[Mono- and poly-chemotherapy, adjuvant chemotherapy, and combined treatments of cancers in adults].
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Adult↗
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Perioperative adjuvant chemotherapy in breast cancer. The Scandinavian Adjuvant Chemotherapy Study 1.
In a randomized study of operable primary breast cancer patients initiated January 1965, 507 patients received one single course with cyclophosphamide 5 mg/kg/day for six days, first dose given immediately after mastectomy. The 519 control patients received no adjuvant chemotherapy. In other respects both groups were treated equally. Median follow-up time is 17.1 years. In terms of relapse-free percentage, the difference between the groups after 20 years is 13.5% in favour of the cyclophosphamide group. The difference is statistically highly significant. This benefit is observed in node positive as well as in node negative patients, and over as well as under 50 years. The immediate side effects of the cyclophosphamide course have been very moderate. No late complications have been observed. In a parallel randomized study with 110 patients where the same course was given 2-4 weeks after mastectomy, no benefit could be observed.
Aged↗
Systemic doxorubicin and intraarterial cisplatin preoperative chemotherapy plus postoperative adjuvant chemotherapy in patients with osteosarcoma.
The role of adjuvant chemotherapy for osteosarcoma has been well defined. Recently, the use of preoperative chemotherapy has been further enhanced by the use of intraarterial cisplatin. The authors describe the use and results of systemic doxorubicin and intraarterial cisplatin as a preoperative regimen for eight pediatric patients with nonmetastatic osteosarcoma of an extremity. The therapy was well tolerated. Six patients achieved satisfactory local tumor control and were able to receive the surgical procedure to permit limb salvage. Two of these six patients subsequently developed metastatic disease. Of the two patients who did not achieve satisfactory local tumor control to permit a limb salvage procedure, both underwent amputation and one later developed metastatic disease. Five patients have remained continuously free of disease for a median of 18 months (range, 12-21 months). This report confirms the observations that intraarterial cisplatin and doxorubicin can be used as a safe and effective regimen preoperatively for pediatric patients with osteosarcoma of an extremity.
Adolescent↗
Primary chemotherapy and postoperative adjuvant chemotherapy in the treatment of squamous cell carcinoma of the uterine cervix.
Two cases with squamous cell carcinoma of the cervix stage IIB with primary tumor mass about 2 X 2 X 2 cm were treated with primary chemotherapy of cis-platinum, 20 micrograms/m2 body surface intravenously daily for 5 consecutive days. Papanicolaou smear turned negative after two courses of chemotherapy in both cases. One of those was followed by radical hysterectomy with lymphadenectomy which confirmed that there was no evidence of disease by histopathology. The third case with stage IIIB and bulky tumor with involvement of pelvic and left common iliac lymph nodes was treated with simple hysterectomy followed by adjuvant chemotherapy with the same medication described above. Complete responses were obtained in all three cases and they are now doing well in a tumor-free state for 26, 30, and 28 months, respectively.
Carcinoma, Squamous Cell↗
Prolonged adjuvant chemotherapy in breast cancer. The Scandinavian Adjuvant Chemotherapy Study 2.
Eleven hundred and sixteen primary female breast cancer patients received one short perioperative chemotherapy course. The node negative patients were randomised between immunotherapy (corynebacterium parvum s.c. around the scar 2 weeks after mastectomy), or no further adjuvant therapy. A moderate, but significant delaying effect was observed, without side effects. The node positive patients were randomised to four groups: 1) the same immunotherapy as in the node negative patients, 2) CMF for 1 year, 3) combination of these two treatments, or 4) no further adjuvant therapy. The prolonged chemotherapy had a significant positive effect, but also considerable and distressing side effects. The immunotherapy had a non-significant negative effect in the node positive patients, but without side effects.
Antineoplastic Combined Chemotherapy Protocols↗
[Treatment with UFT as surgical adjuvant chemotherapy in carcinoma of large intestine. Cooperative Study Group of Surgical Adjuvant Chemotherapy for Colorectal Cancer in Japan].
