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Results for “Neoadjuvant Therapy”

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At least 919 records · Page 51Linked to original sources

PubMed2001

Efficacy of intra-hepatectomy 5-FU on recurrence and metastasis of human hepatocellular carcinoma in nude mice.

A novel intra-operative chemotherapy nude mouse model for human hepatocellular carcinoma (HCC) has been developed. Intra-peritoneal (i.p.) administration of 5-fluorouracil (5-FU) was begun 2 hr before hepatic resection of HCC and then continued post-operatively for 4 consecutive days. This regime, termed intra-hepatectomy chemotherapy (IHC), significantly prolonged animal survival compared with pre-operative 5-FU, neoadjuvant therapy, 5-FU post-operative adjuvant therapy, surgery alone, 5-FU without surgery, and the untreated control. The median survival of the intra-operative 5-FU-treated group was 127 days compared with 78 days for the neoadjuvantly-treated animals and 53 days for the control group (p<0.006). When all animals with neoadjuvant 5-FU treatment had died, 60% of the animals in the IHC group were still alive (p<0.011). Survival of all other treatment groups, including 5-FU without surgery, surgery alone, and adjuvant post-operative chemotherapy, was not significantly different from the untreated control group. Five animals in the IHC group were free of tumor when sacrificed at day 150 post-surgically. While 100% of animals in the control group had lymph nodes draining the liver involved with metastases, only 20% of animals in the IHC group had lymph node metastases. These data suggested that IHC therapy increased survival by preventing metastases of cancer cells not removed in the liver resection procedure. The results of this study indicate that IHC therapy for resection of HCC should be investigated clinically.

Animals↗

PubMed2004

Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a clinical practice guideline.

BACKGROUND: Carcinoma of the esophagus is an aggressive malignancy with an increasing incidence. Its virulence, in terms of symptoms and mortality, justifies a continued search for optimal therapy. A clinical practice guideline was developed based on a systematic review investigating neoadjuvant or adjuvant therapy on resectable thoracic esophageal cancer. METHODS: A systematic review with meta-analysis was developed and clinical recommendations were drafted. External review of the practice guideline report by practitioners in Ontario, Canada was obtained through a mailed survey, and incorporated. Final approval of the practice guideline was obtained from the Practice Guidelines Coordinating Committee. RESULTS: The systematic review was developed and recommendations were drafted, and the report was mailed to Ontario practitioners for external review. Ninety percent of respondents agreed with both the evidence summary and the draft recommendations, while only 69% approved of the draft recommendations as a practice guideline. Based on the external review, a revised document was created. The revised practice guideline was submitted to the Practice Guidelines Coordinating Committee for review. All 11 members of the PGCC returned ballots. Eight PGCC members approved the practice guideline report as written and three members approved the guideline conditional on specific concerns being addressed. After these recommended changes were made, the final practice guideline report was approved. CONCLUSION: In consideration of the systematic review, external review, and subsequent Practice Guidelines Coordinating Committee revision suggestions, and final approval, the Gastrointestinal Cancer Disease Site Group recommends the following:For adult patients with resectable thoracic esophageal cancer for whom surgery is considered appropriate, surgery alone (i.e., without neoadjuvant or adjuvant therapy) is recommended as the standard practice.

Adenocarcinoma↗

PubMed1997

Biology of esophageal cancer and the role of combined modality therapy.

1. The biology of esophageal cancer involves multifactorial environmental and genetic events. 2. The understanding of the clinical significance of molecular markers is rapidly evolving. 3. Combined-modality approaches should still include surgery in good performance status (ECOG scale < or = 2) patients. 4. Neoadjuvant chemoradiation is probably better than surgical resection alone for patients with potentially curable disease, but only validation of this approach by CALGB-9781 can justify this as a new "proven" standard-of-care in the United States. 5. A pathologic complete response to neoadjuvant therapy is the strongest predictor of long-term survival. 6. 5-FU, by either short course or protracted continuous infusion, comprises the backbone of combination chemotherapy in combined-modality design. 7. Radiation therapy should be given at standard 1.8 to 2 Gy/fraction without a scheduled break. 8. Only by enrolling sufficient numbers of patients in prospective clinical trials will clinicians be able to further define the optimal sequencing and actual necessity of each individual component of combined-modality therapy.

