PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Neoadjuvant Therapy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 847 records · Page 47Linked to original sources
PubMed2003

[Changes and complication rate in surgery for thoracic esophageal carcinoma].

AIM: In an analysis over 22 years it was investigated which parameters have changed in the operative treatment of thoracic esophageal carcinoma over time and in how far they have influenced complication rate. PATIENTS AND METHODS: Between 1978 and 1999 386 patients (350 men, 36 women) underwent resection for thoracic esophageal carcinoma (squamous cell carcinoma n=300, adenocarcinoma n=86). Cervical tumors were excluded from analysis. The time periods from 1978 to 1988 (n=242) and from 1989 to 1999 (n=144) were separately analyzed and compared with respect to age, sex, histological type, main tumor location, neoadjuvant therapy, method of operation, esophageal substitute and positioning of the substitute, R-status, pT/pN classification, UICC stage, number of dissected lymph nodes, complication rate, postoperative mortality and survival. RESULTS: Comparison of the two time periods showed a significant increase in adenocarcinomas and main tumor location in the lower thoracic third of the esophagus. Furthermore, significant changes concerning the indication of neoadjuvant chemoradiation, operative approach, esophageal substitute, R-status and number of dissected lymph nodes were observed. Tumor stage (pT/pN classification and UICC stage) significantly shifted towards earlier stages. Total complication rate dropped tendentially form 68.5 % to 59.0 % (p=0.061). Hospital mortality was significantly reduced from 24 % to 12.5 %, whereas anastomotic leakages and multiorgan failure remained on a constant level. Median survival of R0 resected patients was significantly prolonged from 19 months to 34 months. CONCLUSIONS: The increase of esophageal adenocarcinoma, a more strict patient selection (staging, functional status), standardization of operative technique as well as an optimized intensive care management are among the important changes in the operative management of thoracic esophageal carcinoma that have resulted in an improvement of prognosis of curatively resected patients. In spite of a more aggressive operative approach, i. e. lymph node dissection, operative mortality could be reduced by nearly 50 % in the face of a tendentially declining total complication rate.

Adenocarcinoma↗
PubMed2002

Prospective analysis of quality of life after surgical resection for esophageal cancer: preliminary results.

BACKGROUND AND OBJECTIVES: This pilot study prospectively evaluates the impact of esophageal resection on health-related quality of life (HRQL) and mood states at diagnosis and during the first year after surgery. METHODS: Participants included 38 patients with planned esophageal resection. Two instruments were used: the Functional Assessment in Cancer Therapy core instrument with the esophageal subscale (FACT-E), and the Profile of Mood States (POMS). Subjects were evaluated after diagnosis and at 1, 3, 6, 9, and 12 months after surgical resection. RESULTS: All subjects demonstrated a decrease in overall HRQL after resection with a gradual return toward baseline by month 9. The functional and physical subscales of the FACT-E demonstrated the largest decrease at 1 month with a gradual return toward baseline. The POMS subscales that demonstrated the highest amount of disorder after surgery were tension, fatigue, and vigor. Although the trends were similar between patients undergoing surgery alone (n = 18) and those with neoadjuvant therapy (n = 20), the group that had received surgery alone demonstrated a higher HRQL and less mood disorder during the postoperative period, as compared with the neoadjuvant group. CONCLUSIONS: Patient perceptions of HRQL and mood states change over the first 12 months after esophageal resection. Although no statistically significant differences were found in this study, several trends were identified. Ongoing assessments of these changes are important, and interventions need to be developed and implemented to produce an effective decrease in the impact of esophageal resection on HRQL and mood states, particularly after trimodality therapy.

Adult↗
PubMed2005

[Pathologic complete response of thoracic esophageal cancer developing after gastrectomy to neoadjuvant low-dose nedaplatin (CDGP), 5-fluorouracil and radiotherapy].

