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Sample records for cisplatin neoadjuvant chemotherapy

  1. Neoadjuvant chemotherapy with cisplatin and methotrexate in patients with muscle-invasive bladder tumours

    DEFF Research Database (Denmark)

    Sengeløv, Lisa; von der Maase, Hans; Lundbeck, Finn;

    2002-01-01

    This prospective, randomized study based on two associated trials was designed to evaluate the effect of neoadjuvant chemotherapy with cisplatin and methotrexate with folinic acid rescue or no chemotherapy prior to local treatment in patients with T2-T4b, NX-3, MO transitional cell carcinoma of t...... (actuarial rate). Neoadjuvant chemotherapy with cisplatin and methotrexate did not significantly improve disease-free or overall survival in 153 randomized patients with invasive bladder cancer.......This prospective, randomized study based on two associated trials was designed to evaluate the effect of neoadjuvant chemotherapy with cisplatin and methotrexate with folinic acid rescue or no chemotherapy prior to local treatment in patients with T2-T4b, NX-3, MO transitional cell carcinoma of the...

  2. An Epigenomic Approach to Improving Response to Neoadjuvant Cisplatin Chemotherapy in Bladder Cancer.

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    Xylinas, Evanguelos; Hassler, Melanie R; Zhuang, Dazhong; Krzywinski, Martin; Erdem, Zeynep; Robinson, Brian D; Elemento, Olivier; Clozel, Thomas; Shariat, Shahrokh F

    2016-01-01

    Bladder cancer is among the five most common cancers diagnosed in the Western world and causes significant mortality and morbidity rates in affected patients. Therapeutic options to treat the disease in advanced muscle-invasive bladder cancer (MIBC) include cystectomy and chemotherapy. Neoadjuvant cisplatin-based combination chemotherapy is effective in MIBC; however, it has not been widely adopted by the community. One reason is that many patients do not respond to neoadjuvant chemotherapy, and no biomarker currently exists to identify these patients. It is also not clear whether a strategy to sensitize chemoresistant patients may exist. We sought to identify cisplatin-resistance patterns in preclinical models of bladder cancer, and test whether treatment with the epigenetic modifier decitabine is able to sensitize cisplatin-resistant bladder cancer cell lines. Using a screening approach in cisplatin-resistant bladder cancer cell lines, we identified dysregulated genes by RNA sequencing (RNAseq) and DNA methylation assays. DNA methylation analysis of tumors from 18 patients receiving cisplatin-based chemotherapy was used to confirm in vitro results. Cisplatin-resistant bladder cancer cells were treated with decitabine to investigate epigenetic sensitization of resistant cell lines. Our results show that HOXA9 promoter methylation status is associated with response to cisplatin-based chemotherapy in bladder cancer cell lines and in metastatic bladder cancer. Bladder cancer cells resistant to cisplatin chemotherapy can be sensitized to cisplatin by the DNA methylation inhibitor decitabine. Our data suggest that HOXA9 promoter methylation could serve as potential predictive biomarker and decitabine might sensitize resistant tumors in patients receiving cisplatin-based chemotherapy. PMID:27598218

  3. Neoadjuvant and postoperative chemotherapy with paclitaxel plus cisplatin for the treatment of FIGO stage IB cervical cancer in pregnancy

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    Kong, Tae-Wook; Lee, Eun Ju; Lee, Yonghee; Chang, Suk-Joon; Son, Joo Hyuk; Ryu, Hee-Sug

    2014-01-01

    Cervical cancer is one of the most common malignancy diagnosed during pregnancy. The experience of the use of neoadjuvant chemotherapy (NACT) with paclitaxel plus cisplatin during pregnancy is limited. Three pregnant women with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer received NACT with paclitaxel plus cisplatin until fetal lung maturity, and then underwent cesarean delivery and radical hysterectomy. Two of our patients had intermediate pathologic ...

  4. Neoadjuvant chemotherapy of cisplatin and fluorouracil regimen in head and neck squamous cell carcinoma: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SU Yu-xiong; ZHENG Jia-wei; ZHENG Guang-sen; LIAO Gui-qing; ZHANG Zhi-yuan

    2008-01-01

    Background The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas (HNSCC) still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil (PF) regimen in enhancing the overall survival of and decreasing locoregional relapse and distant metastasis in HNSCC patients.Methods Medline and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included Iocoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus Iocoregional treatment) versus the control group (Iocoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (Cl).Results Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the Iocoregional relapse was 0.92 (0.70-1.22, 95%Cl), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33-0.68, 95% Cl) and 1.28 (1.01-1.62, 95% Cl) respectively, which were both statistically significant.Conclusions Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on Iocoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.

  5. Cisplatin Loaded Hyaluronic Acid Modified TiO2 Nanoparticles for Neoadjuvant Chemotherapy of Ovarian Cancer

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    Enling Liu

    2015-01-01

    Full Text Available Novel tumor-targeting titanium dioxide (TiO2 nanoparticles modified with hyaluronic acid (HA were developed to explore the feasibility of exploiting the pH-responsive drug release property of TiO2 and the tumor-targeting ability of HA to construct a tumor-targeting cisplatin (CDDP delivery system (HA-TiO2 for potential neoadjuvant chemotherapy of ovarian cancer. The experimental results indicated that CDDP release from the HA-TiO2 nanoparticles was significantly accelerated by decreasing pH from 7.4 to 5.0, which is of particular benefit to cancer therapy. CDDP-loaded HA-TiO2 nanoparticles increased the accumulation of CDDP in A2780 ovarian cancer cells via HA-mediated endocytosis and exhibited superior anticancer activity in vitro. In vivo real-time imaging assay revealed that HA-TiO2 nanoparticles possessed preferable tumor-targeting ability which might potentially minimize the toxic side effects of CDDP in clinical application.

  6. Pathologic Response Rates of Gemcitabine/Cisplatin versus Methotrexate/Vinblastine/Adriamycin/Cisplatin Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Bladder Cancer

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    Franklin C. Lee

    2013-01-01

    Full Text Available Objectives. To compare pathologic outcomes after treatment with gemcitabine and cisplatin (GC versus methotrexate, vinblastine, adriamycin, and cisplatin (MVAC in the neoadjuvant setting. Methods. Data was retrospectively collected on 178 patients with T2-T4 bladder cancer who underwent radical cystectomy between 2003 and 2011. Outcomes of interest included those with complete response (pT0 and any response (≤pT1. Odds ratios were calculated using multivariate logistic regression. Results. Compared to those who did not receive neoadjuvant chemotherapy, there were more patients with complete response (28% versus 9%, OR 3.11 (95% CI: 1.45–6.64, P=0.03 and any response (52% versus 25%, OR 3.23 (95% CI: 1.21–8.64, P=0.01. Seventy-two patients received GC (n=41 or MVAC (n=31. CR was achieved in 29% and 22% of GC and MVAC patients, respectively (multivariate OR 0.39, 95% CI 0.10–1.58. Any response (≤pT1 was achieved in 56% of GC and 45% of MVAC patients (multivariate OR 0.45, 95% CI 0.12–1.71. Conclusions. We observed similar pathologic response rates for GC and MVAC neoadjuvant chemotherapy in this cohort of patients with muscle invasive urothelial cancer (MIBC. Our findings support the use of GC as an alternative regimen in the neoadjuvant setting.

  7. Neoadjuvant Chemotherapy with Ifosfamide, Cisplatin, Adriamycin and Mitomycin (IMAP for High risk Adult Soft Tissue Sarcomas

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    Mohagheghi Mohammad Ali

    2009-05-01

    Full Text Available To define efficacy of pre-operative chemotherapy in down staging of advanced non-round cell soft tissue sarcomas. From Sep 2002 to Dec 2005, 70 patients were treated by Ifosfamid, MESNA, cisplatin, adriamycin, mitomycin and subsequent surgery. Postoperatively, patients received radiotherapy in cases of microscopically incomplete resection or local recurrence. The median age of the patients was 34 years and the median tumor size was 14 cm. According to AJCC classification 46 patients had stage 3 and 24 had stage 4 diseases. The most common subtypes were MFH and leiomyosarcoma. The most common sites of tumors were lower extremity and trunk. Toxicity grades three or higher consisted of nausea, Leucopenia and infection. About 50% of the patients received G-CSF. Response to chemotherapy was assessable in 63 patients; 9 patients achieved complete response and 16 showed partial response. Disease progressed in 8 and did not change in 37. The best response was seen with MFH, fibrosarcoma and synovial sarcoma. After chemotherapy seventy percent of patients underwent complete surgery. Disease relapsed in 41 patients and twenty two patients died of metastasis. Median survival of patients was 30 months. IMAP plus G-CSF is safe and effective as preoperative chemotherapy in some subtypes of sarcomas, although the metastasis problem has not been eliminated

  8. Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy

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    Wee, Chan Woo; Keam, Bhum Suk; Heo, Dae Seog; Sung, Myung Whun; Won, Tae Bin; Wu, Hong Gyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

  9. Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited

  10. Two cases of cisplatin-induced permanent renal failure following neoadjuvant chemotherapy for esophageal cancer

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    Tomohiko Sasaki

    2016-01-01

    Conclusion: Although cisplatin-related nephrotoxicity is a well-recognized complication, there have been few reports of renal failure requiring hemodialysis in cancer patients. In this report, we present their clinical courses and the pathological findings of cisplatin-related renal failure.

  11. Platinum Concentration and Pathologic Response to Cisplatin-Based Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer.

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    Elizabeth A Guancial

    Full Text Available Platinum (Pt-based chemotherapy is the standard of care for muscle-invasive bladder cancer (MIBC. However, resistance is a major limitation. Reduced intratumoral drug accumulation is an important mechanism of platinum resistance. Our group previously demonstrated a significant correlation between tissue Pt concentration and tumor response to Pt-based neoadjuvant chemotherapy (NAC in lung cancer. We hypothesized that increased Pt concentration in radical cystectomy (RC specimens would correlate with improved pathologic response to Pt-based NAC in MIBC.A cohort of 19 clinically annotated, archived, fresh frozen RC specimens from patients with MIBC treated with Pt-based NAC was identified [ypT0 (pathologic complete response, pCR, N = 4; ≤ypT1N0M0 (pathologic partial response, pPR, N = 6; ≥ypT2 (minimal pathologic response/progression, N = 9]. RC specimens from 2 patients with MIBC who did not receive NAC and 1 treated with a non-Pt containing NAC regimen were used as negative controls. Total Pt concentration in normal adjacent urothelial tissue and bladder tumors from RC specimens was measured by flameless atomic absorption spectrophotometry.Total Pt concentration in normal urothelium differed by tumor pathologic response (P = 0.011. Specimens with pCR had the highest Pt concentrations compared to those with pPR (P = 0.0095 or no response/progression (P = 0.020. There was no significant difference in Pt levels in normal urothelium and tumor between pPR and no response/progression groups (P = 0.37; P = 0.25, respectively.Our finding of increased intracellular Pt in RC specimens with pCR following NAC for MIBC compared to those with residual disease suggests that enhanced Pt accumulation may be an important determinant of Pt sensitivity. Factors that modulate intracellular Pt concentration, such as expression of Pt transporters, warrant further investigation as predictive biomarkers of response to Pt-based NAC in MIBC.

  12. Neoadjuvant and Adjuvant Chemotherapy of Cervical Cancer.

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    Mallmann, Peter; Mallmann, Christoph

    2016-01-01

    Neoadjuvant chemotherapy is indicated in patients who can tolerate the side effects of a chemotherapy and with preoperative presentation of one of the following clinical risk situations: bulky disease with a maximal tumor diameter of > 4 cm, suspicious lymph nodes in magnetic resonance imaging (MRI), computed tomography (CT) scan or endosonography, histopathologically confirmed lymph node metastasis, or histopathologically documented risk factors such as G3 and L1V1. A neoadjuvant chemotherapy followed by surgery should be performed with cisplatin at a dosage of > 25 mg/m2 per week and an application interval of < 14 days. The previously published data suggests an improved rate of complete resection and reduced incidences of positive lymph nodes and parametric infiltration. Accordingly, the percentage of patients in need for adjuvant radiochemotherapy after operation can be significantly reduced. Some studies demonstrated a prolongation of progression-free and overall survival. Following the previously published studies, adjuvant chemotherapy after operation or after radiochemotherapy has no significant effect on the overall survival and, following the current guidelines, should be avoided. PMID:27614740

  13. Neoadjuvant chemotherapy and radiation therapy in advanced stage nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    To assess the feasibility and the toxicity of the neoadjuvant chemotherapy on the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. We analyzed 77 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with neoadjuvant chemotherapy followed by radiation therapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows: AJCC stage 111-2, stage IV-75. Sixty-six patients received infusion of 5-FU (1000 mg/m2, on Day 1-5) and cisplatin (100 mg/m2, on Day 1), eleven patients received infusion of 5.FU (1000 mg/m2, on Day 1-5) and carboplatin (300 mg/m2, on Day 1) as neoadjuvant chemotherapy prior to radiation therapy. The median follow-up for surviving patients was 44 months. The overall chemotherapy response rates were 87%. The toxicities of chemotherapy were mild. Only 3 patients experienced Grade 3 toxicities (1 for cytopenia, 2 for nausea/vomiting). The degree of radiation induced mucositis was not severe, and ten patients developed Grade 2 mucositis. The 5-year overall survival rates were 68% and the 5-year disease free survival rates were 65%. The 5-year freedom from distant metastasis rates were 82% and 5-year locoregional control rates were 75%. This single institution experience suggests that neoadjuvant chemotherapy improves overall survival and disease free survival for patients with advanced stage nasopharyngeal carcinoma without increase of toxicity

  14. Lactate Dehydrogenase B Is Associated with the Response to Neoadjuvant Chemotherapy in Oral Squamous Cell Carcinoma

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    Wenyi Sun; Xiaomin Zhang; Xu Ding; Huaiqi Li; Meiyu Geng; Zuoquan Xie; Heming Wu; Min Huang

    2015-01-01

    Oral squamous cell carcinoma (OSCC) comprises a subset of head and neck squamous cell carcinoma (HNSCC) with poor therapeutic outcomes and high glycolytic dependency. Neoadjuvant chemotherapy regimens of docetaxel, cisplatin and 5-fluorouracil (TPF) are currently accepted as standard regimens for HNSCC patients with a high risk of distant metastatic spread. However, the antitumor outcomes of TPF neoadjuvant chemotherapy in HNSCC remain controversial. This study investigated the role of lactat...

  15. Neoadjuvant chemotherapy followed by radiotherapy should not be a standard approach for locally advanced cervical cancer

    International Nuclear Information System (INIS)

    Purpose: To investigate the role of neoadjuvant chemotherapy followed by radiotherapy in locally advanced cervical cancer. Methods and Materials: This study cites all known literature on the subject in the English language. Articles were selected for analysis by MEDLINE and CANCERLINE computer searches. In Phase II trials, the response rates of some selective series were analyzed. However, This article will specially emphasize the result of all Phase III randomized trials. Results: Several investigators did obtain promising results from Phase II trials of neoadjuvant chemotherapy, mostly cisplatin-based combinations, followed by radiotherapy. However, most Phase III trials failed to demonstrate any benefit in terms of loco-regional relapse and/or survival by up-front chemotherapy. Conclusion: The role of neoadjuvant chemotherapy remains to be defined, and the search for more active new agents must be continued. The neoadjuvant setting is still experimental and could not be recommended as a standard treatment at the present

  16. Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer

    International Nuclear Information System (INIS)

    Objective: To describe the experience at the National Cancer Institute (NCI) on the use of neoadjuvant chemotherapy as primary treatment for epithelial ovarian cancer among patients in stages IIIC and IV. Methods: We conducted a descriptive retrospective study (case series type) of patients diagnosed with epithelial ovarian cancer in stages IIIC and IV, treated at the NCI from January 1, 2003 to December 31,2006, who underwent neoadjuvant chemotherapy as primary treatment. Demographic characteristics and clinical outcomes are described. Results: Seventeen patients who fulfilled the above mentioned criteria were selected. Once neoadjuvant chemotherapy ended, 5 patients (29.4%) achieved complete or partial clinical response; 4 (23.8%) remained in stable condition, and 8 (47.6%) showed signs of progressive illness. Interval debulking surgery was performed on objective response patients. Maximum cytoreduction was achieved in 5 patients (100%); first relapse was reported at month 18 of follow-up; 2 disease-free survivors were identified in December, 2007; 8 (49%) reported some degree of non-severe chemotherapy-related toxicity. No mortality was related to chemotherapy, no post surgical complications were observed and no patient required advanced support management. Conclusions: Neoadjuvant chemotherapy, followed by optimal interval debulking surgery among selected patients, can be an alternative treatment for advanced epithelial ovarian cancer among women with irresecability or the critically ill. Further studies with improved design are required to confirm these findings.

  17. Neoadjuvant Chemotherapy for Locally Advanced Squamous Carcinoma of Oral Cavity: a Pilot Study.

    OpenAIRE

    Sanambar Sadighi; Amanolah Keyhani; Iraj Harirchi; Ata Garajei; Mahdi Aghili; Ali Kazemian; Maziar Motiee Langroudi; Kazem Zendehdel; Nariman Nikparto

    2015-01-01

    To evaluate the effect of adding neoadjuvant chemotherapy to surgery and radiation therapy for locally advanced resectable oral cavity squamous cell carcinoma, 24 patients with T3 or T4a oral cavity squamous cell carcinoma were randomly assigned to surgery alone or Docetaxel, Cisplatin, and 5-FU (TPF) induction chemotherapy followed by surgery. All patients were planned to receive chemoradiotherapy after surgery. The primary end-points were organ preservation and progression-free-survival. SP...

  18. Efficacy of Neoadjuvant Cisplatin in Triple-Negative Breast Cancer

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    Szallasi, Zoltan Imre; Eklund, Aron Charles; Li, Qiyuan;

    2010-01-01

    1 promoter methylation (P = .04), p53 nonsense or frameshift mutations (P = .01), and a gene expression signature of E2F3 activation (P = .03). CONCLUSION Single-agent cisplatin induced response in a subset of patients with TNBC. Decreased BRCA1 expression may identify subsets of TNBCs that are......PURPOSE Cisplatin is a chemotherapeutic agent not used routinely for breast cancer treatment. As a DNA cross-linking agent, cisplatin may be effective treatment for hereditary BRCA1-mutated breast cancers. Because sporadic triple-negative breast cancer (TNBC) and BRCA1-associated breast cancer...... share features suggesting common pathogenesis, we conducted a neoadjuvant trial of cisplatin in TNBC and explored specific biomarkers to identify predictors of response. PATIENTS AND METHODS Twenty-eight women with stage II or III breast cancers lacking estrogen and progesterone receptors and HER2/Neu...

  19. Neoadjuvant chemotherapy in locally advanced colon cancer

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    Jakobsen, Anders; Andersen, Fahimeh; Fischer, Anders;

    2015-01-01

    BACKGROUND: Neoadjuvant chemotherapy has proven valuable in several tumors, but it has not been elucidated in colon cancer. The present phase II trial addressed the issue in high-risk patients selected by computed tomography (CT) scan. MATERIAL AND METHODS: Patients with resectable colon cancer...... mutational status received three cycles of capecitabine 2000 mg/m(2) days 1-14 q3w and oxaliplatin 130 mg iv day 1 q3w. Wild-type patients received the same chemotherapy supplemented with panitumumab 9 mg/kg iv q3w. After the operation, patients fulfilling the international criteria for adjuvant chemotherapy......, i.e. high-risk stage II and III patients, received five cycles of the same chemotherapy without panitumumab. Patients not fulfilling the criteria were offered follow-up only. The primary endpoint was the fraction of patients not fulfilling the criteria for adjuvant chemotherapy (converted patients...

  20. Lactate dehydrogenase B is associated with the response to neoadjuvant chemotherapy in oral squamous cell carcinoma.

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    Wenyi Sun

    Full Text Available Oral squamous cell carcinoma (OSCC comprises a subset of head and neck squamous cell carcinoma (HNSCC with poor therapeutic outcomes and high glycolytic dependency. Neoadjuvant chemotherapy regimens of docetaxel, cisplatin and 5-fluorouracil (TPF are currently accepted as standard regimens for HNSCC patients with a high risk of distant metastatic spread. However, the antitumor outcomes of TPF neoadjuvant chemotherapy in HNSCC remain controversial. This study investigated the role of lactate dehydrogenase B (LDHB, a key glycolytic enzyme catalyzing the inter-conversion between pyruvate and lactate, in determining chemotherapy response and prognosis in OSCC patients. We discovered that a high protein level of LDHB in OSCC patients was associated with a poor response to TPF regimen chemotherapy as well as poor overall survival and disease-free survival. Our in-depth study revealed that high LDHB expression conferred resistance to taxol but not 5-fluorouracil or cisplatin. LDHB deletion sensitized OSCC cell lines to taxol, whereas the introduction of LDHB decreased sensitivity to taxol treatment. Taxol induced a pronounced impact on LDHB-down-regulated OSCC cells in terms of apoptosis, G2/M phase cell cycle arrest and energy metabolism. In conclusion, our study highlighted the critical role of LDHB in OSCC and proposed that LDHB could be used as a biomarker for the stratification of patients for TPF neoadjuvant chemotherapy and the determination of prognosis in OSCC patients.

  1. Neoadjuvant chemotherapy for high-grade advanced gastric cancer.

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    Yonemura, Y; Sawa, T; Kinoshita, K; Matsuki, N; Fushida, S; Tanaka, S; Ohoyama, S; Takashima, T; Kimura, H; Kamata, T

    1993-01-01

    Fifty-five patients with high-grade advanced gastric cancer in whom the presence of stage IV was confirmed by preoperative diagnostic imaging were treated with PMUE therapy by a combined use of cisplatin (CDDP) 75 mg/m2, mitomycin C (MMC) 10 mg/body, etoposide 150 mg/body, and UFT (a combination of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil in a molar ratio of 1:4) 400 mg/day. CDDP and MMC was administered intravenously on the first day, followed by etoposide 50 mg/day on the 3rd, 4th, and 5th days. All the patients had measurable lesions that were evaluated by computed tomography scanning before and after the treatments. These patients were allocated randomly to two groups. Of these cases, 29 belonged to the neoadjuvant chemotherapy (NAC) group to whom PMUE therapy was given preoperatively; the remaining 26 patients underwent operation first and received PMUE thereafter (control group). Background factors did not differ significantly between the two groups. The response rate was higher in the NAC group than in the control group (62% in the former versus 35% in the latter). The resectability rates were 79% and 88% in the NAC and control groups, respectively. However, the rate of potentially curable cases was higher in the NAC group than in the control group (38% in the former versus 15% in the latter). Among the nonresection cases, the prognosis was highly unfavorable in both groups. In the resection cases, however, the survival rate was significantly better in the NAC group than in the control group. These results may indicate that in patients with high-grade, advanced gastric cancer initial chemotherapy (neoadjuvant chemotherapy) and then surgery should be considered. PMID:8511923

  2. Neoadjuvant chemotherapy as ovarian cancer treatment

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    Fagö-Olsen, Carsten L; Ottesen, Bent; Kehlet, Henrik;

    2012-01-01

    INTRODUCTION: The traditional first-line treatment for patients with advanced ovarian cancer with primary debulking surgery (PDS) and adjuvant chemotherapy is controversial as some authors report a potential benefit from the alternative treatment with neoadjuvant chemotherapy (NACT) and interval...... debulking surgery. The aim of this study was to investigate the use of NACT in Denmark in regard to increased use and regional differences. MATERIAL AND METHODS: Stage IIIC and IV ovarian cancer patients treated in the five Danish tertiary referral centres in the 2005-2010-period were included. The study...... is based on validated data from The Danish Gynaecological Cancer Database. RESULTS: Of the 1,367 eligible patients 1,069 were treated with PDS and 298 with NACT. In 2005-2007, 11% of patients were treated with NACT. In 2008-2010, this percentage had risen to 30% (p

  3. Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer

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    Sternberg, Cora N; Donat, S Machele; Bellmunt, Joaquim;

    2007-01-01

    To determine the optimal use of chemotherapy in the neoadjuvant, adjuvant, and metastatic setting in patients with advanced urothelial cell carcinoma, a consensus conference was convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) to critically review the...... published literature on chemotherapy for patients with locally advanced bladder cancer. This article reports the development of international guidelines for the treatment of patients with locally advanced bladder cancer with neoadjuvant and adjuvant chemotherapy. Bladder preservation is also discussed, as...

  4. Neoadjuvant or adjuvant chemotherapy: what is the best treatment of muscle invasive bladder cancer?

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    Nabil Ismaili

    2011-09-01

    Full Text Available Bladder cancer is the fourth most common cancer for men and the eighth most common cancer for women. Transitional cell carcinoma is the most predominant histological type. Bladder cancer is highly chemosensitive. In metastatic setting the treatment is based on cisplatin chemotherapy regimens type MVAC, MVAC-HD or gemcitabine plus cisplatin. The standard treatment of muscle invasive operable bladder cancer (T2–T4 used widely was radical cystectomy with pelvic lymph nodes dissection; the anatomical extent of pelvic lymphadenectomy has not accurately been defined so far. However, in the last decade, the treatment of tumors was improved by the introduction of chemotherapy as part of the management of the disease. Neoadjuvant chemotherapy should be considered at first, as standard treatment of choice, before local treatment for patients with good performance status (0–1 and good renal function–glomerular filtration rate (GFR >60 mL/min. For patients treated with primary surgery, adjuvant chemotherapy is a valuable option in the case of lymph nodes involvement. This brief review would provide the evidence of the role of neoadjuvant chemotherapy in the management of operable muscle invasive (T2–T4 bladder cancer.

