Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and incr...Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.展开更多
OBJECTIVE To investigate the effect of neoadjuvant chemotherapy in treatment of Stage Ⅱ breast cancer. METHODS The data from 113 patients with breast cancer of the same pathologic type in Stage Ⅱ,during the period o...OBJECTIVE To investigate the effect of neoadjuvant chemotherapy in treatment of Stage Ⅱ breast cancer. METHODS The data from 113 patients with breast cancer of the same pathologic type in Stage Ⅱ,during the period of 1995 to 2001,were analyzed retrospectively.Among the patients,47 were treated with neoadjuvant chemotherapy,and 66 received no adjuvant therapy before surgery（control group）.After the patients of the neoadjuvant chemotherapy group had received 2 courses of chemotherapy with the CMF regimen,the surgical procedure was conducted. RESULTS Complete remission（CR）was attained in 9 of the 47 cases receiving neoadjuvant chemotherapy and partial remission（PR）was reached for 22 cases.The rate of breast-conserving surgery was enhanced from 22.73%to 46.81%（P〈0.05）in the neoadjuvant treatment group. There was no difference in the 5-year overall survival（OS）and disease-free survival（DFS）rate between the two groups（P〉0.05）,but the 5-year OS and DFS of the cases with clinical tumor remission was higher compared to the control group（P〈0.05）. CONCLUSION Neoadjuvant chemotherapy can enhance the rate of breast conservation for Stage Ⅱ breast cancer and may improve the prognosis of the cases with clinical remission.展开更多
The management of rectal cancer has evolved significantly in the last few decades.Significant improvements in local disease control were achieved in the 1990s,with the introduction of total mesorectal excision and neo...The management of rectal cancer has evolved significantly in the last few decades.Significant improvements in local disease control were achieved in the 1990s,with the introduction of total mesorectal excision and neoadjuvant radiotherapy.Level 1 evidence has shown that,with neoadjuvant chemoradiation therapy(CRT)the rates of local recurrence can be lower than 6%and,as a result,neoadjuvant CRT currently represents the accepted standard of care.This approach has led to reliable tumor down-staging,with 15–27%patients with a pathological complete response(pCR)—defined as no residual cancer found on histological examination of the specimen.Patients who achieve pCR after CRT have better long-term outcomes,less risk of developing local or distal recurrence and improved survival.For all these reasons,sphincter-preserving procedures or organ-preserving options have been suggested,such as local excision of residual tumor or the omission of surgery altogether.Although local recurrence rate has been stable at 5–6%with this multidisciplinary management method,distal recurrence rates for locally-advanced rectal cancers remain in excess of 25%and represent the main cause of death in these patients.For this reason,more recent trials have been looking at the administration of full-dose systemic chemotherapy in the neoadjuvant setting(in order to offer early treatment of disseminated micrometastases,thus improving control of systemic disease)and selective use of radiotherapy only in non-responders or for low rectal tumors smaller than 5 cm.展开更多
Background and objective:Neoadjuvant chemoradiation therapy(NCRT)followed by radical resection has been a common practice for patients with locally advanced rectal cancer.This study aimed to analyse the association of...Background and objective:Neoadjuvant chemoradiation therapy(NCRT)followed by radical resection has been a common practice for patients with locally advanced rectal cancer.This study aimed to analyse the association of tumor differentiation and prognosis in rectal-cancer patients undergoing NCRT.Methods:Patients with locally advanced,non-mucinous rectal cancer who underwent NCRT followed by radical resection between 2007 and 2017 were identified from an electronic health record system at the Sixth Affiliated Hospital of Sun Yatsen University(Guangzhou,China).Multivariable logistic regression and multivariate Cox regression were performed to analyse the association of response to NCRT and survival with clinicopathological characteristics of all these patients.Results:We identified 325 patients(241 males and 84 females;mean age,54.4611.2 years)who underwent NCRT followed by radical resection,including 26(8.0%)with poorly-differentiated rectal cancer,182(56.0%)with moderately-differentiated cancer and 117(36.0%)with well differentiated cancer.Propensity score matching analysis and multivariable logistic regression analysis results showed that tumor differentiation was significantly associated with response to NCRT.In the poor differentiation and non-poor differentiation groups,the 3-year overall survival(OS)rates were 74.6 and 93.5%,respectively,whereas the 3-year local recurrence rates were 18.6 and 3.7%,respectively.Multivariable Cox regression analyses revealed that poor differentiation was an independent risk factor for local recurrence and OS.Conclusions:Among the patients with locally advanced,non-mucinous rectal cancer,the patients with poorlydifferentiated cancer who underwent NCRT had a worse response to NCRT and poorer prognosis than those with moderately-and well-differentiated diseases.展开更多
