Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age;however...Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age;however, primary high grade osteosarcoma usually occurs in the second decade of life. Historically patients with osteosarcoma were treated with immediate wide or radical amputation. Despite the treatment, 80% patients with apparently isolated disease died of distant metastases. In recent years the number of patients with osteosarcoma of the limb treated by amputation + chemotherapy has increased. In our study, we divided the patients into two groups. One group (A) was treated with amputation + adjuvant chemotherapy. The other group (B) was treated with neo-adjuvant chemotherapy + amputation followed by adjuvant-chemotherapy. In our study, the margin negativity in post surgical specimen was significantly higher (P-value 0.0007) for the group treated with neo-adjuvant chemotherapy. Local recurrence in the group treated without neoadjuvant chemotherapy was significantly more (P-value 0.0005).The systemic recurrence at the end of 6 months was higher the group treated without neoadjuvant chemotherapy (P-value 0.0169).However systemic recurrence between 6 months -1 year and 1 year - 2 years were not significant(P-values 0.1501 and 0.4902). From the above figures it may be concluded that treatment with neo-adjuvant chemotherapy + amputation + adjuvant chemotherapy had definite advantages over upfront amputation + adjuvant chemotherapy.)展开更多
In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to de...In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.展开更多
AIM To provide evidence regarding the postoperative treatment of patients with T4 b N1-3 M0/Tx N3 b M0 gastric cancer, for which guidelines have not been established. METHODS Patients who had undergone curative resect...AIM To provide evidence regarding the postoperative treatment of patients with T4 b N1-3 M0/Tx N3 b M0 gastric cancer, for which guidelines have not been established. METHODS Patients who had undergone curative resection between 1996 and 2014 with a pathological stage of T4 b N1-3 M0/Tx N3 b M0 for gastric cancer were retrospectively analyzed; staging was based on the 7 th edition of the American Joint Committee on Cancer staging system. The clinicopathological characteristics, administration of adjuvant chemotherapy, and patterns of recurrence were studied. Univariate and multivariate analyses of prognostic factors were conducted. The chemotherapeutic agents mainly included fluorouropyrimidine, platinum and taxanes, used as monotherapy, doublet, or triplet regimens. Patterns of first recurrence were categorized as locoregional recurrence, peritoneal dissemination, or distant metastasis.RESULTS The 5-year overall survival(OS) of the whole group(n = 176) was 16.8%, and the median OS was 25.7 mo(95%CI: 20.9-30.5). Lymphovascular invasion and a node positive rate(NPR) ≥ 0.8 were associated with a poor prognosis(P = 0.01 and P = 0.048, respectively). One hundred forty-seven(83.5%) of the 176 patients eventually experienced recurrence; the most common pattern of the first recurrence was distant metastasis. The prognosis was best for patients with locoregional recurrence and worst for those with peritoneal dissemination. Twelve(6.8%) of the 176 patients did not receive adjuvant chemotherapy, while 164(93.2%) patients received adjuvant chemotherapy. Combined chemotherapy, including doublet and triplet regimens, was associated with a better prognosis than monotherapy, with no significant difference in 5-year OS(17.5% vs 0%, P = 0.613). The triplet regimen showed no significant survival benefit compared with the doublet regimen for 5-year OS(18.5% vs 17.4%, P = 0.661). Thirty-nine(22.1%) patients received adjuvant chemotherapy for longer than six months; the median OS in patients who received adjuvant chemotherapy for longer than six months was 40.2 mo(95%CI: 30.6-48.2), significantly longer than the 21.6 mo(95%CI: 19.1-24.0) in patients who received adjuvant chemotherapy for less than six months(P = 0.001).CONCLUSION Patients with T4 b N1-3 M0/Tx N3 b M0 gastric cancer showed a poor prognosis and a high risk of distant metastasis. Adjuvant chemotherapy for longer than six months improved outcomes for them.展开更多
Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemot...Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemotherapy. In this study, we will examine accuracy and feasibility of using Sentinel lymph node biopsy in predicting axillary lymph node status in breast cancer patients after neoadjuvant chemotherapy. Methods: 45 female patients with resectable, nonmetastatic breast carcinoma cases who received neoadjuvant chemotherapy were enrolled in this study according to the routine Mansoura Oncology Center—guidelines of management of breast cancer. Methylene blue dye used for detection of Sentinel lymph node. Results: Successful Sentinel lymph node detection was 82.2%. Skin involvement (T4 disease) were linked to a low identification (P = 0.005). False negative rate equals 11/27 = (40.7%).With advancement of the stage of the tumor, the incidence of false negative results increases significantly (p = 0.012) with 95% confidence interval;1.2 - 5.4. Conclusion: Sentinel lymph node should be adopted to be the standard method for axillary staging with T1-3 tumors after receiving neoadjuvant chemotherapy, in T4 patients, it is associated with low detection rate & high false negative rate making it doubtful technique for axillary staging.展开更多
BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is...BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014.Patients with ypT0–1 disease and those who received ACTx were included.The 5-year overall survival(OS)and 5-year recurrence-free survival(RFS)were analyzed according to the status of the ACTx.RESULTS Of 520 included patients,413 received ACTx(ACTx group)and 107 did not(no ACTx group).No significant difference was observed in 5-year RFS(ACTx group,87.9%vs no ACTx group,91.4%,P=0.457)and 5-year OS(ACTx group,90.5%vs no ACTx group,86.2%,P=0.304)between the groups.cT stage was associated with RFS and OS in multivariate analysis[hazard ratio(HR):2.57,95%confidence interval(CI):1.07–6.16,P=0.04 and HR:2.27,95%CI:1.09–4.74,P=0.03,respectively].Furthermore,ypN stage was associated with RFS and OS(HR:4.74,95%CI:2.39–9.42,P<0.00 and HR:4.33,95%CI:2.20–8.53,P<0.00,respectively),but only in the radical resection group.CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement,regardless of the radicality of resection.Further trials are needed to evaluate the efficacy of ACTx in these group of patients.展开更多
Background Accurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant ...Background Accurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant chemotherapy （NAC） include physical examination （PE）, ultrasound （US）, and magnetic resonance imaging （MRI）. The purpose of this study was to evaluate the accuracy of PE, US, and MRI in predicting the response to NAC in patients with breast cancer. Methods According to the response evaluation criteria in solid tumors guidelines, the largest unidimensional measurement of the tumor diameter evaluated by PE, US, and MRI before and after NAC was classified into four grades, including clinical complete response, clinical partial response, clinical progressive disease, clinical stable disease, and compared with the final histopathological examination. Results Of the 64 patients who received NAC, the pathologic complete response （pCR） was shown in 13 of 64 patients （20%）. The sensitivity of PE, US, and MRI in predicting the major pathologic response was 73%, 75%, and 80%, respectively, and the specificity was 45%, 50%, and 50% respectively. For predicting a pCR, the sensitivity of PE, US, and MRI was 46%, 46%, and 39%, respectively, and the specificity was 65%, 98%, and 92% respectively. Conclusions Compared with final pathologic findings, all these three clinical and imaging modalities tended to obviously underestimate the pCR rate. A more appropriate, universal, and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.展开更多
Objective： To study the effect of Aidi Injection （艾迪注射液,ADI） applied in the bronchial artery infused （BAI） neo-adjuvant chemotherapy for stage ⅢA non-small cell lung cancer （NSCLC） before surgical operati...Objective： To study the effect of Aidi Injection （艾迪注射液,ADI） applied in the bronchial artery infused （BAI） neo-adjuvant chemotherapy for stage ⅢA non-small cell lung cancer （NSCLC） before surgical operation.Methods： The 60 patients with NSCLC stage ⅢA underwent two courses BAI chemotherapy before tumor incision were assigned to two groups,the treatment and the control groups,using a random number table,30 in each group.ADI （100 mL） was given to the patients in the treatment group by adding into 500 mL of 5% glucose injection for intravenous dripping once daily,starting from 3 days before