  5. The role of neoadjuvant chemotherapy for breast cancer treatment.

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    Ikeda, Tadashi; Jinno, Hiromitsu; Matsu, Akira; Masamura, Shigeru; Kitajima, Masaki

    2002-01-01

    Neoadjuvant chemotherapy has become popular, especially for patients with advanced breast cancer. The pros and cons of neoadjuvant chemotherapy for treating breast cancer patients are reviewed. The advantages of neoadjuvant chemotherapy are 1) overall survival and recurrence-free survival rate are the same as post-operative chemotherapy, 2) serves as an in vivo sensitivity test, 3) increases the rate of breast conserving therapy, 4) facilitates the study of cancer biology. On the other hand, the disadvantages of neoadjuvant chemotherapy are 1) it modifies the stage, 2) treatment delay of PD cases, 3) residual intraductal component may be left behind after breast conserving surgery, 4) there are some cases of over-treatment. Combination chemotherapy is one possible way to increase the pathological CR rate, although the optimal order and cycles have not been determined. To avoid residual cancer cells after breast conserving surgery, the shrinkage pattern should be evaluated by MRI. Core needle biopsy should be performed before neoadjuvant chemotherapy to avoid over-treatment. It is essential to develop more effective regimens and stratify patients based on predictive factors. PMID:12196715

  6. Phase II trial of neoadjuvant gemcitabine and cisplatin in patients with resectable bladder carcinoma

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    Daniel Herchenhorn

    2007-10-01

    Full Text Available OBJECTIVES: Gemcitabine and cisplatin (GC is an active combination in the treatment of metastatic bladder cancer. We have prospectively analyzed the efficacy and tolerability of GC as neoadjuvant treatment of invasive bladder cancer MATERIALS AND METHODS: In this single-institution phase II trial, patients with muscle-invasive transitional cell carcinoma received three cycles of gemcitabine 1200 mg/m² on days 1 and 8 with cisplatin 75 mg/m² on day 1 prior to surgery. Radiologic response was evaluated by computed tomography and magnetic resonance imaging. All patients were referred to surgery after chemotherapy completion RESULTS: Between June 2002 and March 2005, 22 patients (19 males were enrolled. Median age was 63 years. Initial stage was II (T2 in 11 and III (T3-4 in 11 patients. Median follow-up is 26 months (4-43. Partial or complete radiologic response rate was documented in 13 out of 20 assessable patients (70%. One patient was excluded due to sarcomatoid carcinoma at definitive pathologic examination. Cystectomy was performed in 15 patients and pelvic radiotherapy in four patients. Nine out of 21 patients (43% relapsed and four (19% died due to disease progression. Complete pathologic response was observed in four patients (26.7% of 15. Median progression-free survival was 27 months (CI 95% not reached with median overall survival of 36 months (CI 95%: 28.7 - 43.3. Grade III/IV toxicity was infrequent, with no deaths due to chemotherapy CONCLUSIONS: The combination of GC is effective and well-tolerated when used as neoadjuvant therapy in muscle-invasive bladder cancer. Longer follow-up is necessary to evaluate its impact on the overall survival of these patients.

  7. APOPTOSIS AND PROLIFERATION OF TUMOR CELLS IN LOCALLY ADVANCED CERVICAL CANCER AFTER NEOADJUVANT INTRAARTERIAL CHEMOTHERAPY

    Institute of Scientific and Technical Information of China (English)

    朱雪琼; 岳天孚; 惠京; 张颖; 王德华

    2003-01-01

    Objective: Through observing the clinical response to neoadjuvant intraarterial chemotherapy in locally advanced cervical cancer and investigating the changes of p53 protein expression, proliferation and apoptosis of tumor cells after chemotherapy, to study the relationship between biological markers and chemotherapeutic response. Methods: 20 women with locally advanced squamous cervical cancer received consecutive infusion chemotherapy of five days of cisplatin and adriamycin via the superselective uterine artery. The response to chemotherapy was evaluated by gynecologic examination and ultrasonography 3 weeks after chemotherapy. The changes of apoptotic index (AI), proliferation index (PI) and p53 expression of tumor cells were detected by immunohistochemical technique. Results: The clinical response rate of locally advanced squamous cervical cancer to uterine artery infusion chemotherapy was 70%. No change of PI was found 3 weeks after treatment, but AI significantly increased from 2.79±0.76 to 4.29±1.13 (P<0.01), and AI/PI from 5.68±1.21 to 9.00±1.95 (P<0.05). On the contrary, the expression of p53 was significantly decreased (P<0.05). Patients who responded to chemotherapy showed higher PI before chemotherapy and significantly increased AI and AI/PI after chemotherapy than non-responders (P<0.05). Conclusion: Higher PI was an indication for neoadjuvant intraarterial chemotherapy. One more cycle of chemotherapy should be given to those who have significantly increased AI or AI/PI after chemotherapy, while definite treatment such as surgery or/and radiotherapy should be immediately given to those patients without increased AI or AI/PI.

  8. Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma

    OpenAIRE

    Elshamy Maged R; Setit Ahmed E; Elshafei Mohamed A; Hegazi Refaat AF; Hegazy Mohamed AF; Eltatoongy Mohamed; Halim Amal AF

    2005-01-01

    Abstract Background Patients with advanced ovarian cancer should be treated by radical debulking surgery aiming at complete tumor resection. Unfortunately about 70% of the patients present with advanced disease, when optimal debulking can not be obtained, and therefore these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been proposed as a novel therapeutic approach in such cases. In this study, we report our results with primary surgery or neoadjuvant chemothe...

  9. The role of neoadjuvant radiochemotherapy using low-dose fraction cisplatin and 5-fluorouracil in patients with carcinoma of the esophagus

    International Nuclear Information System (INIS)

    We clarified the role of neoadjuvant radiochemotherapy in patients with carcinoma of the esophagus and compared it to neoadjuvant chemotherapy. We retrospectively examined 40 patients diagnosed with advanced thoracic esophageal carcinoma who underwent neoadjuvant therapy followed by esophagectomy between 1993 and 1999. We divided them into 2 groups: radiochemotherapy (17) and chemotherapy (23). Radiochemotherapy patients underwent 40 Gy radiation and low-dose fraction cisplatin (7 mg/body/day, 5 days a week x 4 weeks) and 5-fluorouracil (350 mg/body/day x 28 days). Chemotherapy patients received high-dose fraction cisplatin/5-fluorouracil involving 2 courses of cisplatin (70 mg/m2/day on day1) and 5-fluorouracil (700 mg/m2/day on days 1-5). Complete pathological response was 17.6% in the radiochemotherapy group and 0% in the chemotherapy group respectively. No hospital mortality occurred in the radiochemotherapy group, and 1 of the 23 chemotherapy patients died in the hospital due to postoperative complications. The incidence of residual tumors was significantly higher in the chemotherapy group (34.8%) than in the radiochemotherapy group (0%). Actuarial survival in the radiochemotherapy group at 1 year was 80.2% and at 3 years 53.5%. Actuarial survival in the chemotherapy group at 1 year was 56.5% and at 3 years 30.4%. Histological effectiveness was greater in patients treated with preoperative radiochemotherapy than those treated with preoperative chemotherapy. The combination of radiation and low-dose fraction CDDP/5-FU thus is first choice in neoadjuvant radiochemotherapy for the advanced esophageal carcinoma. (author)

  10. The results of a single center pilot study of combined high-dose methotrexate and doxorubicin with cisplatin in neo-adjuvant chemotherapy for osteosarcoma in children and adolescents

    International Nuclear Information System (INIS)

    The study summarizes the treatment results of a newly introduced protocol for high-grade osteosarcoma, combining high dose of methotrexate alternating with doxorubicin and cisplatin. The efficacy of preoperative chemotherapy, evaluated as a proportion of necrotic cells assessed in a primary tumor map, was compared with results achieved in historical studies comprising two modalities: doxorubicin and high dose of methotrexate (the so called SFOPprotocol) or doxorubicin and cisplatin (the so-called EORT protocol) only. Additionally, we performed a comparative analysis of early toxicity of all the three protocols. Apart from statistically insignificant differences between the results of all the three protocols, we have demonstrated that the efficacy of the currently introduces protocol exceeds that of the SFOP protocol and is comparable to the EORTC protocol (48.5% vs. 44% and 49%, respectively), with only two cycles of cardiotoxic doxorubicin applied in the current protocol. The proportion of limb saving procedures in the current protocol (82%>) was comparable to SFOP (85%) and exceeded that achieved in the EORTC protocol (48%). Progression of tumor mass was observed in 4% of patients treated according to the EORTC protocol, in 10% of currently assessed patients and in 44% of patients treated according to the SFOP protocol. Acute toxicity of cytostatics requiring withholding ongoing chemotherapy was considerably less common in the SFOP group (36%), when compared to current protocol (2.5%) and the EORTC protocol (0%). The results of this pilot study demonstrate the comparable or even higher efficacy and safety of the currently introduced protocol as compared to the historical treatment protocols in patients with high-grade osteosarcoma. The comprehensive results of the study and the final assessment of the safety and the efficacy of the currently introduced protocol calls for a long observation period and a larger patient group. (authors)

  11. Efficacy of neoadjuvant chemotherapy and radiotherapy for the histology-confirmed intracranial germinoma-preliminary report

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    Noh, Young Ju; Kim, Hak Jae; Heo, Dae Seog; Shin, Hee Yung; Kim, Il Han [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2002-06-15

    We intended to decrease late CNS reaction after radical radiotherapy for an intracranial germinoma by using combined neoadjuvant chemotherapy and involved-field radiotherapy. The efficacy in terms of its acute toxicity and short-term relapse patterns was analyzed. Eighteen patients were treated with combined neoadjuvant chemotherapy and radiotherapy between 1995 and 2001. The chemotherapy regimen used was the Children's Cancer Group (CCG) 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) for 5 patients younger than 16 years, BEP(bleomycin, VP-16, cisplatin) for 12 patients, and EP (VP-16, cisplatin) for 1 patient. The radiotherapy covered the whole craniospinal axis for 5 patients, the whole brain for 1, and the partial brain (involved field) for 12. the primary lesion received tumour doses between 3,960 and 5,400 cGy. The male to female ratio was 16:2 and the median age was 16 years old. The tumors were located in the pineal gland in 12 patients, in the suprasellar region in 1, in the basal ganglia in 1, in the thalamus in 1. Three patients had multiple lesions and ventricular seedings were shown at MRI. In 3 patients, tumor cells were detected in the cerebrospinal fluid and MRI detected a spinal seeding in 2 patients. The response to neoadjuvant chemotherapy was complete remission in 5 patients, partial remission in 12, and no response in 1. However, after radiotherapy, all except 1 patient experienced complete remission. The toxicity during or after chemotherapy greater than or equal to grade III was remarkable; hematologic toxicity was observed in 11 patients, liver toxicity in none, kidney toxicity in none, and gastrointestinal toxicity in one. One patient suffered from bleomycin-induced pneumonitis. Radiotherapy was therefore stopped and the patient eventually died of respiratory failure. The other 17 are alive without any evidence of disease or relapse during an average of 20 months follow-up. A high response rate and disease control was

  12. Neoadjuvant chemotherapy in advanced sinonasal teratocarcinosarcoma with intracranial extension: Report of two cases with literature review

    Directory of Open Access Journals (Sweden)

    Amit Joshi

    2015-01-01

    Full Text Available Sinonasal teratocarcinosarcoma (SNTCS is a highly aggressive rare tumor of the nasal cavity. Surgery followed by concurrent chemoradiation is the mainstay of treatment in SNTCS. However, intracranial extension may complicate surgical resection, with difficulty in achieving R0 resection. Here we present two cases of SNTCS with intracranial extension; both patients were seen in skull base clinic of our hospital and deemed unsuitable for surgery. These patients then were offered neoadjuvant chemotherapy (NACT, both patients had a partial response with cisplatin and etoposide protocol; subsequently they underwent R0 resection (no macroscopic residual tumor at surgery with all margins were negative for tumor on microscopy. The present cases highlight the fact that NACT with cisplatin and etoposide protocol may be considered in technically unresectable SNTCS.

  13. Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    P Joshi

    2013-01-01

    Full Text Available Objective: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT in changing the management and outcome of advanced hypopharyngeal cancer patients. Materials and Methods: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane or three drug with (platinum, taxane with 5-flurouracil [5 FU] as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1 surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion or (2 organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes. Results: The mean age of this population was 55 years. Most (83% of the patients had pyriform sinus (PFS involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33 and organ preservation protocol was planned after NACT in 73% (19/26 patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%, mucositis 5%, diarrhea 5%. The median progression free survival was 20 months. Conclusions: NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.

  14. Tolerance and toxicity of neoadjuvant docetaxel, cisplatin and 5 fluorouracil regimen in technically unresectable oral cancer in resource limited rural based tertiary cancer center

    OpenAIRE

    V M Patil; Chakraborty, S; P K Shenoy; A Manuprasad; Sajith Babu, T. P.; T Shivkumar; Babu, S.; A Bhatterjee; S Balasubramanian

    2014-01-01

    Background: Recent studies indicate neoadjuvant chemotherapy (NACT) can result in R0 resection in a substantial proportion of patients with technically unresectable oral cavity cancers. However, data regarding the efficacy and safety of docetaxel, cisplatin and 5 fluorouracil (TPF) NACT in our setting is lacking. The present audit was proposed to evaluate the toxicities encountered during administration of this regimen. It was hypothesized that TPF NACT would be considered feasible for routin...

  15. The role of neoadjuvant chemotherapy in the management of locally advanced cervix cancer: a systematic review

    Directory of Open Access Journals (Sweden)

    Mohammed Osman

    2014-09-01

    Full Text Available Cervical cancer is the second most common cancer in women. Neoadjuvant chemotherapy for patients with locally advanced cervix cancer has comparable benefits to concurrent chemoradiotherapy (CCRT, but with fewer side effects. This systematic review aims to provide a comprehensive summary of the benefits of neoadjuvant chemotherapy for the management of locally advanced cervix cancer from stage IB2 (tumor >4.0 cm to IIIB (tumor extending to the pelvic wall and/or hydronephrosis. Our primary objective was to assess benefits in terms of survival. The data source included the USA national library of medicine, Medline search, and the National Cancer Institute PDQ Clinical Protocols. Inclusion criteria for consideration in the current systematic review included studies published between January 1997 and December 2012. In terms of histology, they had to be focused on squamous cell carcinoma, adenosquamous carcinoma, and/or adenocarcinoma. Patients should be either chemotherapy naïve or cervix cancer chemotherapy naïve, and have a performance status ≤2. The search in the above-mentioned scientific websites led to identify 49 publications, 19 of which were excluded, as they did not meet the inclusion criteria of this systematic review. Therefore only 30 studies were deemed eligible. Data was collected from 1760 patients enrolled in the current systematic review study. The mean age was 45.2 years. The mean tumor size was 4.7 cm. The most commonly used chemotherapies were cisplatin doublets. Paclitaxel was the most commonly used chemotherapeutic agent in the doublets. The mean chemotherapy cycles were 2.7. After chemotherapy, patients underwent surgery after a mean time of 2.5 weeks. The standard operation was radical hysterectomy with pelvic lymphadenectomy. Chemotherapy achieved an objective response rate of 84%. The 5-year progression-free survival and overall survival were 61.9% and 72.8% respectively. The treatment protocol was associated

  16. Tracking the genomic evolution of esophageal adenocarcinoma through neoadjuvant chemotherapy

    OpenAIRE

    Murugaesu, Nirupa; Wilson, Gareth A; Birkbak, Nicolai J.; Watkins, Thomas; McGranahan, Nicholas; Kumar, Sacheen; Abbassi-Ghadi, Nima; Salm, Max; Mitter, Richard; Horswell, Stuart; Rowan, Andrew; Phillimore, Benjamin; Biggs, Jennifer; Begum, Sharmin; Matthews, Nik

    2015-01-01

    Esophageal adenocarcinomas (EACs) are associated with dismal prognosis. Deciphering the evolutionary histories of this disease may shed light on therapeutically tractable targets and reveal dynamic mutational processes during the disease course and following neoadjuvant chemotherapy (NAC). We exome sequenced 40 tumor regions from 8 patients with operable EACs, before and after platinum-containing NAC. This revealed the evolutionary genomic landscape of EACs with the presence of heterogeneous ...

  17. Nomogram for Predicting Breast Conservation after Neoadjuvant Chemotherapy

    OpenAIRE

    Kim, Min Kyoon; Han, Wonshik; Moon, Hyeong-Gon; Ahn, Soo Kyung; Kim, Jisun; Lee, Jun Woo; Kim, Ju-Yeon; Kim, Taeryung; Lee, Kyung-Hun; Kim, Tae-Yong; Han, Sae-Won; Im, Seock-Ah; Kim, Tae-You; Park, In Ae; Noh, Dong-Young

    2014-01-01

    Purpose The ability to accurately predict the likelihood of achieving breast conservation surgery (BCS) after neoadjuvant chemotherapy (NCT) is important in deciding whether NCT or surgery should be the first-line treatment in patients with operable breast cancers. Materials and Methods We reviewed the data of 513 women, who had stage II or III breast cancer and received NCT and surgery from a single institution. The ability of various clinicopathologic factors to predict the achievement of B...

  18. Neoadjuvant chemotherapy in advanced epithelial ovarian cancer: A survival study

    OpenAIRE

    Upasana Baruah; Debabrata Barmon; Amal Chandra Kataki; Pankaj Deka; Munlima Hazarika; Bhargab J Saikia

    2015-01-01

    Context: Patients with advanced ovarian cancer have a poor prognosis in spite of the best possible care. Primary debulking surgery has been the standard of care in advanced ovarian cancer; however, it is associated with high mortality and morbidity rates as shown in various studies. Several studies have discussed the benefit of neoadjuvant chemotherapy in patients with advanced ovarian cancer. Aims: This study aims to evaluate the survival statistics of the patients who have been managed with...

  19. Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma

    OpenAIRE

    Joshi, P.; V Patil; Joshi, A; V Norohna; Chaturvedi, P.; Chaukar, D.; P Pai; D Nair; Juvekar, S; Agarwal, J. P.; A K D′cruz; Prabhash, K

    2013-01-01

    Objective: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients. Materials and Methods: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 w...

  20. Role of neoadjuvant chemotherapy in cancer cervix: A brief review

    OpenAIRE

    Aramita Saha; Anindya Mukherjee

    2013-01-01

    Neoadjuvant chemotherapy (NACT) represents a promising modality apart from or radiotherapy as initial treatment of locally advanced cervical cancer. The primary objectives of NACT in the treatment of cervical cancer include improvement in tumor characteristics, to allow avoidance of radiotherapy, to prolong disease-free and overall survival, and facilitation of fertility-sparing surgery. Though several studies have shown promising results of NACT on tumor response, downstaging, decrease in lo...

  1. Cytologic changes of ovarian epithelial cancer induced by neoadjuvant chemotherapy

    OpenAIRE

    Wang, Yiying; Wang, Yue; Zheng, Wenxin

    2013-01-01

    Objective: Neoadjuvant chemotherapy (NACT) followed by cytoreduction has now become a part of standard care for patients with advanced ovarian cancer. Cytologic changes of the cancer cells induced by NACT, however, sometimes may cause confusion in terms of pathologic diagnosis and therefore inappropriate management. The objective of this study was to characterize the histologic or cytologic features of the ovarian cancers from those patients who received NACT in order to improve the diagnosti...

  2. Increased nephrotoxicity of combination taxol and cisplatin chemotherapy in gynecologic cancers as compared to cisplatin alone.

    Science.gov (United States)

    Merouani, A; Davidson, S A; Schrier, R W

    1997-01-01

    To investigate the increased nephrotoxicity of taxol and cisplatin combination chemotherapy in gynecologic cancers as compared to cisplatin alone, the medical records of 25 patients with gynecological cancers were reviewed for evaluation of nephrotoxicity after chemotherapy treatment. The data included age, serum creatinine, calculated creatinine clearance, initial and cumulative dose of cisplatin and taxol, primary site of the cancer, renal ultrasound and hydration protocols. Renal function was evaluated before, during and 6 months after chemotherapy. Renal dysfunction was defined as a greater than 25% decrease in creatinine clearance. Comparing 11 patients treated with taxol and cisplatin versus 14 treated with cisplatin alone, there was a significant difference in effect on renal function. Nine of 11 patients (81%) treated with the combination chemotherapy had a greater than 25% decrease in creatinine clearance while only 4 of the 14 patients (29%) treated with cisplatin alone had such a decrease in creatinine clearance (p < 0.004). The patients treated with the combination chemotherapy, however, received a higher dose of cisplatin (80.4 vs. 66.4 mg/m2, p < 0.02) and were treated longer (6.7 vs. 4.3 months, p < 0.002). Nevertheless, when the patients were matched for age, initial dose and cumulative dose of cisplatin, a higher frequency of nephrotoxicity persisted in patients treated with taxol and cisplatin as compared to cisplatin alone (72 as compared to 20%, p < 0.02). The patients in both groups were comparably hydrated; prerenal failure and urinary tract obstruction were excluded in all patients. Six months after completion of chemotherapy, a significantly lower creatinine clearance was still observed in patients treated with taxol and cisplatin combination therapy (46 vs. 76 ml/min, p < 0.01). In summary, a retrospective analysis of renal function in patients with gynecological cancers showed an increased nephrotoxicity in patients treated with taxol and

  3. Neoadjuvant Chemotherapy for Locally Advanced Squamous Carcinoma of Oral Cavity: a Pilot Study.

    Directory of Open Access Journals (Sweden)

    Sanambar Sadighi

    2015-06-01

    Full Text Available To evaluate the effect of adding neoadjuvant chemotherapy to surgery and radiation therapy for locally advanced resectable oral cavity squamous cell carcinoma, 24 patients with T3 or T4a oral cavity squamous cell carcinoma were randomly assigned to surgery alone or Docetaxel, Cisplatin, and 5-FU (TPF induction chemotherapy followed by surgery. All patients were planned to receive chemoradiotherapy after surgery. The primary end-points were organ preservation and progression-free-survival. SPSS version 17 was used for data analysis. Median follow-up was 16 months. The median age of the patients was 62 years old (23-75 years. Man/woman ratio was 1.13. The primary site of the tumor was the tongue in most patients (48%. No significant difference was observed between pathologic characteristics of the two groups. Chemotherapy group showed 16% complete pathologic response to TPF. No significant difference in organ preservation surgery or overall survival was detected. However, the patients in the chemotherapy group had longer progression-free-survival (P=0.014. Surgery followed by chemoradiotherapy with or without TPF induction results in similar survival time. However, progression-free-survival improves with the TPF induction chemotherapy. Studies with more patents and new strategies are recommended to evaluate organ preservation improvement and long-term outcomes.