We treated a 69-year-old man who had developed esophageal cancer following gastrectomy. Pathologic complete response (pCR) was obtained by neoadjvant chemoradiotherapy using low-dose nedaplatin (CDGP) and 5-fluorouracil. The cancer located in the middle of the thoracic esophagus, had invaded the trachea and metastasized to cervical lymph nodes according to computed tomography. Preoperative chemoradiotherapy combining a low-dose of CDGP with 5-FU was administered together with radiotherapy. Adverse effects included grade 2 stomatitis and leukocytopenia. The esophageal cancer was found by endoscopy to have diminished significantly after completion of neoadjuvant therapy, An endoscopic biopsy specimen was found to contain no malignant cells. The tumor also was smaller by CT, where cervical lymph nodes no longer showed involvement. Partial response was diagnosed based on imaging, and radical resection of the esophageal cancer was performed via right thoracotomy and laparotomy. Operative staging findings indicated Ch x R-T 3 N 0 M 0, Stage II R 0 D 2 Cur A. Pedicled jejunum was used to reconstruct the esophagus through a mediastinal route. Pathologic examination of resected specimens disclosed no viable cancer cells in the esophagus or metastasis to dissected lymph nodes. Neoadjuvant chemoradiotherapy using low-dose CDGP/5-FU is an effective treatment for esophageal cancer.

Aged↗
PubMed1998

Breast-conserving surgery in the neoadjuvant setting.

The use of neoadjuvant chemotherapy for the treatment of patients with operable breast cancer remains controversial. Neoadjuvant chemotherapy is highly effective in achieving significant tumor regression. However, the primary goal of improved survival has yet to be clearly demonstrated. The largest prospective trial with adequate follow-up to report 5-year disease-free survival data demonstrated no significant difference between patients treated with neoadjuvant chemotherapy followed by locoregional treatment and locoregional treatment followed by adjuvant chemotherapy. Survival data from the National Surgical Adjuvant Breast and Bowel Project B-18 trial are not yet available. The potential impact on the breast conservation rate for patients with early operable breast cancer is small, and careful follow-up of the long-term risk of local recurrence for patients with neoadjuvant therapy induced downstaging followed by BCT is not yet available. At this time, neoadjuvant chemotherapy for the treatment of patients with operable breast cancer should be considered investigational.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Use of neoadjuvant and adjuvant therapy to prevent or delay recurrence of prostate cancer in patients undergoing surgical treatment for prostate cancer.

There have been improvements in the outcome of patients with clinically localized prostate cancer treated by radical prostatectomy. However, some patients treated with radical prostatectomy will have clinical or biochemical progression. These men are at increased risk of dying of their disease. Identification of patients with adverse features at the time of radical prostatectomy may permit the use of additional multimodality therapies to improve outcomes. Whether this additional multimodality therapy should be administered in the neoadjuvant or adjuvant setting remains controversial. Further, whether a patient at increased risk for progression after radical prostatectomy requires additional therapy before the development of documented progression remains controversial. This article reviews the potential multimodality approaches to prevent or delay recurrence of prostate cancer in patients undergoing surgical treatment for prostate cancer.

Adenocarcinoma↗
PubMedDate not supplied

Monitoring of serum Her-2/neu predicts histopathological response to neoadjuvant trastuzumab-based therapy for breast cancer.

BACKGROUND: This prospective pilot study was performed to elucidate whether early changes in serum levels of the Her-2/neu extracellular domain (ECD) reflect histopathological response to trastuzumab-based neoadjuvant therapy in patients with Her-2/neu-overexpressing breast cancer. PATIENTS AND METHODS: ECD levels were measured throughout neoadjuvant trastuzumab-based treatment in 16 patients using a Her-2/neu Microtiter ELISA. RESULTS: In 9 (56%) patients with Her-2/neu shedding tumors (ECD > 15 ng/ml), ECD values (in % of baseline) of non-responders vs. responders were 117% vs. 55% on day 8 (p=0.014), 157% vs. 58% on day 22 (p=0.061) and 114% vs. 46% at restaging (p=0.049). CONCLUSION: Serial monitoring of serum Her-2/neu ECD levels may represent a valuable tool to predict pathological response to trastuzumab-based neoadjuvant therapy in patients with Her-2/neu-overexpressing tumors.

Adult↗
PubMed2005

Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients.