A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,t...A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.展开更多
Background and objective:The benefit from adjuvant chemotherapy for patients treated with neoadjuvant chemoradiotherapy(NCRT)and curative surgery remains controversial,particularly among those responding well to NCRT....Background and objective:The benefit from adjuvant chemotherapy for patients treated with neoadjuvant chemoradiotherapy(NCRT)and curative surgery remains controversial,particularly among those responding well to NCRT.This retrospective study aimed to clarify the benefits of adjuvant chemotherapy in terms of the oncological outcomes of patients with ypT0–2N0 rectal cancer after NCRT and curative surgery.Methods:All patients with ypT0–2N0 rectal cancer after NCRT and curative resection between 2005 and 2014 were examined.The oncological outcomes between patients treated with adjuvant chemotherapy and those without any chemotherapy were compared.Results:The clinicopathological characteristics of 110 patients were reviewed in this study;one patient was excluded due to lack of follow-up.Of the 109 patients included,58(53.2%)underwent adjuvant chemotherapy(chemo group),whereas the remaining 51(46.8%)did not receive any chemotherapy(non-chemo group).After a median follow-up of 50 months,there were no significant differences in the 5-year overall survival(OS)or recurrence-free survival(RFS)rates between the groups(OS:92.1 vs 86.3%,P=0.375;RFS:80.9 vs 74.7%,P=0.534).Subgroup analysis also demonstrated no significant differences in 5-year OS and RFS rates between patients with ypT0N0 rectal cancer(P=0.712 and P=0.599,respectively)and those with ypT1–2N0 disease(P=0.255 and P=0.278,respectively).Conclusions:These results indicate that patients with ypT0–2N0 rectal cancer after NCRT followed by curative surgery may not derive significant benefit from adjuvant chemotherapy.However,further prospective randomized trials,with larger sample sizes,are warranted to confirm this conclusion.展开更多
文摘Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.
文摘OBJECTIVE To investigate the effect of neoadjuvant chemotherapy in treatment of Stage Ⅱ breast cancer. METHODS The data from 113 patients with breast cancer of the same pathologic type in Stage Ⅱ,during the period of 1995 to 2001,were analyzed retrospectively.Among the patients,47 were treated with neoadjuvant chemotherapy,and 66 received no adjuvant therapy before surgery（control group）.After the patients of the neoadjuvant chemotherapy group had received 2 courses of chemotherapy with the CMF regimen,the surgical procedure was conducted. RESULTS Complete remission（CR）was attained in 9 of the 47 cases receiving neoadjuvant chemotherapy and partial remission（PR）was reached for 22 cases.The rate of breast-conserving surgery was enhanced from 22.73%to 46.81%（P〈0.05）in the neoadjuvant treatment group. There was no difference in the 5-year overall survival（OS）and disease-free survival（DFS）rate between the two groups（P〉0.05）,but the 5-year OS and DFS of the cases with clinical tumor remission was higher compared to the control group（P〈0.05）. CONCLUSION Neoadjuvant chemotherapy can enhance the rate of breast conservation for Stage Ⅱ breast cancer and may improve the prognosis of the cases with clinical remission.
文摘The management of rectal cancer has evolved significantly in the last few decades.Significant improvements in local disease control were achieved in the 1990s,with the introduction of total mesorectal excision and neoadjuvant radiotherapy.Level 1 evidence has shown that,with neoadjuvant chemoradiation therapy(CRT)the rates of local recurrence can be lower than 6%and,as a result,neoadjuvant CRT currently represents the accepted standard of care.This approach has led to reliable tumor down-staging,with 15–27%patients with a pathological complete response(pCR)—defined as no residual cancer found on histological examination of the specimen.Patients who achieve pCR after CRT have better long-term outcomes,less risk of developing local or distal recurrence and improved survival.For all these reasons,sphincter-preserving procedures or organ-preserving options have been suggested,such as local excision of residual tumor or the omission of surgery altogether.Although local recurrence rate has been stable at 5–6%with this multidisciplinary management method,distal recurrence rates for locally-advanced rectal cancers remain in excess of 25%and represent the main cause of death in these patients.For this reason,more recent trials have been looking at the administration of full-dose systemic chemotherapy in the neoadjuvant setting(in order to offer early treatment of disseminated micrometastases,thus improving control of systemic disease)and selective use of radiotherapy only in non-responders or for low rectal tumors smaller than 5 cm.