  4. Experience with combination of docetaxel, cisplatin plus 5-fluorouracil chemotherapy, and intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Our aim was to evaluate the efficacy and toxicity of cisplatin, fluorouracil, and docetaxel chemotherapy plus intensity-modulated radiotherapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC). Sixty patients with locoregionally advanced NPC were enrolled. Patients received IMRT plus three courses of neoadjuvant chemotherapy and two courses of adjuvant chemotherapy consisting of docetaxel (60 mg/m2/day on day 1), cisplatin (25 mg/m2/day on days 1-3), and 5-fluorouracil (500 mg/m2/day on days 1-3). The overall response rate to neoadjuvant chemotherapy was 89%. Three months after the completion of radiotherapy, 53 (93%) patients achieved complete regression, 3 (5%) achieved partial response (PR), and 1 experienced liver metastasis. However, among the 3 PR patients, 2 patients had no evidence of relapse in the follow-up. With a median follow-up of 27 months (range, 6-43), the 2-year estimated locoregional failure-free survival, distant failure-free survival, progression-free survival, and overall survival were 96.6, 93.3, 89.9, and 98.3%, respectively. Leukopenia was the main adverse effect in chemotherapy; 14 patients experienced grade 3 or grade 4 neutropenia, and 1 patient developed febrile neutropenia. The nonhematological adverse events included alopecia, nausea, vomiting, anorexia, and diarrhea. The incidence of grade 3 acute radiotherapy-related mucositis was 28.3%; no grade 4 acute mucositis was observed. No grade 3 or grade 4 hematological toxicity occurred during radiotherapy. None of the patients had interrupted radiotherapy. The common late adverse effects included xerostomia and hearing impairment. Neoadjuvant-adjuvant chemotherapy using cisplatin, fluorouracil, plus docetaxel combined with IMRT was an effective and well-tolerated alternative for advanced NPC. (author)

  5. Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma

    Directory of Open Access Journals (Sweden)

    Elshamy Maged R

    2005-08-01

    Full Text Available Abstract Background Patients with advanced ovarian cancer should be treated by radical debulking surgery aiming at complete tumor resection. Unfortunately about 70% of the patients present with advanced disease, when optimal debulking can not be obtained, and therefore these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT has been proposed as a novel therapeutic approach in such cases. In this study, we report our results with primary surgery or neoadjuvant chemotherapy as treatment modalities in the specific indication of operable patients with advanced ovarian carcinoma (no medical contraindication to debulking surgery. Patients and methods A total of 59 patients with stage III or IV epithelial ovarian carcinomas were evaluated between 1998 and 2003. All patients were submitted to surgical exploration aiming to evaluate tumor resectability. Neoadjuvant chemotherapy was given (in 27 patients where optimal cytoreduction was not feasible. Conversely primary debulking surgery was performed when we considered that optimal cytoreduction could be achieved by the standard surgery (32 patients. Results Optimal cytoreduction was higher in the NACT group (72.2% than the conventional group (62.4%, though not statistically significant (P = 0.5. More important was the finding that parameters of surgical aggressiveness (blood loss rates, ICU stay and total hospital stay were significantly lower in NACT group than the conventional group. The median overall survival time was 28 months in the conventional group and 25 months in NACT group with a P value of 0.5. The median disease free survival was 19 months in the conventional group and 21 months in NACT group (P = 0.4. In multivariate analysis, the pathologic type and degree of debulking were found to affect the disease free survival significantly. Overall survival was not affected by any of the study parameters. Conclusion Primary chemotherapy followed by interval debulking surgery

  6. Intraoperative imaging identifies thymoma margins following neoadjuvant chemotherapy

    Science.gov (United States)

    Keating, Jane J.; Nims, Sarah; Venegas, Ollin; Jiang, Jack; Holt, David; Kucharczuk, John C.; Deshpande, Charuhas; Singhal, Sunil

    2016-01-01

    Near infrared (NIR) molecular imaging is useful to identify tumor margins during surgery; however, the value of this technology has not been evaluated for tumors that have been pre-treated with chemotherapy. We hypothesized that NIR molecular imaging could locate mediastinal tumor margins in a murine model after neoadjuvant chemotherapy. Flank thymomas were established on mice. Two separate experiments were performed for tumor margin detection. The first experiment compared (i) surgery and (ii) surgery + NIR imaging. The second experiment compared (iii) preoperative chemotherapy + surgery, and (iv) preoperative chemotherapy + surgery + NIR imaging. NIR imaging occurred following systemic injection of indocyanine green. Margins were assessed for residual tumor cells by pathology. NIR imaging was superior at detecting retained tumor cells during surgery compared to standard techniques (surgery alone vs. surgery + NIR imaging, 20% vs. 80%, respectively). Following chemotherapy, the sensitivity of NIR imaging of tumor margins was not significantly altered. The mean in vivo tumor-to-background fluorescence ratio was similar in the treatment-naïve and chemotherapy groups ((p = 0.899): 3.79 ± 0.69 (IQR 3.29 - 4.25) vs. 3.79 ± 0.52 (IQR 3.40 – 4.03)). We conclude that chemotherapy does not affect tumor fluorescence or identification of retained cancer cells at margins. PMID:26689990

  7. Intraoperative imaging identifies thymoma margins following neoadjuvant chemotherapy.

    Science.gov (United States)

    Keating, Jane J; Nims, Sarah; Venegas, Ollin; Jiang, Jack; Holt, David; Kucharczuk, John C; Deshpande, Charuhas; Singhal, Sunil

    2016-01-19

    Near infrared (NIR) molecular imaging is useful to identify tumor margins during surgery; however, the value of this technology has not been evaluated for tumors that have been pre-treated with chemotherapy. We hypothesized that NIR molecular imaging could locate mediastinal tumor margins in a murine model after neoadjuvant chemotherapy. Flank thymomas were established on mice. Two separate experiments were performed for tumor margin detection. The first experiment compared (i) surgery and (ii) surgery + NIR imaging. The second experiment compared (iii) preoperative chemotherapy + surgery, and (iv) preoperative chemotherapy + surgery + NIR imaging. NIR imaging occurred following systemic injection of indocyanine green. Margins were assessed for residual tumor cells by pathology. NIR imaging was superior at detecting retained tumor cells during surgery compared to standard techniques (surgery alone vs. surgery + NIR imaging, 20% vs. 80%, respectively). Following chemotherapy, the sensitivity of NIR imaging of tumor margins was not significantly altered. The mean in vivo tumor-to-background fluorescence ratio was similar in the treatment-naïve and chemotherapy groups ((p = 0.899): 3.79 ± 0.69 (IQR 3.29 - 4.25) vs. 3.79 ± 0.52 (IQR 3.40 - 4.03)). We conclude that chemotherapy does not affect tumor fluorescence or identification of retained cancer cells at margins. PMID:26689990

  8. Neoadjuvant chemotherapy as ovarian cancer treatment: ever more used with major regional differences

    DEFF Research Database (Denmark)

    Fagö-Olsen, Carsten L; Ottesen, Bent; Kehlet, Henrik;

    2012-01-01

    The traditional first-line treatment for patients with advanced ovarian cancer with primary debulking surgery (PDS) and adjuvant chemotherapy is controversial as some authors report a potential benefit from the alternative treatment with neoadjuvant chemotherapy (NACT) and interval debulking...

  9. A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer

    OpenAIRE

    McCormack, M; Kadalayil, L; Hackshaw, A; Hall-Craggs, M A; Symonds, R P; Warwick, V; Simonds, H.; Fernando, I.; Hammond, M.; James, L.; Feeney, A.; Ledermann, J. A.

    2013-01-01

    Background: We investigated the feasibility of dose-dense neoadjuvant chemotherapy (NACT) with paclitaxel and carboplatin before radical chemoradiation (CRT) and assessed the response rate to such a regimen. Methods: CxII is a single-arm phase II trial of 46 patients, with locally advanced cervical cancer (stage Ib2-IVa). Patients received dose-dense carboplatin (AUC2) and paclitaxel (80 mg m−2) weekly for six cycles followed by CRT (40 mg m−2 of weekly cisplatin, 50.4 G...

  10. Neoadjuvant chemotherapy in advanced epithelial ovarian cancer: A survival study

    Directory of Open Access Journals (Sweden)

    Upasana Baruah

    2015-01-01

    Full Text Available Context: Patients with advanced ovarian cancer have a poor prognosis in spite of the best possible care. Primary debulking surgery has been the standard of care in advanced ovarian cancer; however, it is associated with high mortality and morbidity rates as shown in various studies. Several studies have discussed the benefit of neoadjuvant chemotherapy in patients with advanced ovarian cancer. Aims: This study aims to evaluate the survival statistics of the patients who have been managed with interval debulking surgery (IDS from January 2007 to December 2009. Materials and Methods: During the period from January 2007 to December 2009, a retrospective analysis of 104 patients who underwent IDS for stage IIIC or IV advanced epithelial ovarian cancer at our institute were selected for the study. IDS was attempted after three to five courses of chemotherapy with paclitaxal (175 mg/m 2 and carboplatin (5-6 of area under curve. Overall survival (OS and progression free survival (PFS were compared with results of primary debulking study from existing literature. OS and PFS rates were estimated by means of the Kaplan-Meier method. Results were statistically analyzed by IBM SPSS Statistics 19. Results: The median OS was 26 months and the median PFS was 18 months. In multivariate analysis it was found that both OS and PFS was affected by the stage, and extent of debulking. Conclusions: Neoadjuvant chemotherapy, followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers.

  11. Phase I study of neoadjuvant chemoradiotherapy with S-1 plus biweekly cisplatin for advanced gastric cancer patients with lymph node metastasis: -KOGC04-

    International Nuclear Information System (INIS)

    In patients with highly advanced gastric cancer, the recurrence rate remains high and the prognosis disappointing. We previously reported a phase I study of a neoadjuvant chemoradiotherapy of S-1 plus weekly cisplatin. Although adequate safety and efficacy were reported, myelosuppression was frequently observed, leading to treatment delay in several cases. To decrease toxicity and improve efficacy, we planned a phase I study with a modified chemotherapy regimen with biweekly cisplatin. Patients with advanced gastric cancer and lymph node metastasis who were treated by our institution between 2011 and 2012 were eligible for inclusion. The initial chemoradiotherapy schedule consisted of 6 weeks of S-1 orally administered on days 1–15 with an escalating dose of cisplatin administered on days 1 and 15. The starting dose (level 1) of cisplatin was 15 mg/m2, the second dose (level 2) was 20 mg/m2, and the third dose (level 3) was 25 mg/m2. Radiation of 40 Gy was administered in 20 fractions. After initial chemoradiotherapy, one cycle of combination chemotherapy with S-1 plus cisplatin was delivered. The second cycle was 42 days in duration and included S-1 administered on days 1–29 plus biweekly cisplatin administered on days 1, 15, and 29. After neoadjuvant treatment, a curative gastrectomy with extended (D2) lymph node dissection was planned. Nine patients were enrolled. At level 3, one patient had dose-limiting grade 3 diarrhea. Another patient experienced grade 3 nausea and intended to discontinue the treatment. Overall, because 2 of 3 patients experienced dose-limiting toxicity at level 3, we confirmed level 3 (Cisplatin 25 mg/m2) as the maximum tolerated dose and level 2 (Cisplatin 20 mg/m2) as the recommended dose (RD). The response rate was 78%, and 8 patients underwent curative gastrectomy. Resected specimens showed a histological response in 6 patients (75%), including one with a pathological complete response. In this phase I trial, RD of cisplatin was

  12. Postmastectomy Radiotherapy for Locally Advanced Breast Cancer Receiving Neoadjuvant Chemotherapy

    OpenAIRE

    Icro Meattini; Sara Cecchini; Vanessa Di Cataldo; Calogero Saieva; Giulio Francolini; Vieri Scotti; Pierluigi Bonomo; Monica Mangoni; Daniela Greto; Jacopo Nori; Lorenzo Orzalesi; Donato Casella; Roberta Simoncini; Massimiliano Fambrini; Simonetta Bianchi

    2014-01-01

    Neoadjuvant chemotherapy (NAC) is widely used in locally advanced breast cancer (BC) treatment. The role of postmastectomy radiotherapy (PMRT) after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6%) underwent PMRT and 72 cases (42.4%) did not receive radiation. At a median follow-up period of 7.7 years (r...

  13. Neoadjuvant chemotherapy in cervical cancer in pregnancy.

    Science.gov (United States)

    Ilancheran, Arunachalam

    2016-05-01

    Cervical cancer is the most common gynecological cancer encountered in pregnancy. The standard treatment of early cervical cancer is usually surgical removal of the cervix (in selected cases) or, more commonly, the uterus. However, when cervical cancer develops during pregnancy, definitive surgical treatment often needs to be postponed until the fetus reaches maturity. Neoadjuvant chemotherapy (NACT) is an innovative approach in the management of these patients. It helps in controlling the disease and delaying delivery. The paper presents a literature review of the history of NACT, as well as practice points and agenda for further research. PMID:26536815

  14. Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    To evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC). Between August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction. After completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively. HT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings

  15. Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle-invasive bladder cancer

    DEFF Research Database (Denmark)

    Galsky, Matthew D; Pal, Sumanta K; Chowdhury, Simon;

    2015-01-01

    clinical T-classification 2 (cT2) through cT4aN0M0 urothelial cancer of the bladder and received neoadjuvant GC or methotrexate, vinblastine, doxorubicin, plus cisplatin (MVAC) before undergoing cystectomy. Logistic regression was used to compute propensity scores as the predicted probabilities of patients......BACKGROUND: Gemcitabine plus cisplatin (GC) has been adopted as a neoadjuvant regimen for muscle-invasive bladder cancer despite the lack of Level I evidence in this setting. METHODS: Data were collected using an electronic data-capture platform from 28 international centers. Eligible patients had...

  16. A Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy

    International Nuclear Information System (INIS)

    Purpose: To assess the long term efficacy of neoadjuvant MCV (Methotrexate, Cisplatin, Vinblastine) chemotherapy in patients with muscle invading bladder cancer treated by combined modality therapy with selection for consolidation by either cystectomy or Cisplatin and radiation (XRT) based on initial response. Patients and Methods: From 1990 through 1993, 126 patients (median age 68 years, range39 to 83 years) with clinical stage T2-T4aNXM0 bladder cancer were randomized following a thorough transurethral resection (TURBT), if possible, to receive (Arm 1, N=62) or not (Arm 2, N=64) 2 cycles of MCV prior to 39.6Gy pelvic irradiation with concurrent Cisplatin (100mg/M2) 2 courses, 3 weeks apart. Tumor response was scored as a clinical CR when the tumor-site biopsy and urine cytology were negative. The CR patients were treated with consolidation of an additional 25.2Gy to a total of 64.8Gy with 1 additional cycle of Cisplatin. Those with less than a CR were advised prompt cystectomy as were those with a subsequent invasive recurrence. The median follow up of surviving patients is 44 months. Results: 72% of patients completed the protocol with no or minor deviations; 62% on Arm 1 and 82% on Arm 2. The actuarial 5 year overall survival is 47%; 42% in Arm 1 and 50% in Arm 2. 40% of the patients had evidence of distant metastases at 5 years; 35% in Arm 1 and 43% in Arm 2. The 5 year survival with a functioning bladder is 36%, 32% in Arm 1, 39% in Arm 2. Among the 72 CR patients (60% CR in Arm 1 and 55% CR in Arm 2) 13% have had evidence of an invasive tumor relapse at 5 years. Six patients died during treatment; 5 in Arm 1, 1 in Arm 2. No patient required a cystectomy for treatment-related bladder morbidity. Conclusions: Two cycles of MCV neoadjuvant chemotherapy was not shown to provide an improved rate of CR to induction therapy or freedom from metastatic disease, or in five year overall survival. This absence of benefit in any of these endpoints may have resulted more

  17. Neoadjuvant Chemotherapy in Neuroendocrine Bladder Cancer: A Case Report.

    Science.gov (United States)

    Prelaj, Arsela; Rebuzzi, Sara Elena; Magliocca, Fabio Massimo; Speranza, Iolanda; Corongiu, Emanuele; Borgoni, Giuseppe; Perugia, Giacomo; Liberti, Marcello; Bianco, Vincenzo

    2016-01-01

    BACKGROUND Small cell carcinoma of the urinary bladder is a rare and aggressive form of bladder cancer that mainly presents at an advanced stage. As a result of its rarity, it has been described in many case reports and reviews but few retrospective and prospective trials, showing there is no standard therapeutic approach. In the literature the best therapeutic strategy for limited disease is the multimodality treatment and most authors have extrapolated treatment algorithms from the therapy recommendations of small cell lung cancer. CASE REPORT A 71-year-old male patient was referred to our hospital with gross hematuria and dysuria. Imaging and cystoscopy revealed a vegetative lesion of the bladder wall. A transurethral resection of the bladder was performed. Pathological examination revealed a pT2 high-grade urothelial carcinoma with widespread neuroendocrine differentiation. Multimodal treatment with neoadjuvant platinum-based chemotherapy was performed. A CT scan performed after chemotherapy demonstrated a radiological complete response. The patient underwent radical cystectomy and lymphadenectomy. The histopathological finding of bladder and node specimen confirmed a pathological complete response. A post-surgery CT scan showed no evidence of local or systemic disease. Six months after surgery, the patient is still alive and disease-free. CONCLUSIONS A standard treatment strategy of small cell cancer of the urinary bladder is not yet well established, but a multimodal treatment of this disease is the best option compared to surgical therapy alone. The authors confirm the use of neoadjuvant chemotherapy in limited disease of small cell carcinoma of the urinary bladder. PMID:27072610

  18. Clinical trial of neoadjuvant chemotherapy combined with radiotherapy for primary intracranial germinomas

    International Nuclear Information System (INIS)

    Purpose/Objective: Since 1992, we have been using neoadjuvant chemotherapy to reduce the radiation dose and irradiated volume in the treatment of intracranial germinomas. This study evaluates the initial response and complications of the treatment and also the IQ score and pituitary function of patients before radiotherapy. Materials and methods: Fifteen patients with histologically confirmed intracranial germinomas were treated between 1992 and 1997. Six patients with solitary pure germinoma received 3 to 4 courses of etoposide and cisplatin (EP regimen) followed by localized irradiation of 24Gy (in 12 fractions within 3 weeks). Three patients with germinoma with syncytiotrophoblastic giant cells (STGC) and 4 patients with multifocal pure germinoma received 3 to 5 courses of ifosfamide, cisplatin and etoposide (ICE regimen), followed by localized irradiation of 24 Gy. Two patients with disseminated pure germinoma received 2 to 4 courses of ICE regimen followed by craniospinal irradiation of 24 Gy. In the planning of localized irradiation, the treatment field was determined so as to cover the tumor with a margin of 2cm. The IQ score and pituitary function before radiotherapy were also examined. MRI was performed in all patients one month after the completion of treatment and every 6 months in the follow-up study. The treatment data of our institute before 1991, as historical control, was analyzed and compared to that of the present study. Results: Complete remission (CR) was obtained in all patients after the treatment. One patient with germinoma with STGC experienced recurrence out of the field at 39 months after surgery. He was re-treated with salvage therapy including the ICE regimen and obtained a second complete remission. All patients are alive without disease with a median follow-up period of 29 months. The examination of IQ score and pituitary function before radiotherapy revealed mental retardation in 2 patients (22%) and hypopituitarism in 13 patients (86

  19. Standardizing of Pathology in Patients Receiving Neoadjuvant Chemotherapy.

    Science.gov (United States)

    Bossuyt, Veerle; Symmans, W Fraser

    2016-10-01

    The use of neoadjuvant systemic therapy for the treatment of breast cancer patients is increasing. Pathologic response in the form of pathologic complete response (pCR) and grading systems of partial response, such as the residual cancer burden (RCB) system, gives valuable prognostic information for patients and is used as a primary endpoint in clinical trials. The breast cancer and pathology communities are responding with efforts to standardize pathology in patients receiving neoadjuvant chemotherapy. In this review, we summarize the challenges that postneoadjuvant systemic therapy surgical specimens pose and how pathologists and the multidisciplinary team can work together to optimize handling of these specimens. Multidisciplinary communication is essential. A single, standardized approach to macroscopic and microscopic pathologic examination makes it possible to provide reliable response information. This approach employs a map of tissue sections to correlate clinical, gross, microscopic, and imaging findings in order to report the presence of pCR (ypT0 ypN0 and ypT0/is ypN0) versus residual disease, the ypT and ypN stage using the current AJCC/UICC staging system, and the RCB. PMID:27380637

  20. MRI evaluation of residual tumor size after neoadjuvant endocrine therapy vs. neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Takeda, Kazuna [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyoku, Kyoto 606-8507 (Japan); Kanao, Shotaro, E-mail: kanaos@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyoku, Kyoto 606-8507 (Japan); Okada, Tomohisa [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyoku, Kyoto 606-8507 (Japan); Ueno, Takayuki; Toi, Masakazu [Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Ishiguro, Hiroshi [Outpatient Oncology Unit, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Mikami, Yoshiki [Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Tanaka, Shiro [Translational Research Center, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Togashi, Kaori [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyoku, Kyoto 606-8507 (Japan)

    2012-09-15

    Aim: To investigate if there is any difference in evaluation of residual tumor size after neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy (NAE). Methods: Seventy-eight tumors in 57 patients were prospectively enrolled. Residual tumor sizes in contrast-enhanced MRI after NAC and NAE were compared with those measured on surgical specimen by using linear regression analyses. The line slope values >1 indicates overestimation by MRI. Differences in types of shrinkage patterns: concentric shrinkage (CS) and dendritic shrinkage (DS) were also investigated. Results: Fifty lesions were treated with NAC and 28 lesions were treated with NAE. Shrinkage patterns were CS in 33 lesions and in 45 lesions. The slopes values were 0.75 (R = 0.92) and 0.70 (R = 0.90) for NAC and NAE, respectively, and no significant difference was observed (p = 0.46). However, they were 1.02 (R = 0.92) and 0.68 (R = 0.92), respectively for CS and DS with significant difference (p < 0.01). The difference between CS and DS was found only in a subgroup with size by MRI >20 mm. Conclusion: Contrast enhanced MRI enabled fairly accurate measurement in NAE as well as in NAC.

  1. Prognostic value of serum leptin in advanced lung adenocarcinoma patients with cisplatin/pemetrexed chemotherapy

    OpenAIRE

    MOU, WENJUN; Xue, Hui; TONG, HONGLI; Sun, Shengjie; Zhang, Zhuhong; Zhang, Chunyan; Sun, Qiyu; Dong, Jing; Wen, Xinyu; YAN, GUANGTAO; Tian, Yaping

    2014-01-01

    Cisplatin/pemetrexed chemotherapy has been established as a standard treatment in lung adenocarcinoma. However, the response to the cisplatin/pemetrexed combination varies considerably among patients due to individual variations. Thus, novel biomarkers are required to aid the prediction of the response to the cisplatin/pemetrexed combination. We hypothesized that leptin expression may be a determinant for prognosis in lung adenocarcinoma patients with cisplatin/pemetrexed chemotherapy. Serum ...

  2. Using neoadjuvant chemotherapy and replanning intensity-modulated radiotherapy for nasopharyngeal carcinoma with intracranial invasion to protect critical normal tissue

    International Nuclear Information System (INIS)

    To investigate the feasibility of neoadjuvant chemotherapy and replanning intensity-modulated radiotherapy (IMRT) for intracranial invasion nasopharyngeal carcinoma (NPC). From June 2007 to January 2012, 32 patients with intracranial invasion NPC treated with TPF (docetaxel 75 mg/m2, cisplatin 75 mg/m2, 5-FU 2500 mg/m2 every 3 weeks for 3 cycles) neoadjuvant chemotherapy, and replanning IMRT with concurrent chemotherapy were retrospectively studied. The first IMRT plan for each patient was generated based on the original planning CT scan acquired before the start of treatment. Because of tumor shrinkage during radiotherapy, modified gross tumor volume of primary tumor (GTV-P) and high risk clinical target volume (CTV-H), and a new plan was generated and used to complete the course of IMRT. The DVHs of IMRT plan with or without replanning were compared. There weren’t statistically significant differences in the V95, D-mean, D-95, and D-99 to the modified PTVGTV-P and PTVCTV-H with and without replanning IMRT. Replanning reduced the doses to the brain stem, optic nerve, optic chiasm and temporal lobe. Objective responses were 100.0% 3 months after completion of radiotherapy. Acute toxicities were well tolerated, except for the relatively high incidence of neutropenia. The 2-year local control rates and distant-metastasis free survival were 88.2% (95% CI, 72.9% to 100.0%) and 89.6% (95% CI, 75.9% to 100.0%). Neoadjuvant chemotherapy and replanning IMRT according to tumor shrinkage during the treatment is essential to ensure safe doses to normal tissues, and produces encouraging outcome for intracranial invasion NPC

  3. Investigation of the Effect of Neoadjuvant Chemotherapy on Stage II Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    Yanli Song; Dong Wang

    2007-01-01

    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.

  4. Postmastectomy radiotherapy for locally advanced breast cancer receiving neoadjuvant chemotherapy.

    Science.gov (United States)

    Meattini, Icro; Cecchini, Sara; Di Cataldo, Vanessa; Saieva, Calogero; Francolini, Giulio; Scotti, Vieri; Bonomo, Pierluigi; Mangoni, Monica; Greto, Daniela; Nori, Jacopo; Orzalesi, Lorenzo; Casella, Donato; Simoncini, Roberta; Fambrini, Massimiliano; Bianchi, Simonetta; Livi, Lorenzo

    2014-01-01

    Neoadjuvant chemotherapy (NAC) is widely used in locally advanced breast cancer (BC) treatment. The role of postmastectomy radiotherapy (PMRT) after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6%) underwent PMRT and 72 cases (42.4%) did not receive radiation. At a median follow-up period of 7.7 years (range 2-16) for the whole cohort, median time to locoregional recurrence (LRR) was 3.3 years (range 0.7-12.4). The 5-year and 10-year actuarial LRR rate were 14.5% and 15.9%, respectively. At the multivariate analysis the factors that significantly correlated with survival outcome were ≥ 4 positive nodes (HR 5.0, 1.51-16.52; P = 0.035), extracapsular extension (HR 2.18, 1.37-3.46; P = 0.009), and estrogen receptor positive disease (HR 0.57, 0.36-0.90; P = 0.003). Concerning LRR according to use of radiation, PMRT reduced LRR for patient with clinical T3 staged disease (P = 0.015). Our experience confirmed the impact of pathological nodal involvement on survival outcome. PMRT was found to improve local control in patients presenting with clinical T3 tumors, regardless of the response to chemotherapy. PMID:25045694

  5. Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

    OpenAIRE

    Glynne-Jones, R.; Grainger, J.; Harrison, M; Ostler, P.; Makris, A

    2006-01-01

    Neoadjuvant chemotherapy (NACT) is a term originally used to describe the administration of chemotherapy preoperatively before surgery. The original rationale for administering NACT or so-called induction chemotherapy to shrink or downstage a locally advanced tumour, and thereby facilitate more effective local treatment with surgery or radiotherapy, has been extended with the introduction of more effective combinations of chemotherapy to include reducing the risks of metastatic disease. It se...