Adenocarcinoma↗

PubMed2002

Future directions in the treatment of pancreatic cancer.

Fewer than 20% of patients with pancreatic cancer present with disease macroscopically confined to the pancreas, and approximately 40% already have locally advanced disease. Based on data from the Gastrointestinal Tumor Study Group, adjuvant therapy with radiation and 5-fluorouracil has become standard practice in the United States; however, in other countries, adjuvant treatment has not been as widely accepted. Other issues include the potential of neoadjuvant therapy and optimal systemic management. The issue of second-line therapy has also been raised in the treatment of pancreatic carcinoma, after the establishment of gemcitabine as a first-line standard treatment approach, in which it achieves a significant clinical benefit response. Other combination partners with gemcitabine under investigation include the antimetabolite 5-fluorouracil, the topoisomerase-I inhibitor irinotecan, the taxane docetaxel, the platinum oxaliplatin, the multitargeted antifolate pemetrexed, the farnesyl transferase inhibitor R-115777, the anti-HER2/neu antibody trastuzumab, and the epidermal growth factor inhibitor cetuximab. Combined-modality approaches with gemcitabine and radiation are also under active investigation.

Antimetabolites, Antineoplastic↗

PubMed2002

Local excision of rectal tumors.

Local excision of rectal cancer is done with the goal of cure or palliation with minimal morbidity. Careful patient selection is paramount to avoid local recurrence. Endorectal sonography has brought accuracy to the preoperative staging of rectal cancer. Patients with ultrasound stage T1 carcinoma of the distal rectum and well-differentiated or moderately well-differentiated histology can be offered local excision, with expected low morbidity and a low risk of recurrence. Pathologic examination of the entire specimen determines favorable or unfavorable histologic features, and is the basis for final decisions made on therapy. The role of adjuvant therapy after local excision is still being defined. Preoperative chemoradiation followed by local excision appears promising for patients with more advanced or very distal tumors who have a complete pathologic response to the neoadjuvant therapy.

Chemotherapy, Adjuvant↗

PubMed1997

The Roles and Controversies of Radiation Therapy in Breast Conserving Therapy for Breast Cancer.

Breast conserving therapy (BCT) is defined as a combination of conservative surgery for resection of the primary tumor, followed by radiation therapy (RT) for the eradication of residual microscopic disease in the breast. At NIH Consensus Development Conference in 1990, BCT was recognized as the preferred treatment for the majority of women with Stage I and II breast cancer. RT is a potent locoregional treament and its role in BCT in reducing local recurrence is already established. On the other hand, the influence of RT on survival outcome has not yet been closely demonstrated so far. RT appears to be useful as neoadjuvant therapy, and also as exclusive local treatment for patients achieving complete regression (CR) after neoadjuvant chemotherapy. The other possible role of RT is to use it as an alternative to axillary dissection in patients with clinically uninvolved nodes. The question of the appropriateness of using RT in all BCT cases is raised. Since the subgroup of patients who would not deserve any benefit by RT has not yet identified, RT should be delivered as standard treatment following breast conserving surgery for early stage breast cancer.

Journal Article↗

PubMed2006

Should preoperative or postoperative therapy be administered in the management of rectal cancer?

Combined-modality therapy consisting of surgery, radiation, and chemotherapy with 5-fluorouracil is the recommended management for patients with stage II and III rectal cancer. The place of radiation therapy as part of this combined modality treatment for localized rectal cancer will be reviewed, and some of the novel chemoradiation combinations under investigation will be highlighted. Currently, there are two sequencing approaches for the adjuvant administration of pelvic radiation therapy. The first is surgical resection and, if the tumor is stage T(3-4) and/or N(1-2), adjuvant postoperative chemoradiation and further chemotherapy. The second approach for patients with ultrasound T(3-4) or clinical T(4) disease is preoperative therapy followed by surgical resection and postoperative chemotherapy. The adjuvant radiation management approach in the United States and Europe has been shifting toward preoperative therapy to promote sphincter-preserving surgery and decrease acute and late bowel toxicity. The recently published 5-year results of the randomized German CAO/ARO/AIO 94 trial of preoperative versus postoperative chemoradiation support a standard preoperative treatment approach. Preoperative chemoradiation therapy also allows for the investigation of innovative agents (capecitabine, oxaliplatin, irinotecan, bevacizumab, and cetuximab) in combination with pelvic radiation. These new combinations may have the potential to further increase the therapeutic benefit of neoadjuvant therapy.