基金This study was supported by the National Key Clinical Discipline,National Natural Science Foundation of China(No.81570596 and No.81770557)Natural Science Foundation of Guangdong Province(No.E20160107201906268).
文摘Background and objective:Neoadjuvant chemoradiation therapy(NCRT)followed by radical resection has been a common practice for patients with locally advanced rectal cancer.This study aimed to analyse the association of tumor differentiation and prognosis in rectal-cancer patients undergoing NCRT.Methods:Patients with locally advanced,non-mucinous rectal cancer who underwent NCRT followed by radical resection between 2007 and 2017 were identified from an electronic health record system at the Sixth Affiliated Hospital of Sun Yatsen University(Guangzhou,China).Multivariable logistic regression and multivariate Cox regression were performed to analyse the association of response to NCRT and survival with clinicopathological characteristics of all these patients.Results:We identified 325 patients(241 males and 84 females;mean age,54.4611.2 years)who underwent NCRT followed by radical resection,including 26(8.0%)with poorly-differentiated rectal cancer,182(56.0%)with moderately-differentiated cancer and 117(36.0%)with well differentiated cancer.Propensity score matching analysis and multivariable logistic regression analysis results showed that tumor differentiation was significantly associated with response to NCRT.In the poor differentiation and non-poor differentiation groups,the 3-year overall survival(OS)rates were 74.6 and 93.5%,respectively,whereas the 3-year local recurrence rates were 18.6 and 3.7%,respectively.Multivariable Cox regression analyses revealed that poor differentiation was an independent risk factor for local recurrence and OS.Conclusions:Among the patients with locally advanced,non-mucinous rectal cancer,the patients with poorlydifferentiated cancer who underwent NCRT had a worse response to NCRT and poorer prognosis than those with moderately-and well-differentiated diseases.
基金This research was funded in part by the NIH/NCI Cancer Center Support Grant[P30 CA015704(SAC)].
文摘A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.
基金supported by National Key R&D Program of China(No.2017YFC0908203)and CAMS Initiative for Innovative Medicine(No.CAMS-I2M-003).
文摘Background and objective:The benefit from adjuvant chemotherapy for patients treated with neoadjuvant chemoradiotherapy(NCRT)and curative surgery remains controversial,particularly among those responding well to NCRT.This retrospective study aimed to clarify the benefits of adjuvant chemotherapy in terms of the oncological outcomes of patients with ypT0–2N0 rectal cancer after NCRT and curative surgery.Methods:All patients with ypT0–2N0 rectal cancer after NCRT and curative resection between 2005 and 2014 were examined.The oncological outcomes between patients treated with adjuvant chemotherapy and those without any chemotherapy were compared.Results:The clinicopathological characteristics of 110 patients were reviewed in this study;one patient was excluded due to lack of follow-up.Of the 109 patients included,58(53.2%)underwent adjuvant chemotherapy(chemo group),whereas the remaining 51(46.8%)did not receive any chemotherapy(non-chemo group).After a median follow-up of 50 months,there were no significant differences in the 5-year overall survival(OS)or recurrence-free survival(RFS)rates between the groups(OS:92.1 vs 86.3%,P=0.375;RFS:80.9 vs 74.7%,P=0.534).Subgroup analysis also demonstrated no significant differences in 5-year OS and RFS rates between patients with ypT0N0 rectal cancer(P=0.712 and P=0.599,respectively)and those with ypT1–2N0 disease(P=0.255 and P=0.278,respectively).Conclusions:These results indicate that patients with ypT0–2N0 rectal cancer after NCRT followed by curative surgery may not derive significant benefit from adjuvant chemotherapy.However,further prospective randomized trials,with larger sample sizes,are warranted to confirm this conclusion.