  6. EFFECTS OF NEOADJUVANT CHEMOTHERAPY ON MDR1 AND MRP GENE EXPRESSION IN PRIMARY BREAST CANCER

    Institute of Scientific and Technical Information of China (English)

    刘杏娥; 孙晓东; 吴金民

    2004-01-01

    Objective: To investigate the effects of neoadjuvant chemotherapy on the expression of drug resistance genes,multidrug resistance-1 (MDR1) and multidrug resistance-associated protein (MRP), in patients with primary breast cancer. Methods: MDR1 and MRP expression were detected by semi-quantitative RT-PCR in 20 patients with primary breast cancer, before and after chemotherapy.Results: Before chemotherapy, MDR1 and MRP expression can be detected in 15 cases (75%) and 18 cases (90%)respectively. After chemotherapy, expression of MDR1 is not significantly different from that before chemotherapy, but expression of MRP is significantly different from that before chemotherapy. Conclusion: Expression of drug resistance gene MRP, but not MDR1, is enhanced in patients with primary breast cancer submitted to neoadjuvant chemotherapy.

  7. Postmastectomy Radiotherapy for Locally Advanced Breast Cancer Receiving Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Icro Meattini

    2014-01-01

    Full Text Available Neoadjuvant chemotherapy (NAC is widely used in locally advanced breast cancer (BC treatment. The role of postmastectomy radiotherapy (PMRT after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6% underwent PMRT and 72 cases (42.4% did not receive radiation. At a median follow-up period of 7.7 years (range 2–16 for the whole cohort, median time to locoregional recurrence (LRR was 3.3 years (range 0.7–12.4. The 5-year and 10-year actuarial LRR rate were 14.5% and 15.9%, respectively. At the multivariate analysis the factors that significantly correlated with survival outcome were ≥4 positive nodes (HR 5.0, 1.51–16.52; P=0.035, extracapsular extension (HR 2.18, 1.37–3.46; P=0.009, and estrogen receptor positive disease (HR 0.57, 0.36–0.90; P=0.003. Concerning LRR according to use of radiation, PMRT reduced LRR for patient with clinical T3 staged disease (P=0.015. Our experience confirmed the impact of pathological nodal involvement on survival outcome. PMRT was found to improve local control in patients presenting with clinical T3 tumors, regardless of the response to chemotherapy.

  8. Role of neoadjuvant chemotherapy in cancer cervix: A brief review

    Directory of Open Access Journals (Sweden)

    Aramita Saha

    2013-01-01

    Full Text Available Neoadjuvant chemotherapy (NACT represents a promising modality apart from or radiotherapy as initial treatment of locally advanced cervical cancer. The primary objectives of NACT in the treatment of cervical cancer include improvement in tumor characteristics, to allow avoidance of radiotherapy, to prolong disease-free and overall survival, and facilitation of fertility-sparing surgery. Though several studies have shown promising results of NACT on tumor response, downstaging, decrease in local recurrence, improved progression free survival, yet its role is controversial and plenty of study results are waiting to establish its efficacy. After reviewing the available literatures in the internet, and focusing the light of our continuous 3 years experience, we have made an effort to find out the relevance of NACT in cancer cervix. NACT is feasible and produces impressive responses in cervical carcinoma, as has been demonstrated by several phase II and phase III trials. Some meta-analysis suggested that NACT followed by surgery improves overall survival compared with nonstandard radiotherapy alone.

  9. Neoadjuvant chemotherapy in patients with stages Ⅱ and Ⅲ breast cancer

    Institute of Scientific and Technical Information of China (English)

    YUAN Zhu; QU Xiang; ZHANG Zhong-tao; WANG Yu

    2009-01-01

    Background Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. However, only a few studies have published data concerning the outcomes of patients with stages Ⅱ and Ⅲ breast cancer after neoadjuvant chemotherapy. Methods This study retrospectively investigated the clinical value of neoadjuvant chemotherapy for patients with stages Ⅱ and Ⅲ breast cancer. The patients in Group 1 (n=54) were treated with neoadjuvant chemotherapy, followed by definitive surgery and adjuvant therapy. The patients in Group 2 (n=43) initially received definitive surgery, followed by adjuvant chemotherapy and other therapies. The operability rates for breast conservation and dermatoplasty were observed in Group 1 after neoadjuvant chemotherapy. After follow-up, the recurrence and overall and disease-free survival rates of the two groups were analyzed.Results Neoadjuvant chemotherapy increased the operability rates for breast conservation from 17.1% to 40.0% in stage Ⅱ (P=0.034) and 0% to 12.6% in stage Ⅲ (P=0.016), and decreased the dermatoplasty rates from 17.1% to 2.8% in stage Ⅱ (P=0.046) and 28.1% to 8.1% in stage Ⅲ (P=0.026). After a median follow-up of 46.8 months, there were 11 deaths and 13 recurrences in Group 1, and 15 deaths and 19 recurrences in Group 2. The overall and disease-free survival rates of stage Ⅲ disease were significantly higher in Group 1 than in Group 2 (68.4% vs 31.2%, P=0.028, and 63.2% vs 25.0%, P=0.024, respectively). There were no significant differences in the overall and disease-free survival rates of stage Ⅱ disease for Group 1 compared with Group 2 (85.7% vs 85.2%, P=0.953, and 80.6% vs 74.1%, P=0.400, respectively).Conclusions Neoadjuvant chemotherapy resulted in increased operability for breast conservation and decreased dermatoplasty. Neoadjuvant chemotherapy exhibited better recurrence control, and overall and disease

  10. Is neo-adjuvant chemotherapy a better option for management of cervical cancer patients of rural India?

    Directory of Open Access Journals (Sweden)

    G A Dastidar

    2016-01-01

    Full Text Available Objectives: To explore alternate modality of treatment in patients of advanced cancer cervix by neo-adjuvant chemotherapy (NACT followed by External Beam Radiotherapy (ERT and Brachytherapy (BT. Short- (6 months and long- (12 months term follow-up data from these patients were compared with the retrospective data from an urban cancer centre, where standard protocol of concurrent chemo-radiotherapy is practiced. Materials and Methods: Two hundred patients of advanced cervical cancer, treated at our rural cancer centre between January 2007 and December 2007, were included in the study arm (Group A. These patients received three cycles of neo-adjuvant chemotherapy with Cisplatin, Bleomycin, and Vincristine before External-Beam Radiotherapy (EBT followed by brachytherapy. Patients in the control arm (Group B of an urban cancer centre, received EBT with weekly concomitant Cisplatin, followed by brachytherapy. Short- (6 months and long- (12 months term follow-up data from our patients were compared with the retrospective data from the urban cancer centre. Results and Analysis: Complete response rate was comparatively higher among patients of Group A, also correspondingly proportion of patients showing progressive disease and stable disease was lower among them. Local treatment failure was 87.5% among patients from Group A and 94.4% in Group B patients. Concomitant chemoradiation (CRT was associated with more GI toxicities. Conclusion: Our result suggests NACT arm is as effective as CRT arm in respect of complete response with less pelvic failure and G.I toxicities. Further follow-up data are needed before arriving at a definite conclusion.

  11. Changes in Pathological Complete Response Rates after Neoadjuvant Chemotherapy for Breast Carcinoma over Five Years

    OpenAIRE

    McFarland, Daniel C.; Jessica Naikan; Mariya Rozenblit; John Mandeli; Ira Bleiweiss; Amy Tiersten

    2016-01-01

    Historically, neoadjuvant chemotherapy (NACT) was extrapolated from adjuvant regimens. Dual HER2 blockade and the introduction of carboplatin for triple negative breast cancers (TNBC) emerged by December 2013 and have improved pathological complete response (pCR) rates. The objective of this study was to assess the pCR rates before and after the introduction of these new neoadjuvant regimens. Materials and Methods. Stage I–III breast cancer patients who received NACT were analyzed for rates o...

  12. Response and prognosis after neoadjuvant chemotherapy in 1,051 patients with infiltrating lobular breast carcinoma

    OpenAIRE

    Loibl, S.; Volz, C.; Mau, C; Blohmer, JU; Costa, SD; Eidtmann, H.; Fasching, PA; Gerber, B; Hanusch, C; Jackisch, C.; Kümmel, S.; Huober, J; Denkert, C; Hilfrich, J.; Konecny, GE

    2014-01-01

    Invasive lobular carcinomas (ILC) show better clinical behaviour compared with other histological types, but significantly lower pathological complete response (pCR) rates after neoadjuvant chemotherapy (NACT). We investigated whether factors influencing pCR rate in ILC after NACT can be identified and whether clinical outcome is different. 9,020 breast cancer patients from nine German neoadjuvant trials with known histological type were pooled. 11.7 % of tumours were ILC. Endpoints were: pCR...

  13. Neoadjuvant Chemotherapy in Triple Negative Breast Cancer: An Observational Study.

    Science.gov (United States)

    Shao, Zhiying; Chaudhri, Shalini; Guo, Meng; Zhang, Longzhen; Rea, Daniel

    2016-01-01

    Triple negative breast cancer (TNBC) is a phenotype of breast cancer with aggressive clinical behavior. Because of the absence of optimal treatment, the prognosis of this disease is poor. The main purpose of this study was to detect the response to neoadjuvant chemotherapy (NACT) in a TNBC cohort and compare the long-term survival between patients with and without pathological complete response (pCR). A total of 53 patients diagnosed with TNBC from 2005 to 2013 who received NACT at the University Hospital Birmingham were enrolled in this study. Overall survival (OS) and progression-free survival (PFS) were compared between the pCR group and non-pCR group. Demographic information and clinical or pathologic parameters were also analyzed to explore potential predictive and prognostic factors. Fourteen patients (26.4%) achieved pCR to NACT. In univariate analysis, patients with pCR had longer PFS time (p = 0.013) and OS time (p = 0.054) compared with their counterparts without pCR. In multivariate analysis, the existence of lymphovascular invasion (LVI) significantly reduced OS (HR = 17.404, 95% CI = 2.923-103.644) and PFS (HR = 7.776, 95% CI = 1.645-36.753). The achievement of pCR to NACT can significantly postpone the incidence of disease progression in patients with TNBC. There is not enough evidence showing its influence on ultimate survival. LVI may be a more potent prognostic factor than pCR in the TNBC cohort. PMID:27131315

  14. Tolerance and toxicity of neoadjuvant docetaxel, cisplatin and 5 fluorouracil regimen in technically unresectable oral cancer in resource limited rural based tertiary cancer center

    Directory of Open Access Journals (Sweden)

    V M Patil

    2014-01-01

    Full Text Available Background: Recent studies indicate neoadjuvant chemotherapy (NACT can result in R0 resection in a substantial proportion of patients with technically unresectable oral cavity cancers. However, data regarding the efficacy and safety of docetaxel, cisplatin and 5 fluorouracil (TPF NACT in our setting is lacking. The present audit was proposed to evaluate the toxicities encountered during administration of this regimen. It was hypothesized that TPF NACT would be considered feasible for routine administration if an average relative dose intensity (ARDI of ≥0.90 or more in at least 70% of the patients. Materials and Methods: Technically unresectable oral cancers with Eastern Cooperative Oncology Group PS 0-2, with biopsy proven squamous cell carcinoma underwent two cycles of NACT with TPF regimen. Toxicity and response rates were noted following the CTCAE 4.03 and RECIST criteria. Descriptive analysis of completion rates (completing 2 cycles of planned chemotherapy with ARDI of 0.85 or more, reason for delay, toxicity, and response are presented. Results: The NACT was completed by all patients. The number of subjects who completed all planned cycles of chemotherapy are with the ARDI of the delivered chemotherapy been equal to or >0.85 was 11 (91.67%. All toxicity inclusive Grade 3-5 toxicity was seen in 11 patients (91.67%. The response rate of chemotherapy was 83.33%. There were three complete response, seven partial response, and two stable disease seen post NACT in this study. Conclusion: Docetaxel, cisplatin and 5 fluorouracil regimen can be routinely administered at our center with the supportive care methods and precautionary methods used in our study.

  15. INFLUENCE OF NEOADJUVANT INTRAARTERIAL INFUSION CHEMOTHERAPY ON APOPTOSIS AND MULTIDRUG RESISTANCE ASSOCIATED GENES OF ENDOMETRIAL CANCER

    Institute of Scientific and Technical Information of China (English)

    朱雪琼; 岳天孚; 张颖; 惠京; 王德华

    2002-01-01

    Objective: Through investigating the influence of neoadjuvant intraarterial infusion chemotherapy (NIAC) on the timing changes of apoptosis, PCNA and multiple drug resistance associated genes of endometrial cancer, to study the mechanism of chemotherapy and to define the best operation time. Methods: Twenty patients were subjected to neoadjuvant consecutive uterine arterial infusion with CDDP 100 mg and ADM 50 mg. The biopsy of endometrial tumor tissues was performed before, immediate after and 1, 2-2+3 w, 3+3-4 w after chemotherapy. Apoptosis index (AI) was estimated by a combination of histologic and TUNEL assays. Proliferative index (PI) was examined by SABC immunohistochemical staining. Expressions of multidrug resistance 1 (MDR1), multidrug resistance-associated protein (MRP) and lung resistance protein (LRP) were detected by reverse transcription polymerase chain reaction (RT-PCR). Results: The AI of endometrial cancer cells immediate after and 1, 2-2+3 w, after chemotherapy were 3.03%, 3.47% and 5.04%, respectively, much higher than that before chemotherapy which was 2.31%. After chemotherapy, AI/PI gradually increased. It was highest in 2-2+3 w, while 3+3-4 w after chemotherapy the AI and AI/PI were both significantly lower than that before chemotherapy. The expression of MDR1, MRP and LRP all decreased temporarily after chemotherapy, while 3+3-4 w after chemotherapy they all increased to levels higher than that before chemotherapy, but the difference were not significant (P>0.05). Conclusion: Neoadjuvant consecutive intra-arterial infusion chemotherapy via uterine artery can inhibit tumor cells proliferation and induce apoptosis effectively. To evaluate the response of intra-arterial chemotherapy the change of apoptosis index and cell proliferation should be analyzed. The most suitable time for the operation is 3 weeks after intra-arterial infusion chemotherapy.

  16. Complete clinical response to neoadjuvant chemotherapy in a 54-year-old male with Askin tumor.

    LENUS (Irish Health Repository)

    Mulsow, J

    2012-02-01

    Askin tumor is a tumor of the thoracopulmonary region that most commonly affects children and adolescents. These rare tumors are a form of primitive neuroectodermal tumor and typically carry a poor prognosis. Treatment is multimodal and consists of a combination of neoadjuvant chemotherapy, radical resection, and adjuvant chemo- and radiotherapy or all of the above. Surgery is advocated in most cases. We report a case of Askin tumor in a 54-year-old male who showed rapid and complete response to neoadjuvant chemotherapy. This allowed potentially radical surgery to be avoided. At one-year follow-up he remains disease-free.

  17. Neoadjuvant chemotherapy in patients with locally advanced breast cancer: A pilot-observational study

    Directory of Open Access Journals (Sweden)

    Hardik G Dodiya

    2015-01-01

    Full Text Available Background: Locally advanced breast cancer (LABC remains major clinical issue with regard to selection and duration of therapy since many years. Neoadjuvant chemotherapy (NACT is multimodality program, established to treat LABC. Many research tasks are ongoing to develop specific neoadjuvant chemotherapy regimen with specific duration to improve long-term control of LABC. Patients and Methods: Forty-seven patients diagnosed with LABC were Included and analyzed to compare the outcomes [pathological complete response (pCR, clinical response, overall response rate (ORR, disease control rate, overall survival and progression-free survival]. These patients treated with either combination of anthracycline and taxane-based chemotherapy or anthracycline-based chemotherapy. Results: There was no any statistical significance with respect to demographic data treated of patients between two arms (P > 0.05. Patients underwent TAC chemotherapy had pCR 20.8% whereas FAC/FEC chemotherapy patients had pCR 13% (P = 0.48. Higher ORR was noted in TAC chemotherapy arm (75% when compared with FAC/FEC chemotherapy arm (60.9% (P = 0.29. The study also shows better disease control rate in TAC chemotherapy arm (95.8% as compared to FAC/FEC chemotherapy arm (82.6%. There was no statistical significance in overall survival (P = 0.31 and progression-free survival (P = 0.51 between two arms. Conclusion: Despite of the superiority of combination of anthracycline and taxane-based chemotherapy over the anthracycline-based chemotherapy in the present study, further pivotal studies should be conducted to confirm the combination of anthracycline and taxane-based chemotherapy as a better neoadjuvant regimen for treatment of LABC tumors.

  18. Role of Scintimammography in Assessing the Response of Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

    OpenAIRE

    Trehan, Romeeta; Seam, Rajeev K; Manoj K. Gupta; Sood, Ashwani; Dimri, Kislay; Mahajan, Rohit

    2014-01-01

    Locally advanced breast cancer (LABC) is a common cancer in the developing countries. Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such tumors and hence that the disease can be down staged and made amenable for surgery. All the tumors do not respond to the therapy equally. Hence, it becomes very important to predict the response of chemotherapy in such cases. This study evaluated the role of scintimammography in assessing the response to NACT in 23 patients wit...

  19. D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

    OpenAIRE

    Shrikhande Shailesh V; Barreto Savio G; Talole Sanjay D; Vinchurkar Kumar; Annaiah Somashekar; Suradkar Kunal; Mehta Shaesta; Goel Mahesh

    2013-01-01

    Abstract Background Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature. Methods Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperat...

  20. Plasma HER2 amplification in cell-free DNA during neoadjuvant chemotherapy in breast cancer

    DEFF Research Database (Denmark)

    Bechmann, Troels; Andersen, Rikke Fredslund; Pallisgaard, Niels;

    2013-01-01

    Measurement of human epidermal growth factor receptor 2 (HER2) gene amplification in cell-free DNA (cfDNA) is an evolving technique in breast cancer, enabling liquid biopsies and treatment monitoring. The present study investigated the dynamics of plasma HER2 gene copy number and amplification in...... cfDNA during neoadjuvant chemotherapy....

  1. Breast-conserving surgery after neoadjuvant chemotherapy in patients with locally advanced cancer. Preliminary results

    OpenAIRE

    VERGINE, M.; SCIPIONI, P.; GARRITANO, S.; COLANGELO, M.; Di Paolo, A; LIVADOTI, G.; MATURO, A.; Monti, M

    2013-01-01

    Neoadjuvant chemotherapy (NACT) in locally advanced breast tumors may allow an adequate control of the disease impossible with surgery alone. Moreover, NACT increases the chance of breast-conserving surgery. Between 2008 and 2012, we treated with NACT 83 patients with locally advanced breast cancer. We report the preliminary results evaluating the impact of NACT on the type of surgery.

  2. Complications after radical gastrectomy following FOLFOX7 neoadjuvant chemotherapy for gastric cancer

    Directory of Open Access Journals (Sweden)

    Ren Hui

    2011-09-01

    Full Text Available Abstract Background This study assessed the postoperative morbidity and mortality occurring in the first 30 days after radical gastrectomy by comparing gastric cancer patients who did or did not receive the FOLFOX7 regimen of neoadjuvant chemotherapy. Methods We completed a retrospective analysis of 377 patients after their radical gastrectomies were performed in our department between 2005 and 2009. Two groups of patients were studied: the SURG group received surgical treatment immediately after diagnosis; the NACT underwent surgery after 2-6 cycles of neoadjuvant chemotherapy. Results There were 267 patients in the SURG group and 110 patients in the NACT group. The NACT group had more proximal tumours (P = 0.000, more total/proximal gastrectomies (P = 0.000 and longer operative time (P = 0.005 than the SURG group. Morbidity was 10.0% in the NACT patients and 17.2% in the SURG patients (P = 0.075. There were two cases of postoperative death, both in the SURG group (P = 1.000. No changes in complications or mortality rate were observed between the SURG and NACT groups. Conclusion The FOLFOX7 neoadjuvant chemotherapy is not associated with increased postoperative morbidity, indicating that the FOLFOX7 neoadjuvant chemotherapy is a safe choice for the treatment of local advanced gastric cancer.

  3. Neoadjuvant therapy for esophageal cancer. Indication and efficacy

    International Nuclear Information System (INIS)

    Some approaches such as adjuvant chemotherapy, neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy have been tried to improve the efficacy of treatment for resectable esophageal cancer patients. The usefullness of neoadjuvant chemotherapy, has remained a matter of controversy. However, there is a report from JCOG9907 in Japan that two courses of neoadjuvant 5-fluorouracil/cisplatin (5-FU/CDDP) improved the survival of esophageal squamous cell cancer patients. Neoadjuvant chemoradiotherapy has not had a consistent evaluation because of the varying results of each trial. But from the results of meta-analysis and CALGB9781, the neoadjuvant chemoradiotherapy called ''trimodality therapy'' has been a standard treatment in the United States. We should evaluate whether there would be similar effectiveness in Japan, where the histology and operative approach are different. Some approaches such as DNA microarray and proteomics, which can predict the treatment effect, are being tried. (author)

  4. Concurrent chemo-radiotherapy following neoadjuvant chemotherapy in locally advanced breast cancer

    Directory of Open Access Journals (Sweden)

    Zinser-Sierra Juan

    2009-07-01

    Full Text Available Abstract Background Despite broad advances in multimodal treatment of locally advanced breast cancer (LABC, 30 to 40% of patients develop loco-regional relapse. The aim of this study was to analyze in a retrospective manner the effectiveness of concurrent chemo-radiotherapy (CCRTh after neoadjuvant chemotherapy (NCT in patients with LABC. Methods One hundred twelve patients with LABC (stage IIB-IIIB were treated with NCT (5-fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2 (FAC, or doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 (AC IV in four 21-day courses followed by CCRTh (60 Gy breast irradiation and weekly mitomycin 5 mg/m2, 5-fluorouracil 500 mg/m2, and dexamethasone 16 mg, or cisplatin 30 mg/m2, gemcitabine 100 mg/m2 and dexamethasone 16 mg, and 6–8 weeks later, surgery and two additional courses of FAC, AC, or paclitaxel 90 mg/m2 weekly for 12 weeks, and in case of estrogen-receptor positive patients, hormonal therapy. Results Stages IIB, IIIA and -B were 21.4, 42.9, and 35.7%, respectively. Pathological complete response (pCR in the breast was 42% (95% CI, 33.2–50.5% and, 29.5% (95% CI, 21.4–37.5% if including both the breast and the axillary nodes. Multivariate analysis showed that the main determinant of pCR was negative estrogen-receptor status (HR = 3.8; 95% CI, 1.5–9; p = 0.016. The 5-year disease-free survival (DFS was 76.9% (95% CI, 68.2–84.7%. No relationship between pCR and DFS was found. Multivariate analysis demonstrated that the main DFS determinant was clinical stage (IIB and IIIA vs. IIIB, HR = 3.1; 95% CI, 1.02–9.74; p = 0.04. Only one patient had local recurrence. Five-year overall survival was 84.2% (95% CI, 75–93.2%. The toxicity profile was acceptable. Conclusion This non-conventional multimodal treatment has good loco-regional control for LABC. Randomized clinical trials of preoperative CCRTh following chemotherapy, in patients with LABC are warranted.

  5. Concurrent chemo-radiotherapy following neoadjuvant chemotherapy in locally advanced breast cancer

    International Nuclear Information System (INIS)

    Despite broad advances in multimodal treatment of locally advanced breast cancer (LABC), 30 to 40% of patients develop loco-regional relapse. The aim of this study was to analyze in a retrospective manner the effectiveness of concurrent chemo-radiotherapy (CCRTh) after neoadjuvant chemotherapy (NCT) in patients with LABC. One hundred twelve patients with LABC (stage IIB-IIIB) were treated with NCT (5-fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2 (FAC), or doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 (AC) IV in four 21-day courses) followed by CCRTh (60 Gy breast irradiation and weekly mitomycin 5 mg/m2, 5-fluorouracil 500 mg/m2, and dexamethasone 16 mg, or cisplatin 30 mg/m2, gemcitabine 100 mg/m2 and dexamethasone 16 mg), and 6–8 weeks later, surgery and two additional courses of FAC, AC, or paclitaxel 90 mg/m2 weekly for 12 weeks, and in case of estrogen-receptor positive patients, hormonal therapy. Stages IIB, IIIA and -B were 21.4, 42.9, and 35.7%, respectively. Pathological complete response (pCR) in the breast was 42% (95% CI, 33.2–50.5%) and, 29.5% (95% CI, 21.4–37.5%) if including both the breast and the axillary nodes. Multivariate analysis showed that the main determinant of pCR was negative estrogen-receptor status (HR = 3.8; 95% CI, 1.5–9; p = 0.016). The 5-year disease-free survival (DFS) was 76.9% (95% CI, 68.2–84.7%). No relationship between pCR and DFS was found. Multivariate analysis demonstrated that the main DFS determinant was clinical stage (IIB and IIIA vs. IIIB, HR = 3.1; 95% CI, 1.02–9.74; p = 0.04). Only one patient had local recurrence. Five-year overall survival was 84.2% (95% CI, 75–93.2%). The toxicity profile was acceptable. This non-conventional multimodal treatment has good loco-regional control for LABC. Randomized clinical trials of preoperative CCRTh following chemotherapy, in patients with LABC are warranted

  6. Poly(amido)amine (PAMAM) dendrimer-cisplatin complexes for chemotherapy of cisplatin-resistant ovarian cancer cells

    Energy Technology Data Exchange (ETDEWEB)

    Yellepeddi, Venkata Kashyap; Vangara, Kiran Kumar; Palakurthi, Srinath, E-mail: palakurthi@tamhsc.edu [Texas A and M Health Science Center, Irma Lerma Rangel College of Pharmacy (United States)

    2013-09-15

    Dendrimer-cisplatin complexes were prepared using PAMAM dendrimers with terminal -NH{sub 2} and -COOH groups as well as biotin-conjugated dendrimers. Preformulation parameters of dendrimer-cisplatin complexes were studied using differential scanning calorimetry (DSC) and inductively coupled plasma-mass spectrometry (ICP-MS). Cytotoxicity and mechanism of cytotoxicity of dendrimer-cisplatin complexes was investigated in OVCAR-3, SKOV, A2780 and cisplatin-resistant CP70 human ovarian cancer cell lines. The loading of cisplatin in dendrimers was {approx}11 % (w/w). PAMAM G4 dendrimers with amine surface groups (biotinylated and native) have shown 2.5- to 3.0-fold reduction in IC{sub 50} values in ovarian cancer cells when compared with carboxylate surface dendrimers (p < 0.05). A correlation was observed among cytotoxicity of the complexes, cellular uptake, and platinum-DNA adduct formation. Treatment with dendrimer-cisplatin complexes resulted in a 7.0-fold increase (p < 0.05) in expression of apoptotic genes (Bcl2, Bax, p53) and 13.2- to 27.1-fold increase (p < 0.05) in the activity of caspases 3, 8, and 9 in vitro. Results suggest that PAMAM dendrimers can be used as potential carrier for cisplatin chemotherapy of ovarian cancer.

