ObjectiveTo study the latest progress of neoadjuvant chemotherapy in breast cancer. MethodsLiteratures of neoadjuvant chemotherapy in breast cancer, involving with theoretical basis, clinical significance, indications, drugs, predictors, and its relationship of breastconserving surgery, sentinel lymph node biopsy were reviewed. ResultsNeoadjuvant chemotherapy could reduce the clinical stage, increase opportunity of breast-conserving surgery, learn the sensitivity of drugs, prevent distant metastases, but the impact of the sentinel lymph node biopsy was still in dispute. ConclusionNeoadjuvant chemotherapy is an important part of a systemic treatment for breast cancer, but how to select sensitive drugs, develop individualized treatment programs and forecast the outcome needs further study.
Objective To investigate the advances and clinical efficacy evaluation method on neoadjuvant chemotherapy in patients with gastric cancer. Methods Literatures on the advances and clinical efficacy evaluation method on neoadjuvant chemotherapy in patients with gastric cancer were reviewed and analyzed. The agreement between computed tomography (CT), endoscopic ultrasound (EUS), magnetic resonance imaging (MRI) and positron emission tomography (PET) and the results of histopathology and survival was analyzed.Results CT and EUS were the method of efficacy evaluation commonly used at present, but the evaluation indexes and criteria were controversial, and the criteria for solid tumors seemed to be not feasible for gastric cancer. Diffusionweighted imaging (DWI) method needed more investigation, while PET held advantage in early selection of patients without response accurately.Conclusion There is no uniform standard for clinical efficacy evaluation yet, so an integration of diverse imaging methods may be the best choice to improve the accuracy of neoadjuvant chemotherapy in patients with gastric cancer.
Objective To investigate the effect of FLEEOX regiment on nutritional status of advanced gastric cancer patients after neoadjuvant chemotherapy. Methods Forty-eight cases of advanced gastric cancer patients from December 2010 to October 2011 in this hospital were included into. The indexes of body composition and the blood related nutritional indicators before and after neoadjuvant chemotherapy were determined. Results After neoadjuvant chemotherapy，the body weight，intracellular fluid，body mass index，protein，body fat，body cell mass，and arm circumference mildly decreased；extracellular fluid，body water content，inorganic salts，bone mineral content，non-fat group，skeletal muscle，and arm muscle circumference mildly increased，but the differences were not statistically significant （P＞0.05）. The blood albumin，prealbumin，total protein，transferrin，and lymphocytes decreased at different degrees down，but the differences were not statistically significant （P＞0.05）. Conclusion Patients have no obvious changes in nutritional status during chemotherapy of FLEEOX regiment.
Objective To summarize the current value of neoadjuvant chemotherapy (NAC) for potentially resectable gastric cancer. Methods The recent 5-year literatures searched through the PubMed with the key words: stomach neoplasm, gastric cancer/carcinoma, neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed. The present status of NAC for advanced gastric cancer was summarized, the necessity and feasibility were evaluated, and the patients features for selecting, the predictors for response, the mainly existing problems and development trend of NAC were analyzed. Results At present, there were 7 randomized control trails (RCT) published, and among them 3 were phase Ⅲ. It was safe, effective and feasible to most of trails in NAC for gastric cancer. However, it was still little to obtain survival benefit for NAC RCT, and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy. It remained lots of problems such as how to select the appropriate patients, the effective induced regimes and the predicted factors, the evaluated indices for response. Conclusion NAC is a safe, feasible and efficient method to potentially resectable gastric cancer, but strict phase Ⅲ randomized trials are needed. In the future, substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
Objective To investigate the influencing factors for the clinical remission of advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemotherapy, establish an individualized nomogram model to predict the clinical remission of advanced ESCC with neoadjuvant chemotherapy and evaluate its efficacy, providing serve for the preoperative adjuvant treatment of ESCC.Methods The clinical data of patients with esophageal cancer who underwent neoadjuvant chemotherapy (nedaplatin 80 mg/m2, day 3+docetaxel 75 mg/m2, day 1, 2 cycles, 21 days per cycle interval) in the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from February 2016 to August 2020 were analyzed retrospectively. According to the WHO criteria for efficacy assessment of solid tumors, tumors were divided into complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD). CR and PR were defined as effective neoadjuvant chemotherapy, and SD and PD were defined as ineffective neoadjuvant chemotherapy. Univariate and multivariate analyses were used to analyze the influencing factors