each course of chemotherapy,and it lasted for 14 successive days,so a total of 28 days of administration was completed.The therapeutic effectiveness and the adverse reaction that occurred were observed,and the levels of T-lymphocyte subsets,natural killer cell activity,and interleukin-2 in peripheral blood were measured before and after the treatment.Results： The effective rate in the treatment group was higher than that in the control group （70.0% vs.56.7%,P〈0.05）.Moreover,as compared with the control group,the adverse reaction that occurred in the treatment group was less and mild,especially in terms of bone marrow suppression and liver function damage （P〈0.05）.Cellular immune function was suppressed in NSCLC patients,but after treatment,it ameliorated significantly in the treatment group,showing significant difference as compared with that in the control group （P〈0.05）.Conclusion： ADI was an ideal auxiliary drug for the patients in stage ⅢA NSCLC received BAI neo-chemotherapy before surgical operation;it could enhance the effectiveness of chemotherapy,ameliorate the adverse reaction and elevate patients＇ cellular immune function;therefore,it is worthy for spreading in clinical practice.展开更多
Aim:Triple negative breast cancer(TNBC)is known as aggressive subtype and have no identified targeted therapies.We examined the relationship of neoadjuvant chemotherapy response to genetic variations of TNBC.Methods:T...Aim:Triple negative breast cancer(TNBC)is known as aggressive subtype and have no identified targeted therapies.We examined the relationship of neoadjuvant chemotherapy response to genetic variations of TNBC.Methods:The tumors used in this study were collected from Showa University Hospital,Japan.Thirteen formalin-fixed paraffin-embedded tumors from Japanese TNBC patients who underwent neoadjuvant chemotherapy were used for analysis.Of these,eight surgically resected tumors showed progressive disease and/or recurrence after treatment(PD/REC),and biopsy tissues from five patients showing pathological complete response(pCR)were analyzed.DNA extracted from tissue sample were analyzed.The Miseq system and Trusight Tumor Sequence panel kit were used to sequence 174 amplicons over 82 exons of 26 cancer-related genes to identify genetic mutations.Results:Seven somatic non-synonymous variants were detected in three genes(FOXL2,PIK3CA,and TP53)in all five pCR patients,and six somatic non-synonymous variants in two genes(PTEN and TP53)were detected in six of eight PD/REC patients.Eight of 13 TNBC tumors were found to have TP53 pathogenic variants,in both pCR and PD/REC cases.Conclusion:Although TP53 variation was detected in both pCR and PD/REC cases,each location and type of the variant were different.We could not identify genetic mutations associated with chemotherapy response and recurrence.展开更多
文摘Osteosarcoma is a tumour characterized by the production of osteoid by malignant cells. The incidence is approximately 1 to 3 million/year. The incidence is slightly higher in males. Onset can occur at any age;however, primary high grade osteosarcoma usually occurs in the second decade of life. Historically patients with osteosarcoma were treated with immediate wide or radical amputation. Despite the treatment, 80% patients with apparently isolated disease died of distant metastases. In recent years the number of patients with osteosarcoma of the limb treated by amputation + chemotherapy has increased. In our study, we divided the patients into two groups. One group (A) was treated with amputation + adjuvant chemotherapy. The other group (B) was treated with neo-adjuvant chemotherapy + amputation followed by adjuvant-chemotherapy. In our study, the margin negativity in post surgical specimen was significantly higher (P-value 0.0007) for the group treated with neo-adjuvant chemotherapy. Local recurrence in the group treated without neoadjuvant chemotherapy was significantly more (P-value 0.0005).The systemic recurrence at the end of 6 months was higher the group treated without neoadjuvant chemotherapy (P-value 0.0169).However systemic recurrence between 6 months -1 year and 1 year - 2 years were not significant(P-values 0.1501 and 0.4902). From the above figures it may be concluded that treatment with neo-adjuvant chemotherapy + amputation + adjuvant chemotherapy had definite advantages over upfront amputation + adjuvant chemotherapy.)
文摘In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.