Antineoplastic Agents↗

PubMed2004

Magnetic resonance imaging in rectal cancer: the MERCURY experience.

Eleven European clinics, well experienced in a multidisciplinary approach to rectal cancer therapy, were testing magnetic resonance imaging (MRI) as a preoperative tool for staging of unselected rectal cancer patients. Aims and preliminary results of the study are presented. The way of using MRI for patient selection for neoadjuvant therapy is demonstrated from Berlin-Friedrichshain.

Europe↗

PubMed2003

Prostate cancer management: (1) an update on localised disease.

Prostate cancer is receiving ever more publicity with the result that more men are having their prostate specific antigen checked and a greater proportion of men are diagnosed with potentially curable localised disease. Advances in the therapeutic modalities including radical surgery, external beam radiotherapy, and brachytherapy have reduced the incidence of side effects and now offer patients a choice of treatments depending on their tumour characteristics, age, and co-morbidity. A significant proportion of men do not need intervention and may be safely kept under a "watch and wait" policy. The use of genetic markers may in the future distinguish between patients most likely to benefit from radical therapy and those in who either palliation or observation is more appropriate. This review examines the potentially curative options, as well as expectant management, outlining the pros and cons of each. The use of adjuvant and neoadjuvant therapy is also discussed.

Androgen Antagonists↗

PubMed2001

Advances in the treatment of non-small cell lung cancer: molecular markers take the stage.

Increasing evidence that non-small cell lung cancer is a systemic disease from the outset confirms the rationale for adjuvant chemotherapy. However, clinical trial evidence of benefit is still awaited. The position is clearer in the case of neoadjuvant therapy because long-term follow up of two trials now shows that patients randomized to chemotherapy before surgery were significantly more likely to survive to 5 years than patients treated with surgery alone. Early data suggest that neoadjuvant chemotherapy based on docetaxel (Taxotere; Aventis, Antony, France) (possibly used sequentially with other agents) may be as effective as older regimens and better tolerated. Because p53 status influences the expression of microtubule-associated proteins and hence the sensitivity of a tumor to taxanes, it is possible that molecular markers could be used to customize chemotherapy to individual patients. Generally, it is becoming clearer that molecular staging is a more sensitive means of demonstrating tumor dissemination than light microscopy. The Cancer and Leukemia Group B is undertaking a prospective study using reverse transcriptase-polymerase chain reaction to detect MUC-1 RNA in bone marrow and hilar and mediastinal lymph nodes removed at resection with the aim of distinguishing between stage I patients likely to remain disease-free for long periods and those at high risk of relapse. A study of small cell lung cancer is using automated fluorescence microscopy to detect keratin-positive cells in the marrow and blood of patients who have a complete response to initial therapy but are nevertheless at high overall risk of relapse. The identification of genetic lesions in a high proportion of patients with non-small cell lung cancer may guide the development of new therapies aimed at increasing rates of apoptosis among tumor cells.

Antineoplastic Agents↗

PubMed1995

Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma study group (COSS).

The case histories of all patients with osteosarcoma of the trunk entered into the consecutive studies COSS 80 through COSS 86 of the Cooperative German/Austrian Osteosarcoma Study Group (COSS) were analyzed in order to evaluate their clinical characteristics and the impact of modern neoadjuvant therapy on prognosis. They were compared to those of all patients with extremity osteosarcoma treated according to the same protocols. While tumors of the trunk comprised only 32 (4.8%) of 665 primary classical osteosarcomas, secondary osteosarcomas were much more likely to be located in bones of the axial skeleton (6 of 18, 33%). Patients with primary osteosarcoma of the axial skeleton were older (mean: 20.8 vs. 15.2 years, P < 0.01) and were more likely to present with metastases at diagnosis (34% vs 12%, P < 0.001) than those with primary extremity osteosarcoma. In contrast to extremity tumors, local surgical treatment failure was very common in osteosarcomas of the trunk. Complete tumor removal was achieved in less than half of all evaluable cases. The prognosis of eight patients with localized primary axial osteosarcoma and effective surgical local control was not inferior to that of 483 equally evaluable patients with extremity tumors. In conclusion, while secondary systemic spread of axial osteosarcoma may be avoided in patients treated with multiagent chemotherapy, successful treatment is often barred by primary metastatic disease and inability to control the local tumor site.