for the short-term efficacy of neoadjuvant chemotherapy. The R software was used to establish a nomogram model for predicting the clinical remission of advanced ESCC with neoadjuvant chemotherapy, and Bootstrap method for internal verification of the model. C-index, calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the predictive performance of the nomogram.Results Finally 115 patients were enrolled, including 93 males and 22 females, aged 40-75 (64.0±8.0) years. After receiving docetaxel+nedaplatin neoadjuvant chemotherapy for 2 cycles, there were 9 patients with CR, 56 patients with PR, 43 patients with SD and 7 patients with PD. Among them, chemotherapy was effective (CR+PR) in 65 patients and ineffective (SD+PD) in 50 patients, with the clinical effective rate of about 56.5% (65/115). Univariate analysis showed that there were statistical differences in smoking history, alcoholism history, tumor location, tumor differentiation degree, and cN stage before chemotherapy between the effective neoadjuvant chemotherapy group and the ineffective neoadjuvant chemotherapy group (P<0.05). Logistic regression analysis showed that low-differentiation advanced ESCC had the worst clinical response to neoadjuvant chemotherapy, moderately-highly differentiated ESCC responded better (P<0.05). Stage cN0 advanced ESCC responded better to neoadjuvant chemotherapy than stage cN1 and cN2 (P<0.05). The C-index and the area under the ROC curve of the nomogram were both 0.763 (95%CI 0.676-0.850), the calibration curve fit well, the best critical value of the nomogram calculated by the Youden index was 70.04 points, and the sensitivity and specificity of the critical value were 80.0% and 58.0%, respectively.ConclusionThe established clinical prediction model has good discrimination and accuracy, and can provide a reference for individualized analysis of the clinical remission of advanced ESCC with neoadjuvant chemotherapy and the screening of new adjuvant treatment subjects.
Objective To evaluate the effect of neoadjuvant chemotherapy (NAC) on breast conserving surgery and the outcomes of treatment for women with operable breast cancer. Methods We searched The Cochrane Library (Issue 1, 2007), CENTRAL (1970 to 2007), PUBMED (1978 to March 2007), CBM (1978 to 2006), CNKI (1994 to 2007), CMCC (1994 to May 2007) and other relevant databases and journals. We identified randomized controlled trials (RCTs) comparing NAC plus breast conserving therapy (BCT) or mastectomy versus BCT or mastectomy plus postoperative chemotherapy in women with operable breast cancer. Two reviewers independently assessed trial quality and extracted data. Meta-analyses were performed for homogenous studies by using The Cochrane Collaboration’s RevMan 4.2.10. Results Three eligible studies involving 2?391 women were included. The median follow-up in the studies ranged from 17 to 137 months. The methodological quality of the three RCTs was high. Meta-analyses showed that NAC had no significant effect on overall survival (OS) (RR 0.99, 95%CI 0.92 to 1.07), disease-free survival (RR 1.04, 95%CI 0.94 to 1.15) and ipsilateral breast cancer recurrence (RR 1.34, 95%CI 0.84 to 2.13). Two RCTs revealed that NAC significantly increased the rate of BCT in operable breast cancer patients, but the other RCT reported similar rates of BCT in both groups. One RCT indicated that NAC did not increase the incidence of surgery-related local complications. Conclusions NAC is safe for the treatment of women with operable breast cancer, which may increase the rate of BCT and help to evaluate chemosensitivity. There is insufficient evidence to assess the effect of NAC on conserving surgery procedure and survival rate in operable BCT patients. More large-scale RCTs are needed to define further the role of NAC in the treatment of operable breast cancer patients.
ObjectiveTo evaluate the effects of CTX, EADM, VCR, and Pred (CHOP) as preoperative regional intra-arterial infusion chemotherapy in primary gastric malignant lymphoma (PGML). MethodsForty-one patients with PGML underwent preoperative regionalarterial infusion chemotherapy. The regimen consisting of CTX 600 mg/m2, EADM 50 mg/m2, VCR 1.4 mg/m2, and Pred 60 mg/m2, was administrated 14－21 d before operation. Another 33 patients with similar PGML during the same period underwent surgery directly. The response of the tumor and chemotherapy toxicity were observed, together with the survival of the cases. ResultsAmong the 33 patients undergoing surgery directly, 24 cases (72.7%) had curative resection, the 5-year survival rate was 58.3% (14/24). All 41 patients of the neoadjuvant chemotherapy group completed the planned regimen of chemotherapy and surgery successfully. The most common related adverse effects were grade Ⅰ-Ⅱ gastrointestinal discomfort (22 cases) and bone marrow suppression (14 cases). Thirtyseven cases (90.2%) underwent curative resection, the 5year survival rate was 67.7% (21/31). There was no significant difference between two groups in 5year survival rate (χ2=0.517， P＝0.471), while with significant difference in curative resection rate (P＝0.041). ConclusionsNeoadjuvant intra-arterial infusion chemotherapy (CHOP) has been wellrated; it appears to have improved the resectable rate of the PGML patients studied.