文摘AIM To provide evidence regarding the postoperative treatment of patients with T4 b N1-3 M0/Tx N3 b M0 gastric cancer, for which guidelines have not been established. METHODS Patients who had undergone curative resection between 1996 and 2014 with a pathological stage of T4 b N1-3 M0/Tx N3 b M0 for gastric cancer were retrospectively analyzed; staging was based on the 7 th edition of the American Joint Committee on Cancer staging system. The clinicopathological characteristics, administration of adjuvant chemotherapy, and patterns of recurrence were studied. Univariate and multivariate analyses of prognostic factors were conducted. The chemotherapeutic agents mainly included fluorouropyrimidine, platinum and taxanes, used as monotherapy, doublet, or triplet regimens. Patterns of first recurrence were categorized as locoregional recurrence, peritoneal dissemination, or distant metastasis.RESULTS The 5-year overall survival(OS) of the whole group(n = 176) was 16.8%, and the median OS was 25.7 mo(95%CI: 20.9-30.5). Lymphovascular invasion and a node positive rate(NPR) ≥ 0.8 were associated with a poor prognosis(P = 0.01 and P = 0.048, respectively). One hundred forty-seven(83.5%) of the 176 patients eventually experienced recurrence; the most common pattern of the first recurrence was distant metastasis. The prognosis was best for patients with locoregional recurrence and worst for those with peritoneal dissemination. Twelve(6.8%) of the 176 patients did not receive adjuvant chemotherapy, while 164(93.2%) patients received adjuvant chemotherapy. Combined chemotherapy, including doublet and triplet regimens, was associated with a better prognosis than monotherapy, with no significant difference in 5-year OS(17.5% vs 0%, P = 0.613). The triplet regimen showed no significant survival benefit compared with the doublet regimen for 5-year OS(18.5% vs 17.4%, P = 0.661). Thirty-nine(22.1%) patients received adjuvant chemotherapy for longer than six months; the median OS in patients who received adjuvant chemotherapy for longer than six months was 40.2 mo(95%CI: 30.6-48.2), significantly longer than the 21.6 mo(95%CI: 19.1-24.0) in patients who received adjuvant chemotherapy for less than six months(P = 0.001).CONCLUSION Patients with T4 b N1-3 M0/Tx N3 b M0 gastric cancer showed a poor prognosis and a high risk of distant metastasis. Adjuvant chemotherapy for longer than six months improved outcomes for them.
文摘Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemotherapy. In this study, we will examine accuracy and feasibility of using Sentinel lymph node biopsy in predicting axillary lymph node status in breast cancer patients after neoadjuvant chemotherapy. Methods: 45 female patients with resectable, nonmetastatic breast carcinoma cases who received neoadjuvant chemotherapy were enrolled in this study according to the routine Mansoura Oncology Center—guidelines of management of breast cancer. Methylene blue dye used for detection of Sentinel lymph node. Results: Successful Sentinel lymph node detection was 82.2%. Skin involvement (T4 disease) were linked to a low identification (P = 0.005). False negative rate equals 11/27 = (40.7%).With advancement of the stage of the tumor, the incidence of false negative results increases significantly (p = 0.012) with 95% confidence interval;1.2 - 5.4. Conclusion: Sentinel lymph node should be adopted to be the standard method for axillary staging with T1-3 tumors after receiving neoadjuvant chemotherapy, in T4 patients, it is associated with low detection rate & high false negative rate making it doubtful technique for axillary staging.
文摘BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014.Patients with ypT0–1 disease and those who received ACTx were included.The 5-year overall survival(OS)and 5-year recurrence-free survival(RFS)were analyzed according to the status of the ACTx.RESULTS Of 520 included patients,413 received ACTx(ACTx group)and 107 did not(no ACTx group).No significant difference was observed in 5-year RFS(ACTx group,87.9%vs no ACTx group,91.4%,P=0.457)and 5-year OS(ACTx group,90.5%vs no ACTx group,86.2%,P=0.304)between the groups.cT stage was associated with RFS and OS in multivariate analysis[hazard ratio(HR):2.57,95%confidence interval(CI):1.07–6.16,P=0.04 and HR:2.27,95%CI:1.09–4.74,P=0.03,respectively].Furthermore,ypN stage was associated with RFS and OS(HR:4.74,95%CI:2.39–9.42,P<0.00 and HR:4.33,95%CI:2.20–8.53,P<0.00,respectively),but only in the radical resection group.CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement,regardless of the radicality of resection.Further trials are needed to evaluate the efficacy of ACTx in these group of patients.
