Total neoadjuvant chemotherapy (TNT) for gastric cancer. EndoTODAY 이준행

[Gastric cancer 982. Total neoadjuvant chemotherapy (TNT) for gastric cancer] - 終

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직장암에서 total neoadjuvant chemotherapy (TNT) 는 표준치료 중 하나로 자리잡았습니다 (EndoTODAY TNT). 위암에서도 TNT가 적용될 수 있는지 궁금하던 차에 최근 systemic review가 있어 소개합니다 (Surg Open Sci 2026). 아직 후향적 연구 3개 정도가 있을 뿐이고 가까스로 feasibility 정도를 논하고 있고 oncological outcome은 개선하지 못한 것 같습니다.

Perioperative chemotherapy (FLOT 4 + 4) versus total neoadjuvant therapy (TNT; FLOT ×8) for resectable gastric cancer: A systematic review and exploratory meta-analysis

Introduction: Standard perioperative chemotherapy (PC) using FLOT (4 preoperative + 4 postoperative cycles) improves survival but is frequently not completed because of postoperative morbidity. Total Neoadjuvant Therapy (TNT), which delivers all eight FLOT cycles preoperatively (FLOT ×8), has been proposed to improve treatment completion.
Methods: Primary outcomes were chemotherapy completion and pathological complete response (pCR). Secondary outcomes included R0 resection, postoperative morbidity, treatment-related toxicity, overall survival (OS), and disease-free survival (DFS).
Results: Three retrospective comparative studies including 425 patients (136 TNT, 289 PC) were analyzed. TNT was associated with higher completion of planned chemotherapy (OR 4.55; 95% CI 1.13-18.27; p < 0.01) without an increase in major postoperative morbidity (OR 0.96; 95% CI 0.55-1.69; p = 0.50). No significant differences were observed in pCR (OR 1.54; 95% CI 0.65-3.63) or R0 resection rates. Survival outcomes were heterogeneous and could not be reliably pooled.
Conclusion: TNT was associated with improved chemotherapy completion without increased perioperative morbidity. However, the current evidence base is insufficient to support conclusions regarding oncologic efficacy or survival benefit.