery—TNT organizes all therapies before the operation. Patients first receive systemic chemotherapy to shrink the tumor and treat any potential microscopic spread. Radiotherapy follows, delivered either over several weeks or through shorter, highly precise protocols. This phase helps eradicate any remaining tumor cells and allows for a more effective surgery.

An important benefit of TNT is that some patients experience such a strong response that the tumor disappears clinically. When this happens, and under strict medical criteria, a “watch and wait” strategy may be considered. This approach involves intensive surveillance instead of immediate surgery. It is not appropriate for all cases, but it represents a meaningful step forward in terms of quality of life.

For many patients, surgery still plays a key role, but it occurs under better circumstances thanks to the tumor shrinkage achieved during neoadjuvant therapy. Throughout the process, nutritional support, symptom monitoring, and regular follow-up are essential.

TNT has become one of the most significant innovations in Radiation Oncology and in the overall treatment of rectal cancer in Costa Rica. With clear information and a coordinated team, patients can understand each step, engage in shared decision-making, and move through the process with confidence.