The therapeutic results of the method II of the second study of the Cooperative Study Group of Surgical Adjuvant Chemotherapy for Colorectal Cancer in Japan were retrospectively reviewed and the relations of the 3-year survival rate to the dose of UFT per body weight as well as per kg of the patient and discontinuation of the treatment with UFT were investigated. The dose per day of UFT was randomly divided into group C (treated with UFT 600 mg/body/day) and group D (treated with UFT 400 mg/body/day for 12 months) by the envelope method. The 3-year survival rate of the patients whose body weight was 50 kg or more was higher than in the patients weighting less than 50 kg. The 3-survival rate of the patients treated with UFT from 8 to less than 12 mg/kg was the highest, while that of the patients treated with UFT of more than 12 mg/kg was the lowest. However, no statistical difference was observed between the two groups. The same results were observed in carcinoma of the colon and rectum, respectively. The findings indicated that the administration of excess amount of UFT was not effective. The relation between the 3-year survival rate and discontinuation of treatment with UFT was investigated at 6, 9 and 12 months after administration with UFT. The prognostic background factors of the C-group and the D-group were compared, but no difference was observed between the 2 groups at 9 months after administration. The 3-year survival rate of the patients treated continuously with UFT was higher than that of discontinued administration. The difference was especially evident in carcinoma of the colon, and good results were observed in cases treated continuously than in discontinued cases in both C- and D-groups.
Antineoplastic Combined Chemotherapy Protocols↗
[Cooperative study of surgical adjuvant chemotherapy of colorectal cancer (first report): Investigation of background factors and adverse effects. Cooperative Study Group of Surgical Adjuvant Chemotherapy of Colorectal Cancer in Japan].
In order to evaluate the efficacy of surgical adjuvant chemotherapy in patients undergoing gross curative resection for colorectal cancer (excluding m and sm cancer), a randomized controlled study was conducted from January, 1982 to October, 1983. Four hundred and ninety-one institutions participated in this study. The schedules for drug administration differed according to each district. In the Hokkaido and Shikoku districts, the patients were divided into the following two groups, one was a combination of ACNU and Futraful (FT) and the other was FT only. In the Chubu and Kinki districts, three groups were studied, namely those receiving a combination of ACNU and FT, those receiving FT only and those given no adjuvant chemotherapy. In the Tohoku and Kanto districts, a combination of MMC and FT and administration of FT only were studied. In the Chugoku and Kyushu districts, the patients were divided into a combination of ADM and FT, and FT only group. Among the 3,926 registered cases, 3,421 cases were valid for the study. As to the background factors, there were no significant differences among the groups in each district. There were no significant differences in one-year survival rates and one-year disease-free rates. No serious adverse effects were observed in any of the groups.
Alopecia↗
[Mitomycin C plus HCFU adjuvant chemotherapy for noncuratively resected cases of colorectal carcinoma. (Second report): 5-year survival rate. Cooperative Study Group of Kyushu and Chugoku for HCFU Adjuvant Chemotherapy].
In order to examine the efficacy of adjuvant chemotherapy employing mitomycin C (MMC) and carmofur (HCFU) for patients with noncuratively resected colorectal carcinoma, a cooperative study was performed by 54 institutions in the Kyushu and Chugoku areas of Japan. The criteria for patient selection were as follows: 1) Age of 75 years or less and not accompanied by any serious disease. 2) Macroscopic diagnosis as being noncuratively resected on completion of the surgical procedure. 3) Definitive diagnosis of colorectal carcinomas, histologically. 4) No synchronous or metachronous double cancer. The prospective randomized controlled study consisted of two groups. In Group A, the MMC group received bolus intravenous injections of 20 mg MMC on the day of operation and 10 mg the next day, followed by 10 mg every 4 weeks until a total of 100 mg had been administered. In Group B, the MMC + HCFU group received the same treatment in Group A, but with the addition of 600 mg/day of HCFU from the second week, orally for at least one year. Concerning the 69-month survival rate, a better result was observed in the MMC + HCFU group than in the MMC only group (generalized Wilcoxon test: p less than 0.05). Significantly better survival rates were obtained in those cases with disseminating peritoneal metastasis, hepatic metastasis and stage V cancer in the MMC + HCFU group as when compared with the MMC only group. No significant side effects due to the combined administration of HCFU were recognized. The combined administration of MMC and HCFU was suggested to be a safe and effective adjuvant chemotherapy for noncuratively resected cases of colorectal carcinoma.
Antineoplastic Combined Chemotherapy Protocols↗
[Cooperative study of surgical adjuvant chemotherapy of colorectal carcinoma (second study): a preliminary report. Cooperative Study Group of Surgical Adjuvant Chemotherapy of Colorectal Cancer in Japan].