  7. Neoadjuvant hormonal therapy is associated with comparable outcomes to neoadjuvant chemotherapy in post-menopausal women with estrogen receptor-positive breast cancer

    OpenAIRE

    Marcus, David M.; Switchenko, Jeffrey M.; Roshan ePrabhu; Ruth eO'Regan; Amelia eZelnak; Carolina eFasola; Donna eMister; Torres, Mylin A.

    2013-01-01

    Objectives: We compared outcomes in post-menopausal estrogen receptor-positive (ER+) breast cancer patients treated with neoadjuvant hormonal therapy (NAHT) or neoadjuvant chemotherapy (NACT).Methods: We retrospectively identified post-menopausal women who received either NAHT or NACT for non-metastatic, non-inflammatory, ER+, Her2neu negative breast cancer from 2004 to 2011. We compared long-term rates of locoregional relapse free survival (LRFS), distant metastasis free survival (DMFS), ...

  8. Neoadjuvant Hormonal Therapy is Associated with Comparable Outcomes to Neoadjuvant Chemotherapy in Post-Menopausal Women with Estrogen Receptor-Positive Breast Cancer

    OpenAIRE

    Marcus, David M.; Switchenko, Jeffrey M.; Prabhu, Roshan; O’Regan, Ruth; Zelnak, Amelia; Fasola, Carolina; Mister, Donna; Torres, Mylin A.

    2013-01-01

    Objectives: We compared outcomes in post-menopausal estrogen receptor-positive (ER+) breast cancer patients treated with neoadjuvant hormonal therapy (NAHT) or neoadjuvant chemotherapy (NACT). Methods: We retrospectively identified post-menopausal women who received either NAHT or NACT for non-metastatic, non-inflammatory, ER+, Her2neu negative breast cancer from 2004 to 2011. We compared long-term rates of locoregional relapse free survival (LRFS), distant metastasis free survival (DMFS),...

  9. Long-term results in malignant pleural mesothelioma treated with neoadjuvant chemotherapy, extrapleural pneumonectomy and intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    We investigated the clinical outcome and the toxicity of trimodal therapy of malignant pleural mesothelioma (MPM) treated with neoadjuvant chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant intensity-modulated radiotherapy (IMRT). Chemotherapy regimens included Cisplatin/Pemetrexed, Carboplatin/Pemetrexed and Cisplatin/Gemcitabine, followed by EPP. 62 patients completed the adjuvant radiotherapy. IMRT was carried out in two techniques, either step&shoot or helical tomotherapy. Median target dose was 48 Gy to 54 Gy. Toxicity was scored with the Common Terminology Criteria (CTC) for Adverse Events. We used Kaplan-Meier method to estimate actuarial rate of locoregional control (LRC), distant control (DC) and overall survival (OS), measured from the date of surgery. Rates were compared using the logrank test. For multivariate analysis the Cox proportional hazard model was used. The median OS, LRC and DC times were 20.4, 31.4 and 21.4 months. The 1-, 2-, 3-year OS rates were 63, 42, 28 %, the LRC rates were 81, 60, 40 %, and the DC rates were 62, 48, 41 %. We observed no CTC grade 4 or grade 5 toxicity. Step&shoot and helical tomotherapy were equivalent both in dosimetric characteristics and clinical outcome. Biphasic tumor histology was associated with worse clinical outcome compared to epitheloid histology. Mature clinical results of trimodal treatment for MPM were presented. They indicate that hemithoracic radiotherapy after EPP can be safely administered by either step&shoot IMRT and tomotherapy. However, the optimal prospective patient selection for this aggressive trimodal therapy approach remains unclear. This study can serve as a benchmark for current and future therapy concepts for MPM. The online version of this article (doi:10.1186/s13014-015-0575-5) contains supplementary material, which is available to authorized users

  10. Biological markers as predictive factors of response to neoadjuvant taxanes and anthracycline chemotherapy in breast carcinoma

    Institute of Scientific and Technical Information of China (English)

    ZHOU Bo; YANG De-qi; XIE Fei

    2008-01-01

    Background Neoadjuvant chemotherapy provides an excellent model for evaluation of potential predictive factors.The objective of this study was to evaluate the predictive value of different biological factors in breast cancer patients treated with neoadjuvant taxane and anthracycline chemotherapy.Methods One hundred and thirty-five patients treated with 4 cycles of neoadjuvant taxanes and anthracycline were included in this retrospective study.Using pretreatment biopsy materials,immunohistochemical studies were performed for estrogen receptor(ER),progesterone receptor(PgR),HER-2,Ki-67 and p53 protein expression.The associations among biological markers and clinical and pathological complete response (pCR)were analyzed.Results The overall clinical response was 86%,including 33%clinical complete response(cCR)and 53%clinical partial response.The pCR was iust 17%.In the univariate analysis,only HER-2 overexpression was predictive of cCR to neoadjuvant chemotherapy(P=0.018).No significant associations between other biological factors and cCR were found.Absence of ER,PgR expression and overexpression of HER-2 were predictive of the pCR(P=0.002,0.001,0.01,respectively).Ki-67 and p53 failed to show an association with pCR.In multivariate analysis,overexpression of HER-2remained as an independent variable in predicting the cCR(P=0.021).However,negative ER was the only parameter that maintained statistical significance in predicting the pCR(P=0.001).Conclusions Patients with overexoression of HER-2 and negative hormonal receptor status are much more likely to respond to neoadjuvant taxane and anthracycline chemotherapy than those with the opposite characte ristics.These factors could serve as predictive markers for this regimen.

  11. A meta-analysis of neoadjuvant chemotherapy plus radiation in the treatment of locally advanced nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Xun He

    2015-01-01

    Conclusion: Neoadjuvant chemotherapy followed by radiation can decrease the risk of recurrence and metastasis but not improve the 5 years overall survival and 5 years disease free survival compared to radiotherapy alone in the patients with locally advanced nasopharyngeal carcinoma.

  12. Young Cervical Cancer Patients May Be More Responsive than Older Patients to Neoadjuvant Chemotherapy Followed by Radical Surgery

    OpenAIRE

    Jin Zhou; Xiong Li; Kecheng Huang; Yao Jia; Fangxu Tang; Haiying Sun; Yuan Zhang; Qinghua Zhang; Ding Ma; Shuang Li

    2016-01-01

    Objective To evaluate the effects of age and the clinical response to neoadjuvant chemotherapy (NACT) in patients with cervical cancer who received neoadjuvant chemotherapy followed by radical surgery. Methods A total of 1,014 patients with advanced cervical cancer who received NACT followed by radical surgery were retrospectively selected. Patients were divided into young (aged ≤35 years, n = 177) and older (aged >35 years, n = 837) groups. We compared the short-term responses and survival r...

  13. The safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer: a systematic review and meta analysis

    OpenAIRE

    Du HE; Duan, Chunyan; Chen, Jun; Lai, Lin; Chen, Jiaquan; Chen, Dian

    2015-01-01

    Objective: To evaluate the safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer. Methods: A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined neoadjuvant chemotherapy treatment (NACT)/radical surgery treatment (RST) with RST alone in patients with cervical cancer were eligible for inclusion. Results: Eight studies were finally included in this meta analysis, involving a total of ...

  14. Treatment methods of neoadjuvant chemotherapy for locally advanced cervical adenocarcinoma%局部晚期宫颈腺癌新辅助化疗方式探讨

    Institute of Scientific and Technical Information of China (English)

    李桑; 谢榕; 林玉珍

    2011-01-01

    目的:探讨不同用药途径的新辅助化疗对局部晚期宫颈腺癌的疗效,寻找更安全、有效的化疗方法.方法:回顾性分析我院2006 年1月-2009年12月期间收治的58例经手术治疗的局部晚期宫颈腺癌,根据新辅助化疗方式不同分为新辅助动脉化疗(neoadjuvant intra-arterial chemotherapy,NAIC)28例和新辅助化疗(neoadjuvant chemotherapy,NACT)30例.NAIC组采用紫杉醇脂质体、博来霉素、顺铂方案,NACT组采用紫杉醇脂质体、顺铂方案化疗,两组均1-2个疗程后行手术,对比两组化疗后肿瘤退缩及术后病理情况.结果:两组化疗有效率差异无显著性(P>0.05),NAIC组组织学痊愈率明显高于NACT组(P0.05).两组术后均无阴道切缘阳性病例.两组化疗不良反应差异无显著性(P>0.05).结论:新辅助动脉化疗对局部晚期宫颈腺癌产生的组织学痊愈率明显高于静脉化疗,可以减少宫旁浸润和脉管癌栓的发生率,是值得推广的新辅助化疗方式.%Objective:To compare the effect of neoadjuvant intra - arterial chemotherapy and neoadjuvant chemotherapy, to search more effective chemotherapy methods. Methods: Retrospectievely analyzed 58 patients with locally advanced cervical ade no carcinoma in our hospital from January 2006 to December 2009, all patients were divided into two groups, 28 patients in NAIC group were treated by neoadjuvant intra - arterial chemotherapy with paclitaxel liposome.bleomycin plus cisplatin for 2 cycles followed by radical hysterectomy and lymphadenectomy, 30 patients in NACT group were treated by neoadjuvant chemotherapy with paclitaxel liposome and cisplatin for 2 cycles followed by the same operation. To compare the regress rate of tumor, pathologic change of two groups. Results: There was no significant difference in the effective rate of NAIC group and NACT group ( P>0.05 ). The rate of histologic healed in NAIC group was more than that of in NACT group( P 0. 05 ). There was no

  15. State of the art of neoadjuvant chemotherapy in breast cancer: rationale, results and recent developments

    Directory of Open Access Journals (Sweden)

    Solomayer, Erich-Franz

    2005-09-01

    Full Text Available Aims, results, advantages and possible disadvantages of preoperative chemotherapy (pCHT for breast cancer are discussed in this review. Established chemotherapeutic regimens are described with respect to new drugs that are added to combinations now and in the future. Illustrating the potential of new components, trastuzumab and cytotoxic chemotherapy, were combined in neoadjuvant trials for the first time. This approach yielded impressing and unprecedented high pathological response rates. An overview regarding current neoadjuvant cytostatic and immunotherapy trials is given. Established prognostic factors like axillary lymph-nodal status are altered during pCHT, which causes the need for new prognostic markers. The consequences of these changes for clinical decision making are demonstrated. It seems possible that the advances of gene array and protein expression profile technologies will lead to improved prognostic and predictive statements. Tumor tissue can be analyzed before during and after treatment in this regard recent studies investigating the response to specific, chemotherapeutics in correlation to molecular markers are reviewed. These approaches might enable us to identify chemoresistance of specific tumors. Furthermore pCHT allows testing of chemosensitivity in vivo in an early stage, which might lead to a more individualized cancer therapy. We discuss radiotherapy after neoadjuvant therapy and the risk of local relapse after breast conserving surgery, which was made feasible by pCHT. It is shown how the evaluation of efficacy of new cancer drugs, using the neoadjuvant situation, can be done more rapidly than in the metastatic and adjuvant setting.

  16. Therapeutic effect analysis of different neoadjuvant chemotherapy on the locally cervical cancer

    Institute of Scientific and Technical Information of China (English)

    Mei-Ju Li

    2015-01-01

    Objective:To explore the therapeutic effect of different neoadjuvant chemotherapy on the locally cervical cancer.Methods:A total of 85 patients with cervical cancer for the initial treatment who were admitted in our hospital from January, 2011 to January, 2013 were included in the study and divided into the observation group and the control group according to different chemotherapy regimens. The way of drug administration is by transcatheter arterial chemoembolization (TACE). The patients in the observation group were given Taxol in combined with carboplatin for neoadjuvant chemotherapy, while the patients in the control group were given irinotecan in combined with carboplatin. The remission degree of clinical symptoms, chemotherapeutic effect, toxic and side effect, and operation evaluation 14 and 20 days after chemotherapy were evaluated.Results:The comparison of clinical symptom remission between the two groups was not statistically significant. The occurrence rate of myelosuppression in III-IV degree in the observation was significantly higher than that in the control group, but the occurrence rate of diarrhea was significantly lower than that in the control group. The comparisons of operation time and intraoperative amount of bleeding after chemotherapy between the two groups were not statistically significant. The comparisons of the occurrence rates of parametrial infiltration and lymphatic metastasis and the muscular layer invasion depth were not statistically significant.Conclusions:Arterial embolism neoadjuvant chemotherapy can obviously shorten the tumor volume in patients with local cervical cancer, relieve the clinical symptoms, and enhance the living qualities, but in the clinical application, appropriate chemotherapy regimen should be chosen according to the specific condition.

  17. Final report of Intergroup Trial 0122 (ECOG PE-289, RTOG 90-12): Phase II trial of neoadjuvant chemotherapy plus concurrent chemotherapy and high-dose radiation for squamous cell carcinoma of the esophagus

    International Nuclear Information System (INIS)

    Purpose: To determine the outcome of neoadjuvant chemotherapy followed by concurrent chemotherapy plus high-dose radiation therapy in patients with local/regional squamous cell carcinoma of the esophagus. Methods and Materials: Forty-five patients with clinical Stage T1-4N0-1M0 squamous cell carcinoma were entered on a prospective single-arm study, of which 38 were eligible. Patients received 3 monthly cycles of 5-FU (1000 mg/m2/24 h x 5 days) and cisplatin (100 mg/m2 day 1; neoadjuvant segment) followed by 2 additional monthly cycles of 5-FU (1000 mg/m2/24 h x 5 days) and cisplatin (75 mg/m2 day 1) plus concurrent 6480 cGy (combined modality segment). The median follow-up in surviving patients was 59 months. Results: For the 38 eligible patients, the primary tumor response rate was 47% complete, 8% partial, and 3% stable disease. The first site of clinical failure was 39% local/regional and 24% distant. For the total patient group, there were 6 deaths during treatment, of which 9% (4/45) were treatment related. The median survival was 20 months. Actuarial survival at 3 years was 30%, and at 5 years, 20%. Conclusion: This intensive neoadjuvant approach does not appear to offer a benefit compared with conventional doses and techniques of combined modality therapy. However, high dose radiation (6480 cGy) appears to be tolerable, and is being tested further in Intergroup Trial INT 0123

  18. Predicting response to breast cancer neoadjuvant chemotherapy using diffuse optical spectroscopy

    OpenAIRE

    Cerussi, Albert; Hsiang, David; Shah, Natasha; Mehta, Rita; Durkin, Amanda; Butler, John; Tromberg, Bruce J.

    2007-01-01

    Diffuse optical spectroscopy (DOS) and imaging are emerging diagnostic techniques that quantitatively measure the concentration of deoxy-hemoglobin (ctHHb), oxy-hemoglobin (ctO2Hb), water (ctH2O), and lipid in cm-thick tissues. In early-stage clinical studies, diffuse optical imaging and DOS have been used to characterize breast tumor biochemical composition and monitor therapeutic response in stage II/III neoadjuvant chemotherapy patients. We investigated whether DOS measurements obtained be...

  19. Breast DCE-MRI Kinetic Heterogeneity Tumor Markers: Preliminary Associations With Neoadjuvant Chemotherapy Response

    OpenAIRE

    Ahmed Ashraf; Bilwaj Gaonkar; Carolyn Mies; Angela DeMichele; Mark Rosen; Christos Davatzikos; Despina Kontos

    2015-01-01

    The ability to predict response to neoadjuvant chemotherapy for women diagnosed with breast cancer, either before or early on in treatment, is critical to judicious patient selection and tailoring the treatment regimen. In this paper, we investigate the role of contrast agent kinetic heterogeneity features derived from breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for predicting treatment response. We propose a set of kinetic statistic descriptors and present prelimina...

  20. Effect of neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction modalities in 409 patients

    OpenAIRE

    Sameh Goubran; Jon Ver Halen

    2015-01-01

    Aim: While skin-sparing mastectomy (SSM) can be performed in patients with stage II-III breast cancer, the impact of neoadjuvant chemotherapy (NAC) on SSM rates and reconstructive modalities in these patients is not known. Methods: Between January 2007 and December 2009, 409 immediate breast reconstructions (IBRs) were performed in patients with Stage II-III breast cancer. Data were collected on preoperative, operative, and postoperative factors. Results: There was a statistically significant...

  1. Complications after radical gastrectomy following FOLFOX7 neoadjuvant chemotherapy for gastric cancer

    OpenAIRE

    Ren Hui; Wu Qi; Zong Xiang-Long; Wu Xiao-Jiang; Wu Ai-Wen; Bu Zhao-De; Zhang Lian-Hai; Shan Fei; Li Zi-Yu; Ji Jia-Fu

    2011-01-01

    Abstract Background This study assessed the postoperative morbidity and mortality occurring in the first 30 days after radical gastrectomy by comparing gastric cancer patients who did or did not receive the FOLFOX7 regimen of neoadjuvant chemotherapy. Methods We completed a retrospective analysis of 377 patients after their radical gastrectomies were performed in our department between 2005 and 2009. Two groups of patients were studied: the SURG group received surgical treatment immediately a...

  2. Early Prediction and Evaluation of Breast Cancer Response to Neoadjuvant Chemotherapy Using Quantitative DCE-MRI

    OpenAIRE

    Alina Tudorica; Oh, Karen Y.; Stephen Y-C Chui; Nicole Roy; Troxell, Megan L.; Arpana Naik; Kathleen A Kemmer; Yiyi Chen; Megan L Holtorf; Aneela Afzal; Charles S Springer Jr.; Xin Li; Wei Huang

    2016-01-01

    The purpose is to compare quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) metrics with imaging tumor size for early prediction of breast cancer response to neoadjuvant chemotherapy (NACT) and evaluation of residual cancer burden (RCB). Twenty-eight patients with 29 primary breast tumors underwent DCE-MRI exams before, after one cycle of, at midpoint of, and after NACT. MRI tumor size in the longest diameter (LD) was measured according to the RECIST (Response Eval...

  3. Outcome of neoadjuvant chemotherapy in locally advanced breast cancer: A tertiary care centre experience

    OpenAIRE

    Tapesh Bhattacharyya; Suresh C Sharma; Budhi Singh Yadav; Rajinder Singh; Gurpreet Singh

    2014-01-01

    Background: Introduction of neoadjuvant chemotherapy (NACT) has dramatically changed the management of locally advanced breast cancer (LABC). However, very few randomized trials of NACT have been carried out specifically in LABC patients in our country. In this retrospective analysis, we presented our experience with NACT in LABC patients. Materials and Methods: Medical records of 148 patients of stage III LABC patients treated with NACT, followed by surgery and radiotherapy from January 2006...

  4. Tissue Biomarkers in Prognostication of Serous Ovarian Cancer following Neoadjuvant Chemotherapy

    OpenAIRE

    Binny Khandakar; Sandeep R Mathur; Lalit Kumar; Sunesh Kumar; Siddhartha Datta Gupta; Venkateswaran K Iyer; Kalaivani, M.

    2014-01-01

    Serous ovarian cancer (SOC) is a significant cause of morbidity and mortality in females with poor prognosis because of advanced stage at presentation. Recently, neoadjuvant chemotherapy (NACT) is being used for management of advanced SOC, but role of tissue biomarkers in prognostication following NACT is not well established. The study was conducted on advanced stage SOC patients (n = 100) that were treated either conventionally (n = 50) or with NACT (n = 50), followed by surgery. In order t...

  5. Neoadjuvant chemotherapy for locally advanced cervical cancer reduces surgical risks and lymph-vascular space involvement

    OpenAIRE

    Wang, Yue; Wang, Guang; Wei, Li-Hui; Huang, Ling-Hui; Wang, Jian-Liu; Wang, Shi-Jun; Li, Xiao-Ping; Shen, Dan-Hua; Bao, Dong-Mei; Gao, Jian

    2011-01-01

    Neoadjuvant chemotherapy (NACT), which can reduce the size and therefore increase the resectability of tumors, has recently evolved as a treatment for locally advanced cervical cancer. NACT has been reported to decrease the risk of pathologic factors related to prognosis of cervical cancer. To further assess the effects of NACT on surgery and the pathologic characteristics of cervical cancer, we reviewed 110 cases of locally advanced cervical cancer treated with radical hysterectomy with or w...

  6. IMPACT OF SEQUENTIAL NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER: A SERIES OF 10 CASES

    OpenAIRE

    Gopa; Megha; Atul,; Bindu

    2014-01-01

    Breast cancer currently is a major health problem among women worldwide accounting for around 13.7% cancer deaths, nearly 1/3rd of it being due to Locally advanced breast cancer (LABC). Despite progress achieved in diagnosis & therapy of Breast cancer, LABC remains a major clinical challenge and in efforts to increase pCR, CCR & DFS in LABC, Neoadjuvant or primary chemotherapy followed by locoregional therapy and adjuvant systemic CT is well accepted treatment strategy sin...

  7. Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center

    OpenAIRE

    V M Patil; V Noronha; Joshi, A; V M Krishna; S Dhumal; Chaudhary, V.; Juvekar, S; P S Pai; C Pankaj; Chaukar, D.; A K Dcruz; Prabhash, K

    2014-01-01

    Background: Use of any treatment modality in cancer depends not only on the effectiveness of the modality, but also on other factors such as local expertise, tolerance of the modality, cost and prevalence of the disease. Oropharyngeal and laryngeal cancer are the major subsites in which majority of neoadjuvant chemotherapy (NACT) literature in the head and neck cancers is available. However, oral cancers form a major subsite in India. Materials And Methods: This is an analysis of a prospectiv...

  8. 15-PGDH expression as a predictive factor response to neoadjuvant chemotherapy in advanced gastric cancer

    OpenAIRE

    Hu, Min; Li, Kai; Maskey, Ninu; Xu, Zhigao; Peng, Chunwei; Tian, Sufang; Li, Yan; Yang, Guifang

    2015-01-01

    Given the various clinical and pathologic responses to neoadjuvant chemotherapy (NACT) in gastric cancer (GC), potential biomarkers that reflecting the efficacy of NACT on GC should be investigated. The aim of this study was to investigate the 15-PGDH expression response to NACT in GC patients and its relationship with prognosis of GC. Immunohistochemical method was used to assess the level of 15-PGDH expression in 56 GC patients who received NACT before surgery and 46 patients who underwent ...

  9. A Serum Protein Profile Predictive of the Resistance to Neoadjuvant Chemotherapy in Advanced Breast Cancers*

    OpenAIRE

    Hyung, Seok-Won; Lee, Min Young; Yu, Jong-Han; Shin, Byunghee; Jung, Hee-Jung; Park, Jong-Moon; Han, Wonshik; Lee, Kyung-min; Moon, Hyeong-Gon; Zhang, Hui; Aebersold, Ruedi; Hwang, Daehee; Lee, Sang-Won; Yu, Myeong-Hee; Noh, Dong-Young

    2011-01-01

    Prediction of the responses to neoadjuvant chemotherapy (NACT) can improve the treatment of patients with advanced breast cancer. Genes and proteins predictive of chemoresistance have been extensively studied in breast cancer tissues. However, noninvasive serum biomarkers capable of such prediction have been rarely exploited. Here, we performed profiling of N-glycosylated proteins in serum from fifteen advanced breast cancer patients (ten patients sensitive to and five patients resistant to N...

  10. EFFECT OF NEOADJUVANT CHEMOTHERAPY USING PACLITAXEL COMBINED WITH CARBOPLATIN ON ADVANCED NON-SMALL CELL LUNG CANCER

    Institute of Scientific and Technical Information of China (English)

    XIONG Hong-chao; CHEN Jin-feng; ZHANG Li-jian

    2006-01-01

    Objective: To assess the therapeutic effectiveness of preoperative neoadjuvant chemotherapy using a combination of paclitaxel and carboplatin on local advanced non-small cell lung cancer (NSCLC). Methods: Twenty-five patients with advanced NSCLC were treated with paclitaxel and carboplatin for 2 to 4 cycles before undergoing tumor resection and then postoperative chemotherapy/radiotherapy therapy for 2 to 4 cycles. Results: Following neoadjuvant chemotherapy, the most prominent side-effect was bone marrow restraint. The overall response rate of preoperative chemotherapy was 56%. The mean survival time was 26.5 months, with 1-, 2- and 5-year survival rates of 55%, 25%, and 16%, respectively. All NSCLC patients survived the perioperative period. Conclusion: Preoperative neoadjuvant chemotherapy combining paclitaxel and carboplatin produced minimal side-effect while increasing the probability that advanced NSCLC patients would be able to undergo surgery thus improving their prognosis.