AIMS: To investigate the role of hospital volume and individual hospitals on long term outcomes (local recurrence and survival) of rectal cancer patients. METHODS: One thousand thirty-eight patients with rectal cancer were diagnosed between 1996 and 1998. From these, we analysed 884 patients with a resected invasive primary rectal cancer. Median follow-up was 5.7 years. The impact of hospital volume (<10, 10-30 and >30 rectal cancer patients annually) on local recurrence and survival was examined in a Cox model. Differences between the four largest clinics in the high volume group were also investigated. RESULTS: In the multivariate model predicting survival the following variables were significant: UICC stage, grade, age, local recurrence, and (neo-) adjuvant therapy treatment. In the multivariate model predicting local recurrence UICC stage, tumour localisation, and neoadjuvant therapy treatment were significant variables. Hospital volume was not a significant factor for survival or local recurrence. Within the high volume category one hospital showed significantly worse local recurrence rates than all other hospitals, but no survival difference could be seen between the four largest hospitals of the high volume group. CONCLUSIONS: This analysis of a rectal cancer population found that hospital volume did not determine survival or local recurrence. Detailed clinical data with long term follow-up from cancer registries are vital to demonstrate the quality of routine care.

Aged↗
PubMed2000

Non-steroidal anti-androgens in prostate cancer--current treatment practice.

Adenocarcinoma of the prostate is a common disease that causes significant morbidity and mortality in the adult male population. Hormonal therapy for prostate cancer is considered when a patient fails with initial curative therapy, such as radical prostatectomy or definitive radiation therapy, or if he is found with an advanced disease. Many hormonal agents have been developed to exploit the fact that prostate cancer growth is dependent on androgen. Non-steroidal anti-androgens (NSAAs) block androgen at the cellular level. Numerous clinical trials comparing monotherapy of castration and combination therapy of castration and NSAAs have been performed. At present, the results of the trials with regard to the survival of patients under therapy are conflicting. When the disease recurs in a patient in the middle of combination androgen blockade therapy, androgen withdrawal should be considered. The benefits of NSAA in monotherapy, intermittent or neoadjuvant therapy are not clear at present. Better designed, larger cohort clinical trial may be necessary to clarify the confusion.

Calcium Oxalate↗
PubMed2002

Recent progress in the development of anticancer agents.

Cancer chemotherapy started with the discovery of the cytostatic effect of N-mustard and its derivatives more than five decades ago. This observation opened the way for the synthesis of various alkylating agents, antimetabolites and antimitotics expliciting antitumour activity against several human malignancies. The considerable toxicity of these drugs however, limited their application and only hormone-active products were relatively well tolerated. Besides, the majority of human malignant tumours proved to be chemoresistant. Consequently, there was still an urgent need for finding less toxic compounds possessing broader antitumour spectrum. Therefore, it became obvious that better understanding of the cellular metabolism - due to revolution in molecular biology - yielded new targets for cancer chemotherapeutic agents. Key enzymes active in signal transduction pathways could be blocked by new substances. Cell cycle control could be influenced by apoptosis inducers. Mitotic division could be inhibited by antitubulin agents. Multidrug resistance (MDR) could be modified by revertants. New concepts also emerged: a) chemoprevention, which is based on the principle, that since carcinogenesis is a genetically determined, progressive multistep process it can timely be reconverted into the direction of normal cellular metabolism by redifferentiating agents; b) antimetastatic therapy: originally performed postoperatively as an adjuvant therapy nowadays before surgical intervention, in order to block vascular dissemination of tumor cells (neoadjuvant therapy); c) antiangiogenic therapy: substances capable to hinder the vessel production essential for the development of metastasis; d) antitelomerase molecules inhibiting the immortal division capacity of DNA in malignant cells. All these new research approaches necessitate to review the existing drugs which are in clinical use or are investigational agents against human malignancies.

Angiogenesis Inhibitors↗
PubMed2005

Neoadjuvant selective COX-2 inhibition down-regulates important oncogenic pathways in patients with esophageal adenocarcinoma.

OBJECTIVES: To evaluate the effects of neoadjuvant therapy with the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib in vitro and in patients with esophageal adenocarcinoma on COX-2 and MET expression. SUMMARY BACKGROUND DATA: High COX-2 and/or MET expression levels are negative prognostic factors for adenocarcinoma of the esophagus. Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors exert anticancer mechanisms as is evident from epidemiologic studies and from experimental models for esophageal cancer. The mechanisms and the significance of these findings in patients with adenocarcinoma of the esophagus are unknown. METHODS: Esophageal adenocarcinoma cell lines were used to asses the effects in vitro. To study the clinical effects 12 patients with esophageal adenocarcinoma were included for neoadjuvant treatment (4 weeks) with celecoxib at 400 mg twice daily. Fifteen patients not receiving NSAIDs or celecoxib were included as a control. Effects were evaluated using the MTT-cell viability test, Western blot analysis, immunohistochemistry, and RT-PCR. RESULTS: In vitro celecoxib administration resulted in decreased cell viability, increased apoptosis, and decreased COX-2 and MET expression levels. In patients, neoadjuvant treatment with celecoxib significantly down-regulated COX-2 and MET expression in the tumor when compared with the nontreated control group and when compared with pretreatment measurements. CONCLUSIONS: This is the first study to show in vitro and in patients with esophageal adenocarcinoma that selective COX-2 inhibition down-regulates COX-2 and MET expression, both important proteins involved in cancer progression and dissemination. Therefore, (neo)adjuvant therapy with celecoxib might have clinical potential for patients with esophageal adenocarcinoma.