In a prospectively randomized study, the effect of adjuvant chemotherapy with mitomycin C (MMC) and tegafur (FT) on survival and recurrence was analyzed in 2,477 evaluable patients with colon or rectal cancer who underwent macroscopically curative resection. Patients (1,256 with colon cancer, 1,221 with rectal cancer) were divided into the treatment group (group A) and the control group (surgical resection only, group B). In group A, chemotherapy consisted of intravenous administration of MMC (12 mg/m2 on operative day, followed by 6 mg/m2/2 months, 6 times) and oral administration of FT (800 mg/day for one year). No serious adverse effects were observed in the treatment group. There was no significant difference between group A and group B in three-year survival rate. The disease-free interval curve in group A of rectal cancer revealed significantly better results than group B (p = 0.044). There was no difference in the incidence of local recurrence at three years after operation between group A and group B. The incidence of metachronous liver metastases in group A of rectal cancer was significantly lower than in group B (p = 0.036).
Antineoplastic Combined Chemotherapy Protocols↗
[A cooperative study of surgical adjuvant chemotherapy of colorectal cancer (second report): 3-year survival rate. Cooperative Study Group of Surgical Adjuvant Chemotherapy of Colorectal Cancer in Japan].
To evaluate the efficacy of surgical adjuvant chemotherapy for patients with curatively resected colorectal cancer (excluding m and sm cancer), a randomized controlled study was performed from January 1982 to October 1983. The schedules for drug administration were different in four districts, and four randomly assigned protocols were studied using tegafur (FT), ACNU, MMC and ADM. A total of 4,906 cases from 491 institutions were entered and 4,206 cases were varied for the study. There were no significant differences in 3-year survival rate in each district protocol. According to Dukes C for rectal cancer patients, ADM + FT group was higher than the FT only group in 3-year survival rate (p = 0.092) and had a significantly longer survival than FT only group in 3-year disease-free rate (p = 0.011). The rate of local recidivation in colon cancer resected curatively was higher in ACNU + FT group than in FT only group (p less than 0.05). A tendency for decreased liver metastasis was observed in FT group compared with the control group, and liver metastasis of ADM + FT group was lower than that of FT only group. No serious adverse effects were observed in any protocol.
Antineoplastic Combined Chemotherapy Protocols↗
[Cooperative study of surgical adjuvant chemotherapy for colorectal cancer (third report): five-year results. Cooperative Study Group of Surgical Adjuvant Chemotherapy for Colorectal Cancer in Japan].
A randomized controlled study was carried out by the envelope method with 491 institutions in participation across the country in order to find an optimal surgical adjuvant chemotherapy for curatively resected colorectal cancer. The schedules for drug administration were different in four districts: ACNU + Futraful (FT) group and FT alone group in the Hokkaido-Shikoku district; the same schedule groups plus untreated group in the Chubu-Kinki district; MMC+FT group, FT alone group in the Tohoku-Kanto district; and ADM+FT group and FT alone group in the Chugoku-Kyushu district. The numbers of patients admitted to this study were 2,450 cases with colon cancer and 2,456 cases met the evaluation criteria of this study. The 5-year survival rate on the whole did not differ from combination therapy to single drug therapy in either colon cancer or rectal cancer, but in Dukes C rectal cancer the five-year survival rate tended to be higher with the combination therapies. In n2 (+) or a2(s) rectal cancer in particular, combination therapies with MMC and FT and with ADM and FT achieved significantly higher five-year survival rate, and the rate of local recurrence was significantly lower with ADM+FT.
Antineoplastic Combined Chemotherapy Protocols↗
[Prospective adjuvant chemotherapy of mitomycin C plus HCFU for colorectal cancer (2d report)--6-year survival after surgery: Tokai Cooperative Study Group of Surgical Adjuvant Chemotherapy].
A prospective randomized controlled trial of adjuvant chemotherapy for colorectal cancer was performed in forty-one institutions in Tokai district. In this study, effect of postoperative administration of mitomycin C (MMC) and followed by HCFU for more than 3 months (group B) was on the survival time compared with MMC alone (group A). Of 173 patients subjected to curative resection (group A = 80, group B = 93) for colorectal cancer, 148 patients including 69 cases of group A and 79 cases of group B were eligible for survival study. At six years after surgery, Kaplan-Meire's life table showed that the survival of group B was superior to that of group A (generalized Wilcoxon test: p = 0.0446). The difference of survival curves was more distinct (generalized Wilcoxon test: p = 0.0226) for patients of advanced stage those to have lymph node metastasis time and serosal inversion.
Adjuvants, Immunologic↗
[Cooperative study of surgical adjuvant chemotherapy of colorectal carcinoma (second study): 3-year survival after surgery of non-curatively resected patients. Cooperative Study Group of Surgical Adjuvant Chemotherapy of Colorectal Cancer in Japan].
