直肠癌的全面新辅助治疗（TNT）可提高病理完全缓解率和无进展生存率。随着临床反应率的提高，人们对这种疾病的非手术方法/观察等待 (WaW) 的兴趣日益浓厚。 2020年，ACO/AIO/ARO工作组发表了关于TNT使用的共识声明，包括非手术方法。然而，最佳组合方案仍不清楚。尽管 TNT 的使用越来越多，但仍缺乏关于其当前实施和实践的全面数据。为了弥补这一知识差距，开展了一项多中心调查，以了解德语放射治疗部门 TNT 方案的使用情况。 2023 年初，在德国、奥地利和瑞士德语区开展了一项符合 GDPR 的在线调查。调查问卷包含 43 个问题，涵盖 TNT 的各个方面，包括化疗和 WaW 概念。大多数受访者 (98.4%) 确认了解 TNT 治疗直肠癌的共识。机构每年平均治疗 30.22 名直肠癌患者。大多数受访者 (76.2%) 报告超过 80% 的患者接受了新辅助治疗。对于 TNT，33.3% 的人使用这样的方案治疗 21-50% 的人。机构类型和 TNT 申请之间没有发现显着关联。在 62/63 例中，在提供 TNT 之前，肿瘤委员会讨论是标准的。 VMAT 是主要技术 (82.5%)。对于直肠癌剂量，50/50.4Gy 方案最常见，其次是 45Gy 加强剂量和 5 × 5Gy 方案。 TNT 的剂量方案略有不同，与一般直肠癌放射治疗相比，更多参与者报告使用 5 × 5Gy。 CBCT 是主要的 IGRT 方法 (88.9%)。较大的医院通常自行进行化疗，而私人诊所则与肿瘤内科医生合作（p<0.0001）。最常见的同步化疗药物是5-氟尿嘧啶/卡培他滨（64.4%）和奥沙利铂（37.3%）。据报告，63.8% 的机构实施了 WaW 战略。提供 WaW 的时间各不相同，50% 的人在放化疗后提供，47% 的人在知情同意谈话期间提供。对于计划的 WaW，62% 的人更喜欢正常分次 TNT。 TNT 似乎在德语放射肿瘤学界广泛实施，无论机构类型如何。图像引导治疗、多学科团队决策和内部指南发挥着重要作用。 TNT 似乎已经改变了直肠癌的治疗方案，在选定的病例中转向保留器官的方法。在这些 WaW 病例中，正常分割似乎优于低分割。© 2024。作者。

Total neoadjuvant therapy (TNT) of rectal cancer improves rates of pathological complete remission and progression-free survival. With improved clinical response rates, interest grew in a non-operative approach/watch and wait (WaW) for this disease. In 2020, the working groups of ACO/AIO/ARO published a consensus statement on the use of TNT, including a non-operative approach. However, the best combination scheme remains unclear. Despite the increasing use of TNT, there is a lack of comprehensive data on its current implementation and practices. To address this knowledge gap, a multicenter survey was conducted to capture the use of TNT protocols in German-speaking radiotherapy departments. At the beginning of 2023, a GDPR-compliant online survey was conducted in Germany, Austria, and German-speaking Switzerland. The questionnaire comprised 43 questions covering various aspects of TNT, including chemotherapy and WaW concepts. Most respondents (98.4%) confirmed awareness of the consensus on TNT for rectal cancer. Institutions treated an average of 30.22 rectal cancer patients annually. Most respondents (76.2%) reported treating over 80% of patients neoadjuvantly. Regarding TNT, 33.3% treated 21-50% with such a protocol. No significant association was found between the institution type and TNT application. In 62/63 cases, tumor board discussion was standard before offering TNT. VMAT was the predominant technique (82.5%). For rectal cancer dosing, the 50/50.4Gy scheme was most common, followed by 45Gy with a boost and the 5 × 5Gy scheme. Dosing schemes for TNT varied slightly, with more participants reporting the use of 5 × 5Gy compared to radiation therapy for rectal cancer in general. CBCT was the primary IGRT method (88.9%). Larger hospitals typically administered chemotherapy themselves, while private practices collaborated with medical oncologists (p < 0.0001). The most common concurrent chemotherapy drugs were 5-fluorouracil/capecitabine (64.4%) and oxaliplatin (37.3%). A WaW strategy was reported to be institutional implemented by 63.8%. The timing of offering WaW was split, with 50% offering it after radiochemotherapy and 47% during the informed consent talk. For planned WaW, 62% prefer normofractionated TNT. TNT appears to be widely implemented in the German-speaking radio-oncological community, regardless of the type of institution. Image-guided therapy, multidisciplinary team decisions, and internal guidelines play an important role. TNT seems to have already altered treatment protocols for rectal cancer toward an organ-preserving approach in selected cases. In these WaW cases, normofractionation appears to be preferred over hypofractionation.© 2024. The Author(s).