In our last episode, we established the foundational principles of neoadjuvant radiation, proving that giving RT before surgery is superior and comparing the short-course and long-course approaches. That framework is perfect for standard-risk disease. But for patients with the highest-risk tumors, the primary driver of mortality isn't local failure—it's distant metastases.This reality has sparked a true revolution in rectal cancer care. Today, we dive into that revolution: Total Neoadjuvant Therapy, or TNT. We will define TNT and its rationale, dissect the blockbuster trials that have redefined the standard of care for high-risk rectal cancer, and cover the game-changing management for biologically distinct dMMR tumors.

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