【Abstract】Objective Through using neoadjuvant chemotherapy of different circles combined colorectal cancer operations under multi-disciplinary team (MDT), we evaluate effective treatment strategies that suit to colorectal cancer patients in this country. Methods The retrospective study reviewed patients with colorectal cancer treated in general surgery department Ⅲ in West China Hospital of Sichuan University from October 2006 to April 2007. According to the circle times of neoadjuvant chemotherapy, the patients were divided into single-circle group, double-circle group and triple-circle group. And comparing the difference of treatment time, effect index of neoadjuvant chemotherapy and operative results used these stratagies. Results The difference between the time from the end of neoadjuvant chemotherapy to the operation in three groups had no statistical significance （Pgt;0.05）, which were （5.64±2.00） d in single-circle group, (5.80±3.74） d in double-circle group, （6.22±2.76） d in triple-circle group. According to the treatment effects, CEA value decreased during pre- and post-neoadjuvant chemotherapy in each groups （Plt;0.01）. Subjective reception such as hemafecia, anal tenemus and defecation obstruction in double-circle group and triple-circle group were obviously improved than that in single-circle group （Plt;0.01）. Evaluating the tumor condition, the ratio of CR and PR in double-circle group and triple-circle group was higher than that in single-circle group （Plt;0.01）. According to the adverse effect, WBC value of double-circle group and triple-circle group decreased during pre- and post-neoadjuvant chemotherapy, their difference had statistical significance （Plt;0.01）. The difference of WBC pre- and post- neoadjuvant chemotherapy in single-circle group decreased fewer than that in double-circle group and triple-circle group （Plt;0.01）. Nausea and vomit response in triple-circle group were obviously more serious than that in single-circle group and double-circle group （Plt;0.01）. But abdominal distention and diarrhea response had no difference among three groups （Pgt;0.05）. Through our survey, used different neoadjuvant chemotherapy circle, patients in single-circle group and double-circle group were completely accepted within full confidence; but receptance of strategy in triple-circle group was 66.7％(12/18）. All operations were successful. The difference of postoperative aerofluxus time between single-circle group and double-circle group had statistical significance （Plt;0.05）. The difference of postoperative intake time, between triple-circle group and single-circle group, between triple-circle group and double-circle group, had statistical significance （Plt;0.05）. But wound recover time among three groups had no obvious difference （Pgt;0.05）. Conclusion Analyzing neoadjuvant chemotherapy circles, time between neoadjuvant chemotherapy and operation, treatment effect and operation results, it is a feasible and secure colorectal cancer multi-discipinary strategy for patients in West China that choose the treatment of neoadjuvant chemotherapy with double-circle and short preparation time.
Objective To assess the clinical efficacy of neoadjuvant chemotherapy （NAC） for breast invasive ductal carcinoma with MR diffusion weighted imaging. Methods Thirty patients with breast invasive ductal carcinoma underwent conventional MRI scanning and diffusion weighted imaging examination before and after preoperative neoadj-uvant chemotherapy. Two experienced radiologists independently analyzed and measured the maximum lesion diameter and apparent diffusion coefficient （ADC） values before and after treatment，respectively. Statistical analysis was performed for testing the tumor maximum diameter and ADC values ??change by using the paired t-test. Results After NAC treatment，the maximum tumor diameter of invasive ductal breast carcinoma sharply reduced〔（4.33±0.83） cm vs. （2.04±0.64） cm，P＜0.001〕. When b value was 1 000，the mean ADC values of breast massess ??were significantly changed after NAC treatment〔（1.89±0.15） ×10-3mm2/s vs. （1.14±0.31） ×10-3mm2/s， P＜0.05〕. Conclusion MR diffusion weighted imaging can non-invasively and accurately assess the NAC efficacy， which are helpful for making surgical strategies.
Objective To explore the tumor shrinking model, the accurate image evaluation of the residual tumor, and the selection criteria for breast-conserving surgery after neoadjuvant chemotherapy. Methods To review literature on the clinical, imaging, and pathologic study of breast cancer after neoadjuvant chemotherapy. Results The possibility of breast-conserving for patients with large primary tumor is enhanced with neoadjuvant chemotherapy. The tumor shrinking mode after neoadjuvant chemotherapy and its correlation factors are still unclear. MRI is the most accurate image evaluation of the residual tumor at present. M.D.Anderson prognostic index and the American National Cancer Institute selection criteria for breast-conserving surgery after neoadjuvant chemotherapy are helpful for selection of surgical type. Conclusion Tumor shrinking mode and its accurate image evaluation is a key to the selection of breast-conserving surgery and the control of local recurrence after neoadjuvant chemotherapy, and is the research direction in future.