Adolescent↗

PubMed2001

Histologic response of high-grade nonmetastatic osteosarcoma of the extremity to chemotherapy,.

In 510 patients with osteosarcoma of the extremity treated at the authors' institute between March 1983 and June 1995 with different regimens of neoadjuvant chemotherapy, factors that influenced the histologic response were investigated. The rate of total necrosis was not related to the patients' gender, age, site, size of tumor, serum of alkaline phosphatase values, or route of cisplatin administration. The histologic response significantly and independently correlated with the number of drugs administered before surgery and with the histologic subtype of the tumor. According to the number of drugs used, the percentage of total necrosis was 31% for a four-drug regimen, 18% for a three-drug regimen, and only 1.5% for a two-drug regimen. According to the histologic type, the rates of total necrosis were 41% for telangiectatic tumors, 36% for fibroblastic tumors, 15% for osteoblastic tumors, and 3% for chondroblastic tumors. The authors concluded that in neoadjuvant therapy of osteosarcoma, the histologic response to preoperative treatment, which correlates with prognosis, depends on the effectiveness of the chemotherapy regimen and on some features intrinsically inherent to the tumor. These data should be considered when selecting the type of treatment (adjuvant or neoadjuvant) and the combinations of drugs to be used in preoperative treatment of patients with osteosarcoma.

Adolescent↗

PubMed1997

Multimodal therapies in ductal pancreatic cancer. The future.

CONCLUSIONS: Intra-arterial infusion chemotherapy via the celiac axis combined with external beam radiotherapy might be an effective method for palliative and perioperative multimodal treatment in pancreatic cancer. To improve the dismal prognosis in resectable and nonresectable pancreatic cancer, the results of multimodal palliative, adjuvant, and neoadjuvant therapies were reviewed and put into perspective with the results of two intra-arterial palliative and adjuvant treatment studies conducted at our department. The benefits and pitfalls of each method were outweighed, resulting in a concept for performing intra-arterial chemotherapy with radiotherapy in nonresectable stage UICC-III pancreatic cancer that eventually will be developed as a combined neoadjuvant/adjuvant treatment of all potentially resectable ductal pancreatic carcinomas.

Carcinoma, Ductal, Breast↗

PubMedDate not supplied

Role of Magnetic Resonance Imaging in the prediction of tumor response in patients with locally advanced breast cancer receiving neoadjuvant chemo-therapy.

PURPOSE: To evaluate if dynamic contrast enhanced magnetic resonance can predict the tumoural response in patients with breast cancer undergoing neoadjuvant chemotherapy. MATERIALS AND METHODS: Twenty-six patients with biopsy-proven locally advanced breast cancer underwent taxane-based neoadjuvant chemotherapy followed by radical surgery. MRI evaluations were carried out at baseline, after two of the four planned cycles of chemotherapy, and before surgical treatment. MR images, obtained with 1.5 T scanner and using dedicated surface multichannel coil (GEMS), were acquired by 3D SPGR sequences on the coronal plane before and after intravenous administration of gadolinium chelate by an automatic injector. The percent reduction of the early contrast uptake between the baseline and the second MRI was then calculated for every lesion and correlated with the outcome of interest (pCR). RESULTS: At baseline, we identified 26 lesions and two patterns of MRI enhancement: homogeneous (group 1, 14 patients) and peripheral ring-like (group 2, 12 patients). At surgery, pathological complete response was observed in 4 patients (2 patients group 1, 2 patients group 2). In group 1, the 2 cases of pCR showed a gs;70% reduction in the early contrast uptake between baseline examination and after two cycles of chemotherapy, whereas values <70% were seen in 12 cases of partial response (p=0.02). In group 2, the 2 cases of pCR showed a gs; 40% reduction in the early contrast uptake whereas all of the 10 cases of partial response had <40% reduction (p=0.02). CONCLUSIONS: In our series, the percent reduction in the early contrast uptake after two cycles of neoadjuvant chemotherapy was predictive of the achievement of a pathological complete response. However, we identified two distinct morphologic patterns associated with different cut-offs in the predictive value of the early contrast uptake reduction between baseline and intermediate examination.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

[Effects of neoadjuvant chemotherapy on estrogen and progesterone receptors and HER-2 in breast cancer].

