Can total neoadjuvant therapy be considered an option equivalent to standard of care treatment for patients with T3N0 or T3N1 rectal adenocarcinoma?  

NCCN says that it is a standard of care for this group of patients (excluding early T3N0 without threatened mesorectal fascia). Theoretically, TNT should be better tolerated, allow patients to complete all of the chemotherapy, able to improve organ preservation rates, and improve oncologic outcomes...

There are a couple of points of clarification regarding cT3N0 that I think should be made. In colon cancer, only a small and almost unidentifiable subset of patients with stage II disease benefit slightly from adjuvant chemotherapy. In rectal cancer, chemoradiation and chemotherapy have been empiric...