Adenocarcinoma↗
PubMed1990

Overview of systemic treatment of bladder cancer and results with M-VAC therapy.

Cytotoxic chemotherapy is playing an increasingly important role for advanced disease, and is being properly evaluated in prospective trials as neoadjuvant therapy. There has been no major undertaking to examine adjuvant treatment, and hopefully randomized studies will be started in the future. There is sparse data concerning the effectiveness of immunological agents for treatment of this tumor, and phase II efficacy studies are needed. Future studies will need to define more accurately the poor-risk group in whom new agents or regimens using a more intensive schedule, perhaps with G-CSF, can be explored as initial therapy.

Antineoplastic Agents↗
PubMed1999

Current chemotherapeutic possibilities in pancreaticobiliary cancer.

At time of presentation the majority of patients with pancreaticobiliary cancer have locally advanced or metastatic disease which makes them unamenable for curative surgery. In these patients chemotherapy is an option which has gained more support over the past few years. Special problems faced in chemotherapeutic treatment are the patient's poor condition and the difficulties faced in evaluating response. 5-FU has been the only drug with some efficacy for a long time, but more recently gemcitabine appeared to be more efficient. In locally advanced pancreatic cancer the combination of chemotherapy with radiotherapy has not gained much support. However, studies are implicating better local control with combined treatment and recurrences appear more often at distant sides. In some cases irresectable tumors became resectable. Because of the poor survival after surgery with curative intent, adjuvant and neoadjuvant therapy are becoming important issues. Although studies of adjuvant therapy suggest benefit, research is seriously hampered by poor patient accrual due to the morbidity of pancreaticoduodenectomy. Neoadjuvant treatment may overcome this problem. Until now there has been only modest improvement in the treatment of pancreatic cancer. Hopefully, new treatment modalities such as immunotherapy, gene therapy and antiangiogenic therapy will alter this dismal picture. In biliary cancer the role of chemotherapy is less well defined, since only few studies with low patients numbers have been performed.

Biliary Tract Neoplasms↗
PubMed2004

Characteristics of patients with prostate cancer who have initially been treated by hormone therapy in Japan: J-CaP surveillance.

OBJECTIVE: Hormone therapy for prostate cancer has empirically prevailed in Japan. We planned to evaluate the trends and outcome of hormone therapy for establishing an adequate guideline. METHODS: Patients with prostate cancer who were initially treated by hormone therapy were registered through the J-CaP registration system. This report summarizes the background factors. RESULTS: From January 2001 to October 2003, 17,872 patients were registered from 395 institutes throughout Japan. The background factors of 17,312 patients were analyzed. The 17,872 patients were estimated as composing more than half of newly diagnosed prostate cancer patients in Japan. Of these, 22.9, 35.1, 32.9 and 8.6% belonged to T1, T2, T3 and T4, respectively. For the purposes of hormone therapy, 77.5% was primary hormone therapy. Neoadjuvant setting and adjuvant setting were 18.1 and 4.3%, respectively. About 60% of the hormone therapy was combined hormone therapy with LH-RHa plus anti-androgens. CONCLUSION: Irrespective of patients' age, TNM, stage of illness, or histological background, the majority of prostate cancer patients in Japan are receiving hormone therapy. It is necessary to evaluate whether this trend is merely a continuation of past experience of Japanese urologists or if there is a difference in the profile of effect and side-effect in the case of Japanese patients compared to therapy given in Westerners.

Aged↗
PubMed1995

[Low-dose FP (5-FU+low-dose CDDP) therapy for far advanced upper gastro-intestinal carcinoma].