OBJECTIVE: To study the effect of neoadjuvant chemotherapy on estrogen receptor (ER), progesterone receptor (PR), and HER-2 expression in patients with breast cancer. METHODS: From 59 breast cancer patients treated with neoadjuvant chemotherapy and 33 without neoadjuvant therapy (control), core biopsy samples before the chemotherapy or surgery and surgical specimens were obtained for assay of ER, PR, and HER-2 expression. RESULTS: Quantitative alteration of ER expression occurred in 37.29% (22/59) of the patients after neoadjuvant chemotherapy and in 15.15% (5/33) of the control patients, showing statistically significant difference between the two groups (P<0.05), but the changes in ER expression status (conversion between positivity/negativity ratio) exhibited no significant difference. After the surgery, quantitative changes in PR expression was noted in 23.73% (14/59) of patients with neoadjuvant chemotherapy, without significant difference from those in the control group or changes in the expression status. Similarly, the changes in HER-2 expression seen in 13.56% (8/59) of the patients with chemotherapy was also comparable with the control group, without significant changes in the expression status. CONCLUSIONS: Significant changes occur in ER receptor expression after neoadjuvant chemotherapy in patients with breast cancer, but such changes do not affect the ER status. Neoadjuvant chemotherapy has no significant effects on PR and HER-2 expression in breast cancer patients.

Adult↗

PubMed2000

[Neoadjuvant and adjuvant therapy of ductal pancreatic carcinoma].

The optimal oncological management of ductal pancreatic cancer remains undefined. More than 60% of these patients have disseminated disease at the time of presentation. Here radical surgery alone cannot guarantee a cure. Even in the best case of a R0-resection with extended lymph node dissection the reported 5-year survival rates of 20-30% are dissatisfying. This would suggest that neoadjuvant or adjuvant therapies may play an even greater role in improving the medium and long-term survival rates than in other tumor entities. Reports in the literature to date are from small randomised trials which do not elucidate the benefit of therapy. However, it does appear that neoadjuvant radiochemotherapy in combination with R0-resection will best improve patient outcome and mean survival rates. Therefore there is a need for large prospective randomized studies regarding (neo-)adjuvant therapy. Inclusion criteria must be precisely defined and the following factors recorded: standardized preoperative staging procedures extent of tumor disease (histology, stage, vascular infiltration, lymph node involvement, etc.) detailed surgical approach in respect to the extent of pancreas resection and lymph node dissection. Pancreas resections tend to have a higher postoperative complication rate when compared with other tumours and substantial postoperative weight loss often is observed. This may result in a delay or even impossibility of starting adjuvant therapy right in time in a relevant part of patients (up to 1/3 according to literature data) which is a major disadvantage of all adjuvant therapy concepts.

Adenocarcinoma↗

PubMedDate not supplied

Systemic therapy of breast cancer in early and advanced disease.

Despite substantial advances in breast cancer treatment, mortality from this disease remains high. While adjuvant chemo-hormonal therapy has significantly improved survival, breast cancer still claims the lives of more than 45,000 American women each year. This article is a brief review of various modalities used in the management of breast cancer, including adjuvant and neoadjuvant therapy, treatment for advanced disease, dose intensification, and autologous bone marrow transplantation.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1999

Surgical Approaches to Esophageal Cancer.

BACKGROUND: Esophageal cancer is a highly lethal malignancy. Esophageal resection remains the primary treatment in most centers. A number of approaches to esophageal resection have been described. METHODS: The authors review the current approaches to esophageal resection and adjuvant therapy for esophageal cancer. RESULTS: Transthoracic, transhiatal, and minimally invasive techniques are currently employed in esophageal surgery for malignancy. A number of authors favor extended mediastinal and cervical lymphadenectomy in hopes of improving survival. Combined chemotherapy and radiotherapy in the neoadjuvant setting appears to offer some promise. CONCLUSIONS: No consensus of opinion exists regarding the optimal approach or extent of esophageal resection for cancer. Prospective, randomized trials of neoadjuvant therapy may determine its efficacy. Newer approaches may enhance quality of life.

Journal Article↗