文摘Background Accurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant chemotherapy （NAC） include physical examination （PE）, ultrasound （US）, and magnetic resonance imaging （MRI）. The purpose of this study was to evaluate the accuracy of PE, US, and MRI in predicting the response to NAC in patients with breast cancer. Methods According to the response evaluation criteria in solid tumors guidelines, the largest unidimensional measurement of the tumor diameter evaluated by PE, US, and MRI before and after NAC was classified into four grades, including clinical complete response, clinical partial response, clinical progressive disease, clinical stable disease, and compared with the final histopathological examination. Results Of the 64 patients who received NAC, the pathologic complete response （pCR） was shown in 13 of 64 patients （20%）. The sensitivity of PE, US, and MRI in predicting the major pathologic response was 73%, 75%, and 80%, respectively, and the specificity was 45%, 50%, and 50% respectively. For predicting a pCR, the sensitivity of PE, US, and MRI was 46%, 46%, and 39%, respectively, and the specificity was 65%, 98%, and 92% respectively. Conclusions Compared with final pathologic findings, all these three clinical and imaging modalities tended to obviously underestimate the pCR rate. A more appropriate, universal, and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.
文摘Objective： To study the effect of Aidi Injection （艾迪注射液,ADI） applied in the bronchial artery infused （BAI） neo-adjuvant chemotherapy for stage ⅢA non-small cell lung cancer （NSCLC） before surgical operation.Methods： The 60 patients with NSCLC stage ⅢA underwent two courses BAI chemotherapy before tumor incision were assigned to two groups,the treatment and the control groups,using a random number table,30 in each group.ADI （100 mL） was given to the patients in the treatment group by adding into 500 mL of 5% glucose injection for intravenous dripping once daily,starting from 3 days before each course of chemotherapy,and it lasted for 14 successive days,so a total of 28 days of administration was completed.The therapeutic effectiveness and the adverse reaction that occurred were observed,and the levels of T-lymphocyte subsets,natural killer cell activity,and interleukin-2 in peripheral blood were measured before and after the treatment.Results： The effective rate in the treatment group was higher than that in the control group （70.0% vs.56.7%,P〈0.05）.Moreover,as compared with the control group,the adverse reaction that occurred in the treatment group was less and mild,especially in terms of bone marrow suppression and liver function damage （P〈0.05）.Cellular immune function was suppressed in NSCLC patients,but after treatment,it ameliorated significantly in the treatment group,showing significant difference as compared with that in the control group （P〈0.05）.Conclusion： ADI was an ideal auxiliary drug for the patients in stage ⅢA NSCLC received BAI neo-chemotherapy before surgical operation;it could enhance the effectiveness of chemotherapy,ameliorate the adverse reaction and elevate patients＇ cellular immune function;therefore,it is worthy for spreading in clinical practice.
基金This work was supported in part by a Grant-in-Aid for the High-Technology Research Center Project from the Ministry of Education,Culture,Sports,Science and Technology of Japan.
文摘Aim:Triple negative breast cancer(TNBC)is known as aggressive subtype and have no identified targeted therapies.We examined the relationship of neoadjuvant chemotherapy response to genetic variations of TNBC.Methods:The tumors used in this study were collected from Showa University Hospital,Japan.Thirteen formalin-fixed paraffin-embedded tumors from Japanese TNBC patients who underwent neoadjuvant chemotherapy were used for analysis.Of these,eight surgically resected tumors showed progressive disease and/or recurrence after treatment(PD/REC),and biopsy tissues from five patients showing pathological complete response(pCR)were analyzed.DNA extracted from tissue sample were analyzed.The Miseq system and Trusight Tumor Sequence panel kit were used to sequence 174 amplicons over 82 exons of 26 cancer-related genes to identify genetic mutations.Results:Seven somatic non-synonymous variants were detected in three genes(FOXL2,PIK3CA,and TP53)in all five pCR patients,and six somatic non-synonymous variants in two genes(PTEN and TP53)were detected in six of eight PD/REC patients.Eight of 13 TNBC tumors were found to have TP53 pathogenic variants,in both pCR and PD/REC cases.Conclusion:Although TP53 variation was detected in both pCR and PD/REC cases,each location and type of the variant were different.We could not identify genetic mutations associated with chemotherapy response and recurrence.