Low-dose FP therapy was undertaken in 25 patients with far advanced or recurrent carcinoma (13 stomach, 7 esophagus, 3 colon, 1 gallbladder, 1 pancreas). This therapy consisted of intermittent infusion of CDDP (10 mg/body X 5 days) and continuous infusion of 5-FU (500 mg/body X 5 days) for 5 days with 2-day intervals. Patients were treated with at least 2 courses of low-dose FP therapy. Of the 25 patients, 12 with esophageal (7) or gastric (5) carcinoma, in whom curative resection was considered impossible before the operation, were subjected to neoadjuvant chemotherapy. The response rate in the neoadjuvant therapy was 100% (2 disappeared and 5 decreased in size) in the esophageal cancer and 60% (3 decreased in size) in the gastric cancer. But, in 6 patients with esophageal cancer, radiotherapy was combined. In the neoadjuvant cases, pathological effect of Grade 2 was noted in 3 of the 7 esophageal cancers and 1 of the 5 gastric cancers. Of the remaining 13 unresectable patients, a significant improvement of performance status was found in 6 patients. In 19 patients treated with low-dose FP therapy only, leukopenia of Grade 3 was not observed, and there was no nephrotoxicity. Low-dose FP therapy is safe and useful as a neoadjuvant chemotherapy for patients with far advanced esophageal or gastric cancer.

Adult↗
PubMed2002

Current and planned trials with capecitabine in adjuvant/neoadjuvant therapy of breast cancer.

The demonstration of the activity of capecitabine (Xeloda) in advanced breast cancer and of the ability of capecitabine/docetaxel (Taxotere) to improve tumor response, time to disease progression, and survival in this setting has prompted considerable interest in examining uses of capecitabine in adjuvant and neoadjuvant therapy. Trials are planned to compare capecitabine/docetaxel with docetaxel after AC in the adjuvant and neoadjuvant settings, weekly paclitaxel vs capecitabine/docetaxel followed by fluorouracil (5-FU)/epirubicin (Ellence)/cyclophosphamide and local surgery in both adjuvant and neoadjuvant settings, and AC or cyclophosphamide/methotrexate/5-FU vs single-agent capecitabine in adjuvant therapy of elderly patients with node-positive or high-risk node-negative disease. Results of these trials should provide important information on the range of uses of capecitabine in treating breast cancer.

Breast Neoplasms↗
PubMed1996

[Therapy-induced changes in osteosarcoma after neoadjuvant chemotherapy (COSS 86 Therapy Study). Correlation between morphologic findings and clinical follow-up].

207 osteosarcomas were examined morphologically after neoadjuvant chemotherapy according to the COSS-86 protocol using representative slides of one whole tumor plane. The rate of responders 63%. In relapse-free patients both the whole tumors and the vital areas there of were smaller than in patients with relapse during a follow-up period of 5 years. Within the subgroup of osteoblastic osteosarcomas, metastases were observed following smaller tumors than in chondroblastic osteosarcomas. Therefore, in addition to degree of regression, histological subtype and tumor size should be considered in the prognostic evaluation of osteosarcomas.

Adolescent↗
PubMed2000

Vulvar carcinoma.

Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal women. The lesion is most commonly associated with HPV DNA, although, for many, a defined preinvasive to invasive connection is not readily apparent. Most patients experience symptoms of pruritus, irritation, and even pain for weeks or months before the diagnostic biopsy is performed. Patient embarrassment and unfamiliarity and reluctance on the part of the physician to fully evaluate these symptoms add to the delay. Vulvar carcinoma is staged surgically following resection. A concerted effort to conserve as much normal tissue as possible has been the focus of recent investigation. Separate incision resection of the vulvar mass and groin has improved wound healing and quality of life for many patients. The effect these conservative procedures have on long-term survival is currently being evaluated. Increased use of radiation therapy or chemoradiation has allowed organ preservation in many otherwise exenterative cases. In some instances, this neoadjuvant therapy has provided an opportunity to surgically clear otherwise unresectable lesions. Current radiotherapy techniques might also be as effective as groin dissection in certain low-risk patients. Adjuvant radiation and chemoradiation improve local control and reduce groin recurrence risk. In addition, patients with histologically positive groins enjoy longer survival when the pelvis is also treated. Selected use of multimodality therapy will likely extend the lives of women with vulvar cancer.

Aged↗