  11. Thrombosis of abdominal aorta during cisplatin-based chemotherapy of testicular seminoma - a case report

    Directory of Open Access Journals (Sweden)

    Gehrckens Ralf

    2009-12-01

    Full Text Available Abstract Background Vascular complications occurring during cisplatin-based chemotherapy of germ cell tumours are inadequately recognized to date. Case Presentation A 49 year old man with advanced seminoma underwent two courses of chemotherapy according to the PEB regimen. Upon restaging, two thrombotic deposits were noted in the descending part of the thoracic aorta and in the infrarenal abdominal aorta, respectively. Although thrombotic plaques caused aortic occlusion of about 30%, no clinical signs of malperfusion of limbs were registered. The patient was placed on anticoagulant therapy. Six months after completion of chemotherapy, thrombotic deposits had completely resolved. In the absence of other predisposing factors, it must be assumed that cisplatin-based chemotherapy represented a strong stimulus for arterial thrombosis in the aorta. Conclusions This is the first case of endo-aortic thrombosis during chemotherapy for testicular germ cell cancer. Providers of chemotherapy must be aware of arterial thrombosis even in young patients with testicular cancer.

  12. The clinical observation of neoadjuvant chemotherapy in locally advanced breast cancer with DX regimen

    Institute of Scientific and Technical Information of China (English)

    Miao Zhang; Jianing Qiu; Shuxian Qu; Yaling Han; Zhaozhe Liu; Xiaodong Xie

    2014-01-01

    Objective:The recent clinical curative ef ect and adverse events of docetaxel and capecitabine (DX) of neo-adjuvant chemotherapy in patients with local y advanced breast cancer was discussed. Methods:The data of 72 cases of neoadjuvant chemotherapy (DX) in local y advanced breast cancer after 4 cycles were retrospectively analyzed. Docetaxel 75 mg/m2 by infusion 1 h on d1, capecitabine 2000 mg/m2 by oral for twice daily on d1–14, 21 days was a cycle. Results:Al 72 patients were assessed for ef icacy and adverse events. The total ef ective rate was 80.5%(58/72), including pathological complete response (pCR) was 7 (9.7%), clinical complete remission (cCR) was 15(20.8%), clinical partial response (PR) was 43 (59.7%), stable disease (SD) was 8 (11.1%) and progressive disease (PD) was 6 (8.3%). The main adverse events were gastrointestinal reactions and bone marrow suppression. The 3 to 4 degrees of adverse reactions including granulocytopenia in 7 patients (20.6%), hand-foot syndrome in 6 patients (15.2%). Conclusion:The DX regimen provide a favorable ef icacy and safety profile in patients with local y advanced breast cancer for neoadjuvant chemotherapy.

  13. Evaluation of biomarker changes after administration of various neoadjuvant chemotherapies in breast cancer

    Science.gov (United States)

    Jin, Guangchao; Han, Yu; Liu, Cun; Chen, Liansheng; Ding, Butong; Xuan, Shijin; Liu, Xianqiang; Ma, Guohui; Gao, Jun; Tian, Xingsong

    2015-01-01

    To assess the changes in estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67 expression in breast cancer patients after various neoadjuvant chemotherapies. Data from 138 locally advanced breast cancer patients with histological diagnoses were reviewed. Seventy patients (group 1) were given 4 cycles of 500 mg/m2 cyclophosphamide and 50 mg/m2 pirarubicin every 21 days. Sixty-eight patients (group 2) were given 4 cycles of 500 mg/m2 cyclophosphamide and 75 mg/m2 docetaxel every 21 days. The biomarker changes of the operated tumor tissues were compared with the initial core biopsies. ER, PR, HER2 and Ki-67 expression changed by 28.6%, 22.9%, 17.1% and 54.3%, respectively, after neoadjuvant chemotherapy in group 1 and 16.2%, 22.1%, 13.2% and 70.6%, respectively, after neoadjuvant chemotherapy in group 2. There were significant differences between the groups regarding ER and Ki-67 status changes, and these changes can be used to inform treatment strategies. PMID:25755795

  14. Gene expression profile of residual breast cancer after doxorubicin and cyclophosphamide neoadjuvant chemotherapy.

    Science.gov (United States)

    Koike Folgueira, Maria Aparecida Azevedo; Brentani, Helena; Carraro, Dirce Maria; De Camargo Barros Filho, Mateus; Hirata Katayama, Maria Lucia; Santana de Abreu, Ana Paula; Mantovani Barbosa, Edson; De Oliveira, Célia Tosello; Patrão, Diogo F C; Mota, Louise D; Netto, Mario Mourão; Caldeira, José Roberto Figaro; Brentani, Maria Mitzi

    2009-10-01

    In breast cancer patients, primary chemotherapy is associated with the same survival benefits as adjuvant chemotherapy. Residual tumors represent a clinical challenge, as they may be resistant to additional cycles of the same drugs. Our aim was to identify differential transcripts expressed in residual tumors, after neoadjuvant chemotherapy, that might be related with tumor resistance. Hence, 16 patients with paired tumor samples, collected before and after treatment (4 cycles doxorubicin/cyclophosphamide, AC) had their gene expression evaluated on cDNA microarray slides containing 4,608 genes. Three hundred and eighty-nine genes were differentially expressed (paired Student's t-test, pFDR<0.01) between pre- and post-chemotherapy samples and among the regulated functions were the JNK cascade and cell death. Unsupervised hierarchical clustering identified one branch comprising exclusively, eight pre-chemotherapy samples and another branch, including the former correspondent eight post-chemotherapy samples and other 16 paired pre/post-chemotherapy samples. No differences in clinical and tumor parameters could explain this clustering. Another group of 11 patients with paired samples had expression of selected genes determined by real-time RT-PCR and CTGF and DUSP1 were confirmed more expressed in post- as compared to pre-chemotherapy samples. After neoadjuvant chemotherapy some residual samples may retain their molecular signature while others present significant changes in their gene expression, probably induced by the treatment. CTGF and DUSP1 overexpression in residual samples may be a reflection of resistance to further administration of AC regimen. PMID:19724859

  15. Neoadjuvant intraarterial chemotherapy and embolization in treatment of advanced ovarian epithelial carcinoma

    Institute of Scientific and Technical Information of China (English)

    刘恩令; 糜若然

    2004-01-01

    Background The purpose of the study was to evaluate the role of neoadjuvant chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries in treating patients with advanced ovarian epithelial carcinoma.Methods Forty-two patients with advanced ovarian epithelial carcinoma (study group) were treated via the anterior branches of the bilateral internal iliac arteries after cytoreductive surgery and 7 courses of adjuvant platinum-based combination chemotherapy. Primary cytoreductive surgery was performed in 43 patients with advanced ovarian epithelial carcinoma (control group), and then followed by 8 courses of adjuvant platinum-based combination chemotherapy. The rate of optimal cytoreductive surgery, survival rate, blood loss during operation and operative time were investigated in the two groups. Statistical significance was asessed using Student's t test, the Chi-squre test and the log-rank test. Results In the study group, the rate of optimum debulking after platinum-based chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries was 71.43%(30/42) (χ2=10.06, P0.05).Conclusions Neoadjuvant platinum-based combination chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries is an alternative treatment for patients with advanced ovarian epithelial carcinoma, in whom the chance of optimal cytoreductive surgery is low. The treatment can reduce blood loss, decrease operative time, and increase the rate of optimal cytoreductive surgery; but the median survival can't be improved significantly.

  16. Neoadjuvant chemotherapy of breast cancer: early assessment of therapeutic response with in-vivo 1HMR spectroscopy

    International Nuclear Information System (INIS)

    Objective: To investigate the values of tCho concentration in early assessment therapeutic response of tumor to neoadjuvant chemotherapy with 1HMR spectroscopy. Methods: Twenty patients with breast cancer were recruited. All patients underwent biopsy before neoadjuvant chemotherapy and surgery after chemotherapy. The pathologic results before and after neoadjuvant chemotherapy were compared. The patients were divided into effective response group (R) and ineffective response group (IR). MRS acquisitions were performed within 1 week before chemotherapy and within 3 week after the first cycle of chemotherapy, respectively. The tCho concentration was calculated quantitatively using external standard method. The tCho concentrations before and after chemotherapy and the tumor sizes between R group and IR group were compared using t test and nonparametric test. The values of tCho concentration in early assessment of the effectiveness of chemotherapy were analyzed by ROC. Results: Of 20 cases, 16 were included in R group and 4 in IR group. In R group, significant differences of tCho concentration (t=5.040, P0.05]. The median sizes of tumor between R and IR group had no significant differences (0.00,0.00 cm, U=2300, W=33.00, P= 0.437). The area under ROC curve of tCho concentration was 0.984. Conclusion: With in vivo 1HMRS, the tCho concentration in breast cancer can serve as an indicator for predicting response to neoadjuvant chemotherapy with relatively high sensitivity and specificity. (authors)

  17. Impact of various options of neoadjuvant chemotherapy on the hormonal status of patients with breast cancer

    Directory of Open Access Journals (Sweden)

    Yu. S. Sidorenko

    2010-01-01

    Full Text Available Objective: to study hormone balance changes caused by various options of neoadjuvant chemotherapy (CT in patients with breast cancer (BC. Materials and methods. Data on 200 patients aged 30 to 65 years with primary BC (Stages IIB-IIIA, who had been treated at the Rostov Cancer Research Institute in 2006 to 2009, served as a material for the study. The levels of steroid hormones of the estrogenic, androgenic, and glucocorticoid series were studied before and after neoadjuvant CT.Results. When neoadjuvant poly-CT (PCT was performed on automedia, the levels of total estrogens were almost unchanged; the frac- tions of estrone and estriol also remained stable. Only estradiol levels were recorded to show a certain declining tendency.There were considerable changes in the expression of all steroid hormones during preoperative systemic PCT.According o the drug therapy option, significant differences were found in the time course of changes in blood cortisol levels. Conclusion. Neoadjuvant CT on automedia results in diminished estrogenization irrespective of age and the phase of the menstrual cycle.

  18. First chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil (T.P.F.) followed by concomitant chemoradiotherapy in the treatment of cavum locally evolved undifferentiated carcinomas without metastases; Chimiotherapie premiere par docetaxel, cisplatine et 5-fluoro-uracile (TPF) suivie de chimioradiotherapie concomitante dans le traitement des carcinomes indifferencies localement evolues non metastatiques du cavum

    Energy Technology Data Exchange (ETDEWEB)

    Sahli, B.; Bali, M.S.; Miles, I.; Djemaa, A. [CHU Benbadis, Constantine (Algeria)

    2009-10-15

    It is a prospective study in order to evaluate the feasibility and the toxicity of a chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil followed by a concomitant chemoradiotherapy in the treatment of non metastatic locally evolved undifferentiated carcinomas of the cavum. The conclusion was despite the low number of patients in our series, the observed results show that this neoadjuvant chemotherapy followed by a concomitant chemoradiotherapy in the locally evolved undifferentiated carcinomas of the cavum is feasible. however, the high acute toxicity needs the use of conformal irradiation techniques. Besides, a longer follow up is necessary to evaluate the therapy efficiency and the delayed toxicity of this protocol. (N.C.)

  19. Prognostic value of tumor suppressors in osteosarcoma before and after neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Primary bone cancers are among the deadliest cancer types in adolescents, with osteosarcomas being the most prevalent form. Osteosarcomas are commonly treated with multi-drug neoadjuvant chemotherapy and therapy success as well as patient survival is affected by the presence of tumor suppressors. In order to assess the prognostic value of tumor-suppressive biomarkers, primary osteosarcoma tissues were analyzed prior to and after neoadjuvant chemotherapy. We constructed a tissue microarray from high grade osteosarcoma samples, consisting of 48 chemotherapy naïve biopsies (BXs) and 47 tumor resections (RXs) after neoadjuvant chemotherapy. We performed immunohistochemical stainings of P53, P16, maspin, PTEN, BMI1 and Ki67, characterized the subcellular localization and related staining outcome with chemotherapy response and overall survival. Binary logistic regression analysis was used to analyze chemotherapy response and Kaplan-Meier-analysis as well as the Cox proportional hazards model was applied for analysis of patient survival. No significant associations between biomarker expression in BXs and patient survival or chemotherapy response were detected. In univariate analysis, positive immunohistochemistry of P53 (P = 0.008) and P16 (P16; P = 0.033) in RXs was significantly associated with poor survival prognosis. In addition, presence of P16 in RXs was associated with poor survival in multivariate regression analysis (P = 0.003; HR = 0.067) while absence of P16 was associated with good chemotherapy response (P = 0.004; OR = 74.076). Presence of PTEN on tumor RXs was significantly associated with an improved survival prognosis (P = 0.022). Positive immunohistochemistry (IHC) of P16 and P53 in RXs was indicative for poor overall patient survival whereas positive IHC of PTEN was prognostic for good overall patient survival. In addition, we found that P16 might be a marker of osteosarcoma chemotherapy resistance. Therefore, our study supports the use of tumor RXs to

  20. Metabolic response at repeat PET/CT predicts pathological response to neoadjuvant chemotherapy in oesophageal cancer

    International Nuclear Information System (INIS)

    Reports have suggested that a reduction in tumour 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) examination during or after neoadjuvant chemotherapy may predict pathological response in oesophageal cancer. Our aim was to determine whether metabolic response predicts pathological response to a standardised neoadjuvant chemotherapy regimen within a prospective clinical trial. Consecutive patients staged with potentially curable oesophageal cancer who underwent treatment within a non-randomised clinical trial were included. A standardised chemotherapy regimen (two cycles of oxaliplatin and 5-fluorouracil) was used. PET/CT was performed before chemotherapy and repeated 24-28 days after the start of cycle 2. Forty-eight subjects were included: mean age 65 years; 37 male. Using the median percentage reduction in SUVmax (42%) to define metabolic response, pathological response was seen in 71% of metabolic responders (17/24) compared with 33% of non-responders (8/24; P = 0.009, sensitivity 68%, specificity 70%). Pathological response was seen in 81% of subjects with a complete metabolic response (13/16) compared with 38% of those with a less than complete response (12/32; P = 0.0042, sensitivity 52%, specificity 87%). There was no significant histology-based effect. There was a significant association between metabolic response and pathological response; however, accuracy in predicting pathological response was relatively low. (orig.)

  1. Primary Surgery or Neoadjuvant Chemotherapy in Advanced Ovarian Cancer: The Debate Continues….

    Science.gov (United States)

    Leary, Alexandra; Cowan, Renee; Chi, Dennis; Kehoe, Sean; Nankivell, Matthew

    2016-01-01

    Primary debulking surgery (PDS) followed by platinum-based chemotherapy has been the cornerstone of treatment for advanced ovarian cancer for decades. Primary debulking surgery has been repeatedly identified as one of the key factors in improving survival in patients with advanced ovarian cancer, especially when minimal or no residual disease is left behind. Achieving these results sometimes requires extensive abdominal and pelvic surgical procedures and consultation with other surgical teams. Some clinicians who propose a primary chemotherapy approach reported an increased likelihood of leaving no macroscopic disease after surgery and improved patient-reported outcomes and quality-of-life (QOL) measures. Given the ongoing debate regarding the relative benefit of PDS versus neoadjuvant chemotherapy (NACT), tumor biology may aid in patient selection for each approach. Neoadjuvant chemotherapy offers the opportunity for in vivo chemosensitivity testing. Studies are needed to determine the best way to evaluate the impact of NACT in each individual patient with advanced ovarian cancer. Indeed, the biggest utility of NACT may be in research, where this approach provides the opportunity for the investigation of predictive markers, mechanisms of resistance, and a forum to test novel therapies. PMID:27249696

  2. Quimioterapia neoadjuvante em câncer localmente avançado do colo do útero Neoadjuvant chemotherapy in locally advanced cancer of the cervix

    Directory of Open Access Journals (Sweden)

    Eduardo Schünemann Jr

    2002-12-01

    Full Text Available OBJETIVOS: avaliar a quimioterapia neoadjuvante no câncer localmente avançado do colo uterino, por meio da sua aceitabilidade, tolerabilidade, toxicidade, taxa de complicações cirúrgicas, taxa de resposta, taxa de operabilidade e sobrevida em 5 anos. MÉTODOS: foram incluídas 60 mulheres com câncer do colo uterino localmente avançado (IIB e IIIB, submetidas à quimioterapia neoadjuvante com doxorrubicina-bleomicina-cisplatina. Aquelas que se tornaram operáveis após a quimioterapia foram submetidas à cirurgia de Wertheim-Meigs, seguida de radioterapia pélvica complementar. Nas pacientes em que a cirurgia não foi possível após a quimioterapia, realizou-se radioterapia. RESULTADOS: o seguimento médio foi de 108 meses. A taxa de resposta global à quimioterapia foi de 80%, sendo 100% para o estádio IIB e 60% para o estádio IIIB. A porcentagem de pacientes operadas, após a quimioterapia foi de 65%. A sobrevida global em 5 anos para todo o grupo foi 62%. No grupo operado (n=34, a sobrevida global foi de 82,14%, independentemente do estádio inicial. No grupo não operado (n=18, a sobrevida em 5 anos foi 16,67%. CONCLUSÕES: A quimioterapia neoadjuvante com doxorrubicina-bleomicina-cisplatina no câncer do colo uterino localmente avançado é segura, com baixo índice de complicações e permitiu uma alta taxa de operabilidade.PURPOSE: to evaluate neoadjuvant chemotherapy in locally advanced cervical cancer as to its acceptability, tolerability, toxicity, surgical complications, operability, response rate, and overall survival in 5 years. METHODS: sixty women with locally advanced cervical cancer (stages IIB and IIIB, who were submitted to neoadjuvant chemotherapy, were included. All patients were treated with doxorubicin-bleomycin-cisplatin. Those who had a good response, allowing a surgical approach, underwent the Wertheim-Meigs procedure. After surgery, they were submitted to pelvic radiotherapy. Those that could not be submitted

  3. Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Purpose: To analyze the impact of neoadjuvant chemotherapy on the treatment of locoregionally advanced nasopharyngeal carcinoma and to assess the outcomes of patients receiving such treatment. Methods and Materials: We analyzed 137 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with either radiation therapy only or combined radiation therapy and chemotherapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows: AJCC Stage III-21, Stage IV-61 in the radiation therapy group (RT group); AJCC Stage III-1, Stage IV-54 in neoadjuvant chemotherapy and radiation therapy group (CT/RT group). The median follow-up for surviving patients was 48 months. Results: The 5-year overall survival (OS) rates were 71% for the CT/RT group and 59% for the RT group (p = 0.04). The 5-year actuarial disease-free survival (DFS) rates were 63% for the CT/RT group and 52% for the RT group (p = 0.04). Distant metastasis (DM) incidence was significantly lower in the CT/RT group. The 5-year freedom from distant metastasis rates were 84% for the CT/RT group and 66% for the RT group (p 0.01). The incidence of locoregional failures was also lower in the CT/RT group, although this difference did not reach statistical significance (69% vs. 56%, p = 0.09) Conclusion: While not providing conclusive evidence, historical evidence from this institution suggests that neoadjuvant chemotherapy significantly improves both overall and the disease-free survival of patients with advanced stage nasopharyngeal carcinoma

  4. Neoadjuvant chemotherapy and radiotherapy for large soft tissue sarcomas

    International Nuclear Information System (INIS)

    Purpose: The treatment of soft tissue sarcomas of the extremity with radiation therapy and limb sparing surgery results in local control rates of greater than 90%. Because of these excellent results, interest is now focused on reducing the incidence of distant failure. We have begun a phase II trial evaluating The efficacy of preoperative chemotherapy with Mesna, Adriamycin, Ifosfamide and Dacarbazine (MAID) and radiation, followed by resection and postoperative radiotherapy and chemotherapy. Materials and Methods: Adult patients with AJCC stage IIB or IIIB extremity soft tissue sarcomas, ≥ 8 cm were treated with three cycles of MAID chemotherapy combined with 44 Gy. After a three week rest surgical resection was performed. If surgical margins were positive, an additional 16 Gy boost was delivered. All patients received an additional three cycles of MAID. Results: A total of 26 patients who were clinically M0 at entry have completed protocol therapy. The median follow-up time for this group of patients is 13 months (range 3-76 months). Pathologic response rates have varied from 10 to 100% with mean and median values of 84% and 96%. In general, radiographic volume change did not correlate with pathologic response rates and therefore was not a good predictor of treatment response. For example, patients with ≥ 95% necrosis had only a 16% decrease in tumor volume compared to 34% for patients 50-<95% necrosis. The local control, disease-free survival and overall survival of these patients has been compared to a control group of 32 matched historically for tumor size, grade, age and era of treatment. The actuarial five-year local control, disease-free survival rate and overall survival rates for MAID patients is 100, 84 and 93%, respectively. For the control group these rates are 97, 45 and 60%, respectively. Conclusion: Following a course of aggressive of chemotherapy and radiation therapy 85% of patients with high risk soft tissue sarcoma are free of disease at

  5. Early metabolic response using FDG PET/CT and molecular phenotypes of breast cancer treated with neoadjuvant chemotherapy

    Directory of Open Access Journals (Sweden)

    Han Wonshik

    2011-10-01

    Full Text Available Abstract Background This study was aimed 1 to investigate the predictive value of FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography for histopathologic response and 2 to explore the results of FDG PET/CT by molecular phenotypes of breast cancer patients who received neoadjuvant chemotherapy. Methods Seventy-eight stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. FDG PET/CTs were acquired before chemotherapy and after the first cycle of chemotherapy for evaluating early metabolic response. Results The mean pre- and post-chemotherapy standard uptake value (SUV were 7.5 and 3.9, respectively. The early metabolic response provided by FDG PET/CT after one cycle of neoadjuvant chemotherapy was correlated with the histopathologic response after completion of neoadjuvant chemotherapy (P = 0.002. Sensitivity and negative predictive value were 85.7% and 95.1%, respectively. The estrogen receptor negative phenotype had a higher pre-chemotherapy SUV (8.6 vs. 6.4, P = 0.047 and percent change in SUV (48% vs. 30%, P = 0.038. In triple negative breast cancer (TNBC, the pre-chemotherapy SUV was higher than in non-TNBC (9.8 vs. 6.4, P = 0.008. Conclusions The early metabolic response using FDG PET/CT could have a predictive value for the assessment of histopathologic non-response of stage II/III breast cancer treated with neoadjuvant chemotherapy. Our findings suggest that the initial SUV and the decline in SUV differed based on the molecular phenotype. Trial Registration ClinicalTrials.gov: NCT01396655

  6. Effects on heart function of neoadjuvant chemotherapy and chemoradiotherapy in patients with cancer in the esophagus or gastroesophageal junction – a prospective cohort pilot study within a randomized clinical trial

    International Nuclear Information System (INIS)

    Neoadjuvant therapy for cancer of the esophagus or gastroesophageal (GE)-junction is well established. The pros and cons of chemoradiotherapy and chemotherapy are debated. Chemoradiotherapy might impair cardiac function eliciting postoperative morbidity. The aim of this pilot study was to describe acute changes in left ventricular function following chemoradiotherapy or chemotherapy. Patients with esophageal and (GE)-junction cancer enrolled at our center into a multicenter trial comparing neoadjuvant chemoradiotherapy and chemotherapy were eligible. Patients were randomized to receive cisplatin and 5-fluorouracil with or without the addition of 40 Gy radiotherapy prior to surgery. Left ventricular function was evaluated using echocardiography and plasma N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) before and after neoadjuvant treatment. The primary outcome measure was left ventricular global strain (GS). Clinical effects were assessed using repeated exercise tests. Linear mixed models were used to analyze the effects of treatment group, and the interaction between groups. 40 patients participated (chemoradiotherapy, n = 17; chemotherapy, n = 23). In the chemoradiotherapy group there was no change in left ventricular global strain but mitral annular plane systolic excursion (MAPSE) of the ventricular septum, early diastolic filling velocity (E-velocity), and the ratio of early to late ventricular filling velocities (E/A ratio) decreased significantly (p = 0.02, p = 0.01, and p = 0.03, respectively). No changes were observed in the chemotherapy group. There was a trend towards an interaction effect for MAPSE sept and E (p = 0.09 and p = 0.09). NT-proBNP increased following chemoradiotherapy (p = 0.05) but not after chemotherapy (p > 0.99), and there was a trend towards an interaction effect (p = 0.07). Working capacity decreased following neoadjuvant treatment (chemoradiotherapy p = 0.001, chemotherapy p = 0.03) and was more pronounced after

  7. Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102)

    OpenAIRE

    Katsumata, N; Yoshikawa, H; Kobayashi, H.; Saito, T.; Kuzuya, K; Nakanishi, T; Yasugi, T; Yaegashi, N; Yokota, H; Kodama, S.; Mizunoe, T; Hiura, M; Kasamatsu, T; Shibata, T.; Kamura, T

    2013-01-01

    Background: A phase III trial was conducted to determine whether neoadjuvant chemotherapy (NACT) before radical surgery (RS) improves overall survival. Methods: Patients with stage IB2, IIA2, or IIB squamous cell carcinoma of the uterine cervix were randomly assigned to receive either BOMP (bleomycin 7 mg days 1–5, vincristine 0.7 mg m−2 day 5, mitomycin 7 mg m−2 day 5, cisplatin 14 mg m−2 days 1–5, every 3 weeks for 2 to 4 cycles) plus RS (NACT group) or RS alone (RS group). Patients with pa...

