Discussion
tumor, colon cancer
TUMOR, METASTASIS, COLON CANCER, LYMPH NODE METASTASIS, RECTAL CANCER
Recent clinical studies have achieved promising results in reducing distant metastasis in LARC using TNT compared with surgery first or traditional preoperative CRT followed by surgery. Although the long-term outcomes of TNT in terms of OS and DFS are still awaited, TNT has emerged as an alternative to conventional treatment, potentially redefining the standard of care. At the time of launching the present trial, only one randomized clinical trial (POLISH II [This SOLAR trial compares the neoadjuvant treatment protocols (SCRT followed by four cycles of mFOLFOX6 vs. CRT) in rectal cancer with cT3–4, cN+, or extramural venous invasion. This trial is designed for mid- or low rectal cancer (tumor height  ≤ 10 cm from the anal verge) as upper rectal cancer can sometimes be treated like colon cancer and surgery can be modified as tumor-specific mesorectal excision [Although the RAPIDO trial used SCRT in a TNT arm, it compared a TNT regimen with longer chemotherapy duration with conventional CRT in LARC with high-risk features such as cT4, mesorectal fascia involvement, cN2, lateral lymph node metastasis, and extramural venous invasion [In this SOLAR trial, all patients are planned to undergo TME, without the option for nonoperative management, which is a trending approach for LARC. We plan to develop criteria for accurately diagnosing clinical complete response by leveraging the clinical and pathologic outcomes of this study, thereby informing future treatment protocols involving watchful waiting.Our current treatment protocol presents a practical alternative, addressing concerns about potential over-treatment associated with TNT and the missed treatment opportunity of a watchful waiting strategy.Studies comparing the cost-effectiveness of various preoperative treatment options in patients with LARC are scarce. The direct medical cost was lower in SCRT than in CRT [The quality of surgical resection is well known to be a crucial factor in local control and sphincter preservation following preoperative treatment and surgical resection [