A prospective randomized study was carried out to evaluate the efficacy of surgical adjuvant chemotherapy for non-curatively resected colorectal carcinoma patients as a collaborative study at 428 institutes in Japan from Jan., 1984 to Dec., 1985. A total of 1,138 patients were entered in this study. All patients were divided according to disease location (colon or rectum) and received one of two chemotherapeutic regimens after surgery (Regimen C: MMC 12 mg/m2 i.v. at operation day and 6 mg/m2 in every 2 months +UFT 600 mg/day p.o., D: the same dose of MMC + UFT 400 mg/day p.o.) randomly. 556 cases (colon carcinoma regimen C: 148, D: 185 cases, rectal carcinoma regimen C: 94, D: 129 cases) were evaluable at this presentation. Three-year-survival rate of histologically confirmed non-curatively resected colon carcinoma patients was higher in the group receiving regimen C than in regimen D. But no significant difference was found among the other groups.
Antineoplastic Combined Chemotherapy Protocols↗
Combination chemotherapy and surgical adjuvant chemotherapy on MS-2 sarcoma and lung metastases in mice.
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Animals↗
Adjuvant chemotherapy.
At present, adjuvant chemotherapy exerts no significant impact on long-term survival and only occasionally provides brief palliation in head and neck cancer. The major contribution of chemotherapy has been in the preoperative period, when therapy for advanced squamous cell carcinoma may render some patients candidates for curative operations or radiotherapy. This article discusses the use of single-agent chemotherapy, combination chemotherapy, and combination irradiation and surgery as well as the advantages of adjuvant chemosurgery.
Antineoplastic Agents↗
Adjuvant chemotherapy of solid tumors.
Adjuvant chemotherapy for microscopic disease following eradication of clinically detectable lesions by primary surgery and/or radiotherapy is of documented benefit for some oncology patients. However, for many primary cancers efficacy is limited to specific subgroups of patients or has demonstrated no advantage over primary therapy alone. The rationale for adjuvant chemotherapy and results of selected trials are reviewed. In patients for whom adjuvant therapy is of demonstrated benefit, further trials aimed at delineation of patient selection factors, optimal chemotherapy regimens and schedules, and duration of therapy are needed; progress in adjuvant treatment of other subgroups may require development of more effective antineoplastic drugs, in addition to exploration of these factors.
Breast Neoplasms↗
[Adjuvant chemotherapy after cystectomy of bladder tumor].
Adjuvant chemotherapy mainly consisting of cisplatin, adriamycin and mitomycin C was administered to 17 patients after cystectomy for bladder tumor (chemotherapy group). Seventeen concurrently treated patients did not receive adjuvant chemotherapy (control group). From the comparison of survival curves of these two groups, the following results were obtained. 1) Survival curves of the patients in all stages did not differ significantly between chemotherapy and control groups. 2) Among patients in stage pT3, pT4 and/or N+, survival of the chemotherapy group seemed to have some advantage over that of the control group, but the survival curves did not differ significantly between these two groups. 3) Among patients in N+, survival of the chemotherapy group was far better than that of the usual cases. Review of the literature on adjuvant chemotherapy after cystectomy for bladder tumor revealed the necessity of randomized study to determine whether adjuvant chemotherapy is effective.
Aged↗
[Adjuvant chemotherapy of colorectal carcinoma].
Clinical studies on adjuvant chemotherapy in colorectal cancer started 30 years ago, but some proof of its effectiveness did not come until recently. Only randomized prospective studies can provide definite evidence in this regard. Obviously, the potential value of an effective adjuvant treatment for a frequent disease such as colorectal cancer is enormous. Randomized studies had failed to provide evidence in favour of adjuvant chemotherapy in colon cancer until a recently reported study on 5-fluorouracil and levamisole. As of today, the latter regimen may be considered as the reference one for adjuvant chemotherapy in Dukes C colon cancer. In rectal cancer some studies displayed statistically significant results in favour of adjuvant chemotherapy: however, sufficient data are still unavailable to support adjuvant chemotherapy as standard treatment. On the contrary, postoperative radiotherapy is definitely effective in decreasing local relapses. Studies are underway on the combination of chemotherapy and radiotherapy in rectal cancer. In addition to systemic chemotherapy, portal infusion of cytotoxic drugs has been tested in colorectal cancer. Controlled studies are underway, but available results would not seem to support regional treatment. Recent improvement in the chemotherapy of advanced colorectal cancer has probably occurred through the pharmacologic modulation of 5-fluorouracil by leucovorin. If this will be confirmed, one will be able to resort to more effective multidrug regimens than those tested so far and an improvement in adjuvant chemotherapy may be anticipated too.
Antineoplastic Combined Chemotherapy Protocols↗