  8. The correlation analysis between 18F-FDG PET-CT in breast cancer with neoadjuvant chemotherapy and the expression of Ki-67 and COX-2 before neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Objective: To study the expression of Ki-67 (a kind of proliferation cell nuclear antigen), cyclooxygenase-2 (COX-2) in breast cancer before neoadjuvant chemotherapy, and its correlation with the changes of maximum standarded uptake value (SUVmax). Methods: In a prospertive trial, 18F-FDG PET-CT were performed in 19 women with primary breast cancer before and after the first and second cycle of neoadjuvant chemotherapy respectively, the changes of SUVmax were computered. Divided the patients into different groups according to the Ki-67 and COX-2 expression,then compared the rate of change of SUVmax in different groups. Results: There was no correlation between the changes of SUVmax after chemotherapy and the expression of Ki-67, COX-2 before neoadjuvant chemotherapy. Conclusions: The expression of Ki-67 and COX-2 before neoadjuvant chemotherapy were unable to sufficiently explain the changes of 18F-FDG uptake during the chemotherapy process. The metabolic changes were most likely explained by a complex interaction between cellular energy demand and tumoral microenvironment. (authors)

  9. Induction chemotherapy with docetaxel, cisplatin and S-1 followed by proton beam therapy concurrent with cisplatin in patients with T4b nasal and sinonasal malignancies

    International Nuclear Information System (INIS)

    For the treatment of patients with T4b nasal and sinonasal malignancies, definitive chemoradiotherapy was contraindicated due to the risk of brain damage and blindness. However, combination chemotherapy with docetaxel, cisplatin and S-1 is well tolerated and effective. We conducted a retrospective analysis to evaluate the efficacy and feasibility of induction chemotherapy using docetaxel, cisplatin and S-1 followed by proton beam therapy concurrent with cisplatin. Thirteen patients treated with docetaxel, cisplatin and S-1 were analyzed. Docetaxel, cisplatin and S-1 consisted of 60-70 mg/m2/day docetaxel on day 1, 70 mg/m2/day cisplatin on day 1 and 60-80 mg/m2/day S-1 on days 1-14. Treatment was repeated every 3-4 weeks with a maximum number of three treatment cycles. According to the response to docetaxel, cisplatin and S-1, patients received either proton beam therapy concurrent with 20 mg/m2/day cisplatin on days 1-4 every 3 weeks or proton beam therapy alone. Neutropenia represented the most common Grade 3/4 hematological toxicity (76.9%), while the most frequently observed non-hematological toxicity was nausea (23.0%). After the completion of docetaxel, cisplatin and S-1, the overall response rate was 38.4% (5 of 13), with 1 patient achieving complete response and 4 patients achieving partial response. Subsequently, 10 patients received proton beam therapy concurrent with cisplatin, 2 received proton beam therapy alone and 1 received palliative radiation. No severe toxicity was observed during proton beam therapy. After the completion of proton beam therapy, 11 patients (84.6%) achieved complete response and no brain damage or blindness occurred. Induction chemotherapy with docetaxel, cisplatin and S-1 followed by proton beam therapy concurrent with cisplatin is well tolerated and displays promising antitumor activity that warrants further investigation. (author)

  10. Management of Inflammatory Breast Cancer After Neoadjuvant Chemotherapy

    International Nuclear Information System (INIS)

    Purpose: To assess the benefit of breast surgery for inflammatory breast cancer (IBC). Methods and Materials: This retrospective series was based on 232 patients treated for IBC. All patients received primary chemotherapy followed by either exclusive radiotherapy (118 patients; 51%) or surgery with or without radiotherapy (114 patients; 49%). The median follow-up was 11 years. Results: The two groups were comparable apart from fewer tumors <70 mm (43% vs. 33%, p = 0.003), a higher rate of clinical stage N2 (15% vs. 5%, p = 0.04), and fewer histopathologic Grade 3 tumors (46% vs. 61%, p <0.05) in the no-surgery group. The addition of surgery was associated with a significant improvement in locoregional disease control (p = 0.04) at 10 years locoregional free interval 78% vs. 59% but with no significant difference in overall survival rates or disease-free intervals. Late toxicities were not significantly different between the two treatment groups except for a higher rate of fibrosis in the no-surgery group (p <0.0001) and more lymphedema in the surgery group (p = 0.002). Conclusion: Our data suggest an improvement in locoregional control in patients treated by surgery, in conjunction with chemotherapy and radiotherapy, for IBC. Efforts must be made to improve overall survival.

  11. Neoadjuvant Chemotherapy and Radical Surgery in Locally Advanced Cervical Cancer During Pregnancy: Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Zohreh Yousefi

    2013-01-01

    Full Text Available For pregnant patients with cervical cancer, treatment recommendations are individualized and dependent on the stage of the disease, gestational age at the time of diagnosis, and the patient's desire as to the cosntinuation of the pregnancy. The aim of this study is to describe the outcome of neoadjuvant chemotherapy with radical surgery and pelvic lymphadenectomy in a woman with cervical cancer who wished to maintain her pregnancy. This is a report of a 26-week pregnant woman with locally advanced cervical cancer stage Ib2 (FIGO who was successfully treated with neoadjuvant chemotherapy Paclitaxel plus platinum, followed by C/S and radical surgery. Her neonate was healthy and had no abnormalities. This case was the first cervical cancer during pregnancy that was treated using this method at the tumor clinic, Mashhad University of Medical Sciences, Iran. Neoadjuvant chemotherapy is an effort to allow time for the fetal to reach viability by preventing the progression of the disease.

  12. Comparison between ultrasonography and [18F]FDG PET for pathological response of breast cancer to neo-adjuvant chemotherapy

    International Nuclear Information System (INIS)

    To compare between ultrasonography (US) and the predictive value of [18F]fluorodeoxyglucose positron emission tomography (FDG PET) for the pathological response of breast cancer after completion of neo-adjuvant chemotherapy. Twenty eight patients with newly diagnosed, locally advanced breast cancer were evaluated with US and PET before and after neo-adjuvant chemotherapy. Chemotherapy response with US was classified by UICC. Reduction rate of pSUV with PET was measured for residual disease assessment. Pathological responses were classified into three groups: pathological non-response (pNR), pathological partial response (pPR), and pathological complete response (pCR). PET correctly predicted pathologic responses in 22 of 28 patients (78.6%); US correctly predicted in 21 of 28 patients (75%). Significant differences between chemotherapy responses of US and residual tumor assessments of PET to neo-adjuvant chemotherapy were not observed (>0.05). Two patients with pPR who were predicted with US to have complete response were classified as partial response in PET. Also, a patient with pNR was predicted with US to have partial response in US, but partial response in PET. In this study, differences between US and PET were not statistically significant. But PET provides additional information that cannot be assessed in US for the pathological response of breast cancer after completion of neo-adjuvant chemotherapy

  13. Salvage chemotherapy for ovarian cancer recurrence: weekly cisplatin in combination with epirubicin or etoposide.

    Science.gov (United States)

    Zanaboni, F; Scarfone, G; Presti, M; Maggi, R; Borello, C; Bolis, G

    1991-10-01

    From December 1986 to April 1990, 40 consecutive ovarian cancer patients who relapsed after response to cisplatin-based chemotherapy regimens were treated with seven courses of weekly cisplatin, in combination with epirubicin or etoposide. The overall response rate obtained with the intensive schedule was 60% and the complete response rate was 25%; median duration of response was 7 months and median survival time, 13.5 months. Responsive cases seem to have longer survival; a prognostic factor for response to salvage treatment and longer survival is the disease-free interval after the first-line chemotherapy. Weekly cisplatin as intensive treatment was very well tolerated and showed acceptable toxicity in both the combination protocols with epirubicin or etoposide. PMID:1959783

  14. In vivo intratumor angiogenic treatment effects during taxane-based neoadjuvant chemotherapy of ovarian cancer

    International Nuclear Information System (INIS)

    The aim of our study was to analyze the effect of taxane-based chemotherapy on tumor angiogenesis in patients with advanced epithelial ovarian cancer. Within a prospective phase II trial, 32 patients with stage IIIC and IV ovarian cancer were treated with either two or three cycles of neoadjuvant chemotherapy prior to cytoreductive surgery. Carboplatin (AUC5) and docetaxel (75 mg/m2) were administered intravenously in a 3-weekly schedule. Changes in intratumor microvessel density (MVD) were assessed with immunohistochemistry by staining pre- and posttreatment surgical tumor specimens with panendothelial, neovascular and lymphatic vessel markers. Mean values of MVD defined by CD31, CD34, CD105 and D2-40 antibodies showed 12.3, 21.0, 2.7 and 3.1 vessels per high power field (HPF) before chemotherapy and increased after treatment to 15.3, 21.8, 4.8 and 3.6 per HPF, respectively. These changes were significant for CD31 (p = 0.04) and for CD105 (p = 0.02). Taxane-based chemotherapy appears to promote tumor vascularization when administered every 3 weeks. A possible explanation is the secondary recovery of MVD in response to immediate cytotoxic and antiangiogenic effects of the chemotherapy. If confirmed prospectively, these findings favor shorter treatment intervals of taxane-based chemotherapy to counteract proangiogenic recovery

  15. Dynamic diffuse optical tomography for assessing changes of breast tumors during neoadjuvant chemotherapy

    Science.gov (United States)

    Gunther, Jacqueline E.; Lim, Emerson; Kim, Hyun Keol; Brown, Mindy; Refice, Susan; Kalinsky, Kevin; Hershman, Dawn; Hielscher, Andreas H.

    2015-03-01

    We have developed a dynamic diffuse optical tomography imaging system that is capable of 3D imaging of both breasts simultaneously. In an ongoing study subjects receiving neoadjuvant chemotherapy are imaged at 6 time points throughout their 5-month treatment. At each time point the subjects preform a breath hold to observe the hemodynamic effects in the breasts. For each session the percent change of various hemodynamic parameters during the breath hold is determined. Preliminary results from show statistically significant differences in washout rates and deoxyhemoglobin changes at the 2-week imaging point between subjects that respond and do not respond to treatment.

  16. [Regional and systemic neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri].

    Science.gov (United States)

    Baĭchev, G; Gorchev, G; Deliĭski, T

    1996-01-01

    Neoadjuvant chemotherapy with bleomycin and Cisplastin was administered on ten patients with cervical cancer (IIB, IIIA, IIIB). On three successive days, five minutes after deep bilateral subcutaneous application of 100E Hylase in the medical surface of the lower third of the shin, 20 mg/msq of bleomycin was introduced slowly. The chemotherapeutic drug was absorbed by the lymph capillaries predominantly, and then transferred to the pelvic lymph nodes. Cisplastin was administered intravenously, at a dose of 50 mg/msq. Treatment was applied three times, third week. Remission was observed in 5 out of the 10 cases. PMID:9254558

  17. P-glycoprotein expression as a predictor of response to neoadjuvant chemotherapy in breast cancer

    OpenAIRE

    S Vishnukumar; Umamaheswaran, G.; D Anichavezhi; Indumathy, S.; C Adithan; Srinivasan, K.; D Kadambari

    2013-01-01

    Background: Chemoresistance is an important factor determining the response of tumor to neoadjuvant chemotherapy (NACT). P-glycoprotein (P-gp) expression-mediated drug efflux is one of the mechanisms responsible for multi-drug resistance. Our study was aimed to determine the role of P-gp expression as a predictor of response to NACT in locally advanced breast cancer (LABC) patients. Materials and Methods: P-gp expression was performed by real-time quantitative polymerase chain reaction [qRT-P...

  18. Serum nucleosomes during neoadjuvant chemotherapy in patients with cervical cancer. Predictive and prognostic significance

    Directory of Open Access Journals (Sweden)

    Cetina Lucely

    2005-06-01

    Full Text Available Abstract Background It has been shown that free DNA circulates in serum plasma of patients with cancer and that at least part is present in the form of oligo- and monucleosomes, a marker of cell death. Preliminary data has shown a good correlation between decrease of nucleosomes with response and prognosis. Here, we performed pre- and post-chemotherapy determinations of serum nucleosomes with an enzyme-linked immunosorbent assay (ELISA method in a group of patients with cervical cancer receiving neoadjuvant chemotherapy. Methods From December 2000 to June 2001, 41 patients with cervical cancer staged as FIGO stages IB2-IIIB received three 21-day courses of carboplatin and paclitaxel, both administered at day 1; then, patients underwent radical hysterectomy. Nucleosomes were measured the day before (baseline, at day seven of the first course and day seven of the third course of chemotherapy. Values of nucleosomes were analyzed with regard to pathologic response and to time to progression-free and overall survival. Results All patients completed chemotherapy, were evaluable for pathologic response, and had nucleosome levels determined. At a mean follow-up of 23 months (range, 7–26 months, projected progression time and overall survival were 80.3 and 80.4%, respectively. Mean differential values of nucleosomes were lower in the third course as compared with the first course (p >0.001. The decrease in the third course correlated with pathologic response (p = 0.041. Survival analysis showed a statistically significant, better progression-free and survival time in patients who showed lower levels at the third course (p = 0.0243 and p = 0.0260, respectively. Cox regression analysis demonstrated that nucleosome increase in the third course increased risk of death to 6.86 (95% confidence interval [CI 95%], 0.84–56.0. Conclusion Serum nucleosomes may have a predictive role for response and prognostic significance in patients with cervical cancer

  19. Association of cytochrome P450 genetic polymorphisms with neoadjuvant chemotherapy efficacy in breast cancer patients

    Directory of Open Access Journals (Sweden)

    Seredina Tatyana A

    2012-06-01

    Full Text Available Abstract Background The enzymes of the cytochrome P450 family (CYPs play an important role in the metabolism of a great variety of anticancer agents; therefore, polymorphisms in genes encoding for metabolizing enzymes and drugs transporters can affect drug efficacy and toxicity. Methods The genetic polymorphisms of cytochrome P450 were studied in 395 patients with breast cancer by RLFP analysis. Results Here, we studied the association of functionally significant variant alleles of CYP3A4, CYP3A5, CYP2B6, CYP2C8, CYP2C9 and CYP2C19 with the clinical response to neoadjuvant chemotherapy in breast cancer patients. A significant correlation was observed between the CYP2C9*2 polymorphism and chemotherapy resistance (OR = 4.64; CI 95% = 1.01 – 20.91, as well as between CYP2C9*2 heterozygotes and chemotherapy resistance in women with nodal forms of breast cancer and a cancer hereditary load (OR = 15.50; CI 95% = 1.08 – 826.12 when the potential combined effects were examined. No significant association between chemotherapy resistance and the other examined genotypes and the potential combined clinical and tumour-related parameters were discovered. Conclusion In conclusion, CYP2C9*2 was associated with neoadjuvant chemotherapy resistance (OR = 4.64; CI 95% = 1.01 – 20.91 in the population of interest.

  20. PD-L1 expression correlates with tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy in breast cancer

    OpenAIRE

    Wimberly, Hallie; Brown, Jason R.; Schalper, Kurt; Haack, Herbert; Silver, Matthew R.; Nixon, Christian; Bossuyt, Veerle; Pusztai, Lajos; Lannin, Donald R.; Rimm, David L.

    2014-01-01

    Programmed death 1 ligand 1 (PD-L1) is an immune regulatory molecule that limits antitumor immune activity. Targeting of PD-L1 and other immune checkpoint proteins has shown therapeutic activity in various tumor types. The expression of PD-L1 and its correlation with response to neoadjuvant chemotherapy in breast cancer has not been studied extensively. Our goal was to assess PD-L1 expression in a cohort of breast cancer patients treated with neoadjuvant chemotherapy. Pre-treatment biopsies f...

  1. Effect of neoadjuvant chemotherapy on locally advanced cervical cancer by internal iliac arterial infusion

    Institute of Scientific and Technical Information of China (English)

    Chen; Aiping; Ding; Zhaoxia; Xu; Bing; Zhao; Shuping; Dai; Shuzhen

    2007-01-01

    Objective:To evaluate the effect of preoperative chemotherapy on locally advanced cervical cancer by internal iliac arterial infusion.Methods:Sixty two patients with bulky or locally advanced cervical cancer from 1999 to 2004 were underwent internal iliac arterial infusion chemotherapy by using Seldinger technique.Combined regimens were applied including cisplatin as the major drug.Two weeks later,all patients received radical hysterectomy.Results:The local tumor regression rate was 93.55%.Postoperative pathologic examination showed that no cervical tumor residue in stumps were found in 61 of 62 patients who underwent radical hysterectomy.Large quantity of necrotic tissue appeared on primary tumor.In 16 patients with positive lymph nodes,15 demonstrated necrotic lymph nodes.Conclusion:Internal iliac arterial infusion chemotherapy could effectively reduce tumor volume,increase surgical success rate and decrease lymph nodes and subclinical metastasis rates.

  2. Sequential FDG-PET and induction chemotherapy in locally advanced adenocarcinoma of the Oesophago-gastric junction (AEG): The Heidelberg Imaging program in Cancer of the oesophago-gastric junction during Neoadjuvant treatment: HICON trial

    International Nuclear Information System (INIS)

    18-Fluorodeoxyglucose-PET (18F-FDG-PET) can be used for early response assessment in patients with locally advanced adenocarcinomas of the oesophagogastric junction (AEG) undergoing neoadjuvant chemotherapy. It has been recently shown in the MUNICON trials that response-guided treatment algorithms based on early changes of the FDG tumor uptake detected by PET are feasible and that they can be implemented into clinical practice. Only 40%-50% of the patients respond metabolically to therapy. As metabolic non-response is known to be associated with a dismal prognosis, metabolic non-responders are increasingly treated with alternative neoadjuvant chemotherapies or chemoradiation in order to improve their clinical outcome. We plan to investigate whether PET can be used as response assessment during radiochemotherapy given as salvage treatment in early metabolic non-responders to standard chemotherapy. The HICON trial is a prospective, non-randomized, explorative imaging study evaluating the value of PET as a predictor of histopathological response in metabolic non-responders. Patients with resectable AEG type I and II according to Siewerts classification, staged cT3/4 and/or cN+ and cM0 by endoscopic ultrasound, spiral CT or MRI and FDG-PET are eligible. Tumors must be potentially R0 resectable and must have a sufficient FDG-baseline uptake. Only metabolic non-responders, showing a < 35% decrease of SUV two weeks after the start of neoadjuvant chemotherapy are eligible for the study and are taken to intensified taxane-based RCT (chemoradiotherapy (45 Gy) before surgery. 18FDG-PET scans will be performed before (= Baseline) and after 14 days of standard neoadjuvant therapy as well as after the first cycle of salvage docetaxel/cisplatin chemotherapy (PET 1) and at the end of radiochemotherapy (PET2). Tracer uptake will be assessed semiquantitatively using standardized uptake values (SUV). The percentage difference ΔSUV = 100 (SUVBaseline - SUV PET1)/SUVBaseline will be

  3. Intraarterial chemotherapy with gemcitabine and cisplatin in locally advanced or recurrent penile squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jian-Ye Liu; Yong-Hong Li; Zhuo-Wei Liu; Zhi-Ling Zhang; Yun-Lin Ye; Kai Yao; Hui Han; Zi-Ke Qin; Fang-Jian Zhou

    2013-01-01

    The prognosis of locally advanced or recurrent squamous cell carcinoma (SCC) of the penis after conventional treatment is dismal. This study aimed to evaluate the therapeutic effects of intraarterial chemotherapy with gemcitabine and cisplatin on local y advanced or recurrent SCC of the penis. Between April 1999 and May 2011, we treated 5 patients with locally advanced penile SCC and 7 patients with recurrent disease with intraarterial chemotherapy. The response rate and toxicity data were analyzed, and survival rates were calculated. After 2 to 6 cycles of intraarterial chemotherapy with gemcitabine and cisplatin, 1 patients with locoregional y advanced disease achieved a complete response, and 4 achieved partial response. Of the 7 patients with recurrent disease, 2 achieved complete response, 3 achieved partial response, 3 had stable disease, and 1 developed progressive disease. An objective tumor response was therefore achieved in 10 of the 12 patients. The median overal survival for the patients was 24 months (range, 10-50 months). Three out of 10 patients who responded were long-term survivors after intraarterial chemotherapy. Intraarterial chemotherapy with gemcitabine and cisplatin may be effective and potential y curative in locoregional y advanced or recurrent penile SCC. The contribution of this therapy in the primary management of advanced or recurrent penile SCC should be prospectively investigated.

  4. Pemetrexed/cisplatin as first-line chemotherapy for advanced lung cancer with brain metastases

    Science.gov (United States)

    He, Guangzhao; Xiao, Xiaoguang; Zou, Man; Zhang, Chengliang; Xia, Shu

    2016-01-01

    Abstract Background: Brain metastases (BMs) are a common and serious complication of non-small cell lung cancer (NSCLC). Whole-brain radiotherapy (WBRT), surgery, and molecular targeted therapy are usually used to treat NSCLC with BM. Chemotherapeutic options for BM are limited by tumor resistance, ineffective agents, and the blood–brain barrier. Pemetrexed/cisplatin is the preferred chemotherapy in nonsquamous NSCLC, but the efficacy of this treatment for nonsquamous NSCLC with BM is uncertain. Methods: We present a case of nonsquamous NSCLC with asymptomatic BM presenting with irritating cough and right shoulder back pain (unknown sensitizing epidermal growth factor receptor mutations or anaplastic lymphoma kinase). Results: He benefited from administration of first-line chemotherapy of pemetrexed/cisplatin. Partial remission was achieved in the primary lesion of the lungs and BM lesion. He was further given 3 cycles of pemetrexed monotherapy and WBRT. Complete remission was further achieved in BM lesion. Conclusion: The findings of clinical trials and theoretical studies about the current pemetrexed/cisplatin in the treatment of nonsquamous NSCLC with BM are also summarized to provide a reference for the application of pemetrexed/cisplatin in nonsquamous NSCLC with BM. Whether or not pemetrexed/cisplatin is definitely effective in nonsquamous NSCLC with BM must be proven by subsequent phase III clinical trials. PMID:27512852

  5. Texture analysis for survival prediction of pancreatic ductal adenocarcinoma patients with neoadjuvant chemotherapy

    Science.gov (United States)

    Chakraborty, Jayasree; Langdon-Embry, Liana; Escalon, Joanna G.; Allen, Peter J.; Lowery, Maeve A.; O'Reilly, Eileen M.; Do, Richard K. G.; Simpson, Amber L.

    2016-03-01

    Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in the United States. The five-year survival rate for all stages is approximately 6%, and approximately 2% when presenting with distant disease.1 Only 10-20% of all patients present with resectable disease, but recurrence rates are high with only 5 to 15% remaining free of disease at 5 years. At this time, we are unable to distinguish between resectable PDAC patients with occult metastatic disease from those with potentially curable disease. Early classification of these tumor types may eventually lead to changes in initial management including the use of neoadjuvant chemotherapy or radiation, or in the choice of postoperative adjuvant treatments. Texture analysis is an emerging methodology in oncologic imaging for quantitatively assessing tumor heterogeneity that could potentially aid in the stratification of these patients. The present study derives several texture-based features from CT images of PDAC patients, acquired prior to neoadjuvant chemotherapy, and analyzes their performance, individually as well as in combination, as prognostic markers. A fuzzy minimum redundancy maximum relevance method with leave-one-image-out technique is included to select discriminating features from the set of extracted features. With a naive Bayes classifier, the proposed method predicts the 5-year overall survival of PDAC patients prior to neoadjuvant therapy and achieves the best results in terms of the area under the receiver operating characteristic curve of 0:858 and accuracy of 83:0% with four-fold cross-validation techniques.

  6. Changes in Pathological Complete Response Rates after Neoadjuvant Chemotherapy for Breast Carcinoma over Five Years

    Directory of Open Access Journals (Sweden)

    Daniel C. McFarland

    2016-01-01

    Full Text Available Historically, neoadjuvant chemotherapy (NACT was extrapolated from adjuvant regimens. Dual HER2 blockade and the introduction of carboplatin for triple negative breast cancers (TNBC emerged by December 2013 and have improved pathological complete response (pCR rates. The objective of this study was to assess the pCR rates before and after the introduction of these new neoadjuvant regimens. Materials and Methods. Stage I–III breast cancer patients who received NACT were analyzed for rates of pCR by clinical characteristics (i.e., age, BMI, axillary lymphadenopathy, and histologic subtype, by time period (1 = 3/2010–11/2013, 2 = 12/2013–3/2015, and by type of chemotherapy (e.g., anthracycline/taxane only, carboplatin-containing, and HER2 blockade. Results. 113 patients received NACT. Overall pCR rate was 26.5 percent (n=30. The pCR rate increased from 14% to 43.1% (p=0.001 from time period 1 to time period 2 and were associated with HER2 positivity (p=0.003, receiving treatment during time period 2 (p=0.001 and using an anthracycline/taxane plus additional agent type of regimen (p=0.004. Conclusions. Our study revealed a significant difference in rates of pCR over five years. Window of opportunity trials and other trials that utilize pCR analysis should be encouraged.

  7. Changes in Pathological Complete Response Rates after Neoadjuvant Chemotherapy for Breast Carcinoma over Five Years.

    Science.gov (United States)

    McFarland, Daniel C; Naikan, Jessica; Rozenblit, Mariya; Mandeli, John; Bleiweiss, Ira; Tiersten, Amy

    2016-01-01

    Historically, neoadjuvant chemotherapy (NACT) was extrapolated from adjuvant regimens. Dual HER2 blockade and the introduction of carboplatin for triple negative breast cancers (TNBC) emerged by December 2013 and have improved pathological complete response (pCR) rates. The objective of this study was to assess the pCR rates before and after the introduction of these new neoadjuvant regimens. Materials and Methods. Stage I-III breast cancer patients who received NACT were analyzed for rates of pCR by clinical characteristics (i.e., age, BMI, axillary lymphadenopathy, and histologic subtype), by time period (1 = 3/2010-11/2013, 2 = 12/2013-3/2015), and by type of chemotherapy (e.g., anthracycline/taxane only, carboplatin-containing, and HER2 blockade). Results. 113 patients received NACT. Overall pCR rate was 26.5 percent (n = 30). The pCR rate increased from 14% to 43.1% (p = 0.001) from time period 1 to time period 2 and were associated with HER2 positivity (p = 0.003), receiving treatment during time period 2 (p = 0.001) and using an anthracycline/taxane plus additional agent type of regimen (p = 0.004). Conclusions. Our study revealed a significant difference in rates of pCR over five years. Window of opportunity trials and other trials that utilize pCR analysis should be encouraged. PMID:27382369

  8. Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential {sup 18}F-FDG PET/CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Byung Hyun; Lim, Ilhan; Kim, Byung Il; Choi, Chang Woon [Korea Institute of Radiological and Medical Sciences (KIRAMS), Departments of Nuclear Medicine, Seoul (Korea, Republic of); Kong, Chang-Bae [Korea Institute of Radiological and Medical Sciences (KIRAMS), Orthopedic Surgery, Seoul (Korea, Republic of); Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Department of Orthopedic Surgery, Seoul (Korea, Republic of); Song, Won Seok; Cho, Wan Hyeong; Jeon, Dae-Geun; Lee, Soo-Yong [Korea Institute of Radiological and Medical Sciences (KIRAMS), Orthopedic Surgery, Seoul (Korea, Republic of); Koh, Jae-Soo [Korea Institute of Radiological and Medical Sciences (KIRAMS), Pathology, Korea Cancer Center Hospital, Seoul (Korea, Republic of); Lim, Sang Moo [Korea Institute of Radiological and Medical Sciences (KIRAMS), Departments of Nuclear Medicine, Seoul (Korea, Republic of); Korea Institute of Radiological and Medical Sciences (KIRAMS), Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2014-08-15

    We evaluated the potential of sequential fluorine-18 fluorodeoxyglucose ({sup 18}F-FDG) positron emission tomography (PET)/computed tomography (CT) and MRI (PET/MRI) after one cycle of neoadjuvant chemotherapy to predict a poor histologic response in osteosarcoma. A prospective study was conducted on 30 patients with osteosarcoma treated with two cycles of neoadjuvant chemotherapy and surgery. All patients underwent PET/MRI before, after one cycle, and after the completion of neoadjuvant chemotherapy, respectively. Imaging parameters [maximum standardized uptake value (SUV{sub max}), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor volume based on magnetic resonance (MR) images (MRV)] and their % changes were calculated on each PET/MRI data set, and histological responses were evaluated on the postsurgical specimen. A total of 17 patients (57 %) exhibited a poor histologic response after two cycles of chemotherapy. Unlike the little volumetric change in MRI, PET parameters significantly decreased after one and two cycles of chemotherapy, respectively. After one cycle of chemotherapy, SUV{sub max}, MTV, and TLG predicted the poor responders. Among these parameters, either MTV ≥ 47 mL or TLG ≥ 190 g after one cycle of chemotherapy was significantly associated with a poor histologic response on multivariate logistic regression analysis (OR 8.98,p = 0.039). The sensitivity, specificity, and accuracy of these parameters were 71 %, 85 % and 77 %; and 71 %, 85 % and 77 %, respectively. The histologic response to neoadjuvant chemotherapy in osteosarcoma can be predicted accurately by FDG PET after one course of chemotherapy. Among PET parameters, MTV and TLG were independent predictors of the histologic response. (orig.)

  9. Computer-Aided Evaluation of Breast MRI for the Residual Tumor Extent and Response Monitoring in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

    OpenAIRE

    Lyou, Chae Yeon; Cho, Nariya; Kim, Sun Mi; Jang, Mijung; Park, Jeong-Seon; Baek, Seung Yon; Moon, Woo Kyung

    2011-01-01

    Objective To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Materials and Methods Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after compl...

  10. Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Roberto; Biffi; Nicola; Fazio; Fabrizio; Luca; Antonio; Chiappa; Bruno; Andreoni; Maria; Giulia; Zampino; Arnaud; Roth; Jan; Christian; Schuller; Giancarla; Fiori; Franco; Orsi; Guido; Bonomo; Cristiano; Crosta; Olivier; Huber

    2010-01-01

    AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.METHODS:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and flu...

  11. Pathological predictive factors for tumor response in locally advanced breast carcinomas treated with anthracyclin-based neoadjuvant chemotherapy

    OpenAIRE

    Trupti Patel; Anuja Gupta; Manoj Shah

    2013-01-01

    Aim: Neoadjuvant chemotherapy (NACT) is used as a primary treatment for locally advanced breast carcinoma (LABC) and also extended to operable breast cancer. The aim of this study was to evaluate the predictive value of different histological parameters in core biopsy of LABC patients treated with anthracycline-based chemotherapy regimen. Pathological assessment of the excised tumor bed is the gold standard and is essential for identifying the group of patients with pathologic complete respon...

  12. Role of p-glycoprotein expression in predicting response to neoadjuvant chemotherapy in breast cancer-a prospective clinical study

    OpenAIRE

    Bhatia Ashima; Bansal Anju; Saxena Sunita; Mittal Mahesh K; Singh Jai; Chintamani,; Kulshreshtha Pranjal

    2005-01-01

    Abstract Background Neoadjuvant chemotherapy (NACT) is an integral part of multi-modality approach in the management of locally advanced breast cancer. It is vital to predict response to chemotherapy in order to tailor the regime for a particular patient. The prediction would help in avoiding the toxicity induced by an ineffective chemotherapeutic regime in a non-responder and would also help in the planning of an alternate regime. Development of resistance to chemotherapeutic agents is a maj...

  13. Clinical value of hematologic test in predicting tumor response to neoadjuvant chemotherapy with esophageal squamous cell carcinoma

    OpenAIRE

    Liu, Yinan; Chen, Jinfeng; Shao, Ningsheng; Feng, Yuan; Wang, Yuzhao; Zhang, Lijian

    2014-01-01

    Background To investigate the relationship between hematologic test results and the predictive effect of regression of esophageal cancer after neoadjuvant chemotherapy (NACT), we analyzed pre-NACT hematologic data and their relationship to tumor regression. Methods Thirty-eight consecutive patients with locally advanced squamous cell esophageal carcinoma who had undergone two cycles of paclitaxel/carboplatin NACT were enrolled. On the day prior to the first cycle of chemotherapy, hematologic ...

  14. Neoadjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: Defining high-risk patients who may benefit before concurrent chemotherapy combined with intensity-modulated radiotherapy

    OpenAIRE

    Xiao-Jing Du; Ling-Long Tang; Lei Chen; Yan-Ping Mao; Rui Guo; Xu Liu; Ying Sun; Mu-Sheng Zeng; Tie-Bang Kang; Jian-Yong Shao; Ai-Hua Lin; Jun Ma

    2015-01-01

    The purpose of this study was to create a prognostic model for distant metastasis in patients with locally advanced NPC who accept concurrent chemotherapy combined with intensity-modulated radiotherapy (CCRT) to identify high-risk patients who may benefit from neoadjuvant chemotherapy (NACT). A total of 881 patients with newly-diagnosed, non-disseminated, biopsy-proven locoregionally advanced NPC were retrospectively reviewed; 411 (46.7%) accepted CCRT and 470 (53.3%) accepted NACT followed b...

  15. Effect of preoperative rescue concomitant FUN/XUN-based chemo-radiotherapy for neoadjuvant chemotherapy-refractory breast cancer

    International Nuclear Information System (INIS)

    Even though tumor progression under neoadjuvant chemotherapy is uncommon, its locoregional management remains absolutely unclear. What is the best time for radical surgery or radiotherapy? “Rescue” chemo-radiotherapy could be a suitable radiosensitizing strategy to further reduce tumor progression and allow curative surgery while maintaining systemic therapy.

  16. Clinical application of FDG PET for pathological response of breast cancer after neo-adjuvant chemotherapy

    International Nuclear Information System (INIS)

    The purpose of this study was to assess the clinical usefulness of FDG PET in predicting the pathological response in breast cancer after neoadjuvant chemotherapy. 33 patients with newly diagnosed, locally advanced breast cancer had PET scans before and after chemotherapy to assess tumor response, and then pathology was confirmed after surgery. FDG PET for assessing tumor response was done by measuring peak SUV (pSUV) and then calculating reduction rate (RR). RR was stratified into RR complete response (rrCR) at >88% reduction, RR partial response (rrPR) at RR between 56∼87%, and no response (rrNR) in reductions <55%. Clinical assessment was done with physical exams, U/S, and CT. Histopathological response were classified into pathological no response(pNR), pathological partial response (pPR) and pathological complete response (pCR). 15% (5 of 33) patients had pCR, 85% (28 of 33) had pPR. Using a 88% reduction in SUV as a threshold value for differentiation between pCR from pPR, PET scans correctly differentiated pCR in 3 patients out of 5. When using a cut off value of 55% reduction rate, PET scans correctly differentiated pPR in 19 patients out of 21, and for pNR, the PET scans correctly differentiated only 2 patients out of 7. Diagnostic accuracy of PET for pathologic response was 25 out of 33 cases (75.8%). The diagnostic accuracy of clinical assessment was 25 of 33 cases (72.7%). This study suggests that pSUV reduction rate can be a useful tool when predicting the pathological response of primary breast cancers after neo-adjuvant chemotherapy

  17. Using diffuse optical tomograpy to monitor tumor response to neoadjuvant chemotherapy in breast cancer patients

    Science.gov (United States)

    Gunther, Jacqueline E.; Lim, Emerson; Kim, Hyun Keol; Flexman, Molly; Brown, Mindy; Refrice, Susan; Kalinsky, Kevin; Hershman, Dawn; Hielscher, Andreas H.

    2013-03-01

    Breast cancer patients often undergo neoadjuvant chemotherapy to reduce the size of the tumor before surgery. Tumors which demonstrate a pathologic complete response associate with improved disease-free survival; however, as low as 10% of patients may achieve this status. The goal is to predict response to anti-cancer therapy early, so as to develop personalized treatments and optimize the patient's results. Previous studies have shown that tumor response can be predicted within a few days of treatment initiation. We have developed a diffuse optical tomography (DOT) imaging system for monitoring the response of breast cancer patients to neoadjuvant chemotherapy. Our breast imaging system is a continuous wave system that uses four wavelengths in the near-infrared spectrum (765 nm, 808 nm, 827 nm, and 905 nm). Both breasts are imaged simultaneously with a total of 64 sources and 128 detectors. Three dimensional reconstructions for oxy-hemoglobin concentration ([HbO2]), deoxy-hemoglobin ([Hb]) concentrations, and water are performed using a PDE-constrained multispectral imaging method that uses the diffusion approximation as a model for light propagation. Each patient receives twelve weekly treatments of Taxane followed by four cycles of Doxorubicin and Cyclophosphamide (AC) given every other week. There are six DOT imaging time points: baseline, week 3 and 5 of Paclitaxel, before cycle 1 and 2 of AC, and before surgery. Preliminary results show that there is statistical significance for the percent change of [HbO2], [Hb], [HbT], and percent water at week 2 from the baseline between patients with a pathologic response to chemotherapy.

  18. Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a Prospective Phase I trial

    Directory of Open Access Journals (Sweden)

    El-Sayed Mohamed I

    2010-08-01

    Full Text Available Abstract Background Neoadjuvant chemotherapy is the standard care for locally advanced breast cancer. Our study aimed at evaluating the feasibility of breast conversation surgery (BCS after neoadjuvant chemotherapy. Patients and methods Forty five patients had stage IIB (except those with T2N1 disease and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤5 cm underwent a tentative BCS while patients who had tumour size >5 cm underwent radical surgery. Negative margin is essential for BCS. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients. Results Thirty four patients had BCS. Response to chemotherapy was the only statistically significant factor which influences the BCS. Incidence of local recurrence was 5.9% for patients who had BCS at a median follow up 24 months. Conclusion Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤4 cm after chemotherapy are the best candidates for BCS.

  19. Intravenous or oral administration of vinorelbine in adjuvant chemotherapy with cisplatin and vinorelbine for resected NSCLC

    DEFF Research Database (Denmark)

    Sorensen, Steffen Filskov; Carus, Andreas; Meldgaard, Peter

    2015-01-01

    OBJECTIVES: Cisplatin and vinorelbine given intravenously is a well-established adjuvant chemotherapy regimen after surgery for early-stage NSCLC. Vinorelbine can also be administered orally. However, the efficacy of orally administrated vinorelbine in adjuvant treatment of NSCLC is unknown. We a...... conclusion we observed that intravenous or oral administration of vinorelbine in combination with cisplatin after surgery for NSCLC appear equally effective in terms of overall and disease-free survival.......OBJECTIVES: Cisplatin and vinorelbine given intravenously is a well-established adjuvant chemotherapy regimen after surgery for early-stage NSCLC. Vinorelbine can also be administered orally. However, the efficacy of orally administrated vinorelbine in adjuvant treatment of NSCLC is unknown. We...... assessed the overall survival (OS) and disease-free survival (DFS) of patients treated with adjuvant i.v. vinorelbine or p.o. vinorelbine, in combination with i.v. cisplatin. MATERIALS AND METHODS: We reviewed two time-separated cohorts of patients referred to the Department of Oncology at Aarhus...

  20. Efficacy and safety of neoadjuvant chemotherapy with modified FOLFOX7 regimen on the treatment of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jun; CHEN Ren-xiong; ZHANG Jing; CAI Jun; MENG Hua; WU Guo-cong; ZHANG Zhong-tao; WANG Yu; WANG Kang-li

    2012-01-01

    Background Gastric cancer is one of the most common types of malignant tumors in China and East Asia and has the highest mortality rate of the malignant gastrointestinal tumors.Neoadjuvant chemotherapy is a systemic or local chemotherapy that is given prior to the local treatment of malignant tumors.Neoadjuvant therapy is currently showing some positive prospects; however,its clinical effects remain controversial.In this study,we used the modified FOLFO×7 (mFOLFO×7) regimen as a neoadjuvant chemotherapy regimen.Perioperative clinical and pathological efficacy,toxicity,effects of surgery,postoperative observation,and prognosis were studied to investigate its clinical efficacy and safety.Methods Eighty patients with advanced gastric cancer were treated in our surgery department from 2005 to 2009; 38 of these patients received mFOLFO×7 neoadjuvant chemotherapy,the other 42 patients assigned to the control group.The perioperative effects of mFOLFO×7 chemotherapy,including clinical effects and toxicity,were observed in each patient.Results After mFOLFO×7 chemotherapy,clinical and pathologic stages decreased in 21.1% and 36.8% of the patients,respectively,but the results were not statistically significant (P=0.129).The clinical response rate was 50% (19/38).Toxicity was mild; most adverse events were grade I or ll and involved no severe infections or deaths.Compared with the control group,the radical resection rate increased (92.1% vs.85.7%; P=0.437); surgical effects were completed without an increased incidence of perioperative complications.The 1-,2-,and 3-year survival rates were 78.70%,57.40%,and 51.66%,respectively,in the neoadjuvant chemotherapy group and 78.57%,56.87%,and 43.16%,respectively,in the control group.Conclusions The mFOLFO×7 regimen was very effective and well-tolerated as a neoadjuvant chemotherapy for advanced gastric cancer.However,the 1-,2-,and 3-year survival rates in the mFOLFO×7 group were not significantly

  1. Intra-Arterial Chemotherapy with Doxorubicin and Cisplatin Is Effective for Advanced Hepatocellular Cell Carcinoma

    OpenAIRE

    Ming-Chun Ma; Yen-Yang Chen; Shau-Hsuan Li; Yu-Fan Cheng; Chih-Chi Wang; Tai-Jan Chiu; Sung-Nan Pei; Chien-Ting Liu; Tai-Lin Huang; Chen-Hua Huang; Yu-Li Su; Yen-Hao Chen; Sheng-Nan Lu; Kun-Ming Rau

    2014-01-01

    Advanced hepatocellular carcinoma (HCC) remains a fatal disease even in the era of targeted therapies. Intra-arterial chemotherapy (IACT) can provide therapeutic benefits for patients with locally advanced HCC who are not eligible for local therapies or are refractory to targeted therapies. The aim of this retrospective study was to analyze the effect of IACT with cisplatin and doxorubicin on advanced HCC. Methods. Patients with advanced HCC who were not eligible for local therapies or were r...

  2. Effect of Neoadjuvant Chemotherapy on Improvement of Surgical Resectibility and Survival of Patients with Stage ⅢA Non Small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    LIJian; YULichao; 等

    2002-01-01

    Ojbective To assess the effect of neoadjuvant chemotherapy on surgical resectibility and survival in patients with stage ⅢA non small cell lung cancer(NSCLC).Methods 42 patients with stage ⅢA NSCLC were randomized to receive either two cycles chemotherapy followed by surgery(neoadjuvant chemotherapy group)or surgery alone(surgery alone group).All patients received four cycles chemotherapy after surgery.Results The overall response to chemotherapy was 42.9%(38.1% partial response and 4.8% complete response).Toxicity of chemotherapy was minor and consisted mainly of gastroenterological side effects and myelosuppression.Patients treated with neoadjuvant chemotherapy had estimated surgical resection rate of 95.2%(n=20)and a complete resection rate in 52.4%(n=11) compared to 66.7%(n=14)and 28.6%(n=6)respectively,for patients with surgery alone(P<0.05).None of the patients died from the operation.The median survival was 24.6 months in the neoadjuvant chemotherapy group as compared to only 10.8 months in the surgery alone group(P<0.05).The 2-year survival rate was 57.1% in the chemotherapy group as compared to 28.6% in the surgery alone group(P<0.05).Conclusion Neoadjuvant chemotherapy improves the surgical resectibility and increases the median survival and 2-year survival rate of patients with stage ⅢA NSCLC.

  3. Neoadjuvant chemotherapy in 13 patients with locally advanced poorly differentiated thyroid carcinoma based on Turin proposal - a single institution experience

    International Nuclear Information System (INIS)

    There is a paradigm that chemotherapy is ineffective in thyroid carcinoma. The aim of our study was to find out whether neoadjuvant chemotherapy before thyroid surgery had an effect on the size of primary tumour in patients with poorly differentiated thyroid carcinoma (PDTC) based on Turin proposal. Altogether, 13 patients (8 women, 5 men; median age 61 years) with PDTC based on Turin proposal were treated with neoadjuvant chemotherapy between 1986 and 2005. Tumour diameter was from 4.5 to 18 cm (median 9 cm). Regional and distant metastases were detected in 6 and 9 patients, respectively. Eight patients had pT4 tumour. Altogether, 29 (range 1–5) cycles of chemotherapy were given. Tumour diameter decreased in all the patients and by more than 30% in 5 patients (= 38%). Two of these five patients had also preoperative external beam irradiation (EBRT). Total thyroidectomy, lobectomy and neck dissection were performed in 10, 3 and 5 cases, respectively. R0 and R1 resection was done in 5 and 8 cases, respectively. Eight patients had postoperative EBRT of the neck and upper mediastinum. The 5-year and 10-year cause-specific survival rates of patients were 66% and 20%, respectively. After neoadjuvant chemotherapy a partial tumour regression was observed in 38% of patients with PDTC based on Turin proposal

  4. Neoadjuvant plus adjuvant chemotherapy benefits overall survival of locally advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Xin-Zu Chen; Kun Yang; Jie Liu; Xiao-Long Chen; Jian-Kun Hu

    2011-01-01

    Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.

  5. IMPACT OF SEQUENTIAL NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER: A SERIES OF 10 CASES

    Directory of Open Access Journals (Sweden)

    Gopa

    2014-04-01

    Full Text Available Breast cancer currently is a major health problem among women worldwide accounting for around 13.7% cancer deaths, nearly 1/3rd of it being due to Locally advanced breast cancer (LABC. Despite progress achieved in diagnosis & therapy of Breast cancer, LABC remains a major clinical challenge and in efforts to increase pCR, CCR & DFS in LABC, Neoadjuvant or primary chemotherapy followed by locoregional therapy and adjuvant systemic CT is well accepted treatment strategy since last 3 decades. Further to address the issue of drug resistance in NACT sequential anthracycline-taxane NACT has been evaluated by many researchers and has resulted in better outcome in terms of overall survival and pCR. In this study we have evaluated 4 cycles of sequential anthracycline-taxane, 2 cycles of Cyclophosphamide, Epirubicin, Fluracil +2 cycles of Docetaxel, Epirubicin (CEF- DE NACT in a series of 10 cases of ER/PR +ve, Her -2 neu negative patients of LABC. 9/10 cases were rendered operable after primary chemotherapy and were subjected to further 4 cycles of adjuvant chemotherapy (1 cycle CEF, 1 cycle DE, 2cycles single agent Docetaxel, followed by locoregional RT. This tailored sequential NACT protocol in our subgroup of patient was well tolerated, well accepted and resulted in substantial increase in operability with CCR & DFS in 6/10 cases on 3 years follow up and pCR in one patient. Sequential NACT needs further validation by more RCT with extensive follow up

  6. Early identification of non-responding locally advanced breast tumors receiving neoadjuvant chemotherapy

    Science.gov (United States)

    Van de Giessen, Martijn; Schaafsma, Boudewijn E.; Charehbili, Ayoub; Smit, Vincent T. H. B. M.; Kroep, Judith R.; Lelieveldt, Boudewijn P. F.; Liefers, Gerrit-Jan; Chan, Alan; Löwik, Clemens W. G. M.; Dijkstra, Jouke; van de Velde, Cornelis J. H.; Wasser, Martin N. J. M.; Vahrmeijer, Alexander L.

    2015-02-01

    Diffuse optical spectroscopy (DOS) may be advantageous for monitoring tumor response during chemotherapy treatment, particularly in the early treatment stages. In this paper we perform a second analysis on the data of a clinical trial with 25 breast cancer patients that received neoadjuvant chemotherapy. Patients were monitored using delayed contrast enhanced MRI and additionally with diffuse optical spectroscopy at baseline, after 1 cycle of chemotherapy, halfway therapy and before surgery. In this analysis hemoglobin content between tumor tissue and healthy tissue of the same breast is compared on all four monitoring time points. Furthermore, the predictive power of the tumor-healthy tissue difference of HbO2 for non-responder prediction is assessed. The difference in HbO2 content between tumor and healthy tissue was statistically significantly higher in responding tumors than in non-responding tumors at baseline (10.88 vs -0.57 μM, P=0.014) and after one cycle of chemotherapy (6.45 vs -1.31 μM, P=0.048). Before surgery this difference had diminished. In the data of this study, classification on the HbO2 difference between tumor and healthy tissue was able to predict tumor (non-)response at baseline and after 1 cycle with an area-under-curve of 0.95 and 0.88, respectively. While this result suggests that tumor response can be predicted before chemotherapy onset, one should be very careful with interpreting these results. A larger patient population is needed to confirm this finding.

  7. A wearable optical device for continuous monitoring during neoadjuvant chemotherapy infusions

    Science.gov (United States)

    Teng, Fei; Cormier, Timothy; Sauer-Budge, Alexis; Roblyer, Darren M.

    2016-03-01

    We present a new continuous-wave (CW) wearable diffuse optical device aimed at investigating the hemodynamic response of locally advanced breast cancer patients during a patient's first neoadjuvant chemotherapy infusion. The system consists of a flexible substrate that supports an array of surface-mount LED and photodiode pairs (i.e. optodes). Probe performance was evaluated using solid tissue-simulating phantoms. Measurements revealed high SNR (65dB), low source-detector crosstalk (-59 dB), high measurement precision (0.17%), and good thermal stability (0.2% Vrms/°C). A cuff occlusion experiment was performed on the forearm of a healthy volunteer to demonstrate the ability to track rapid hemodynamic changes.

  8. Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients?

    DEFF Research Database (Denmark)

    Fagö-Olsen, Carsten Lindberg; Ottesen, Bent Smedegaard; Kehlet, Henrik;

    2014-01-01

    OBJECTIVE: In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS). METHODS...... patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT-IDS had shorter operation times, less blood loss, less...... extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT-IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had...

  9. Role of Postmastectomy Radiation After Neoadjuvant Chemotherapy in Stage II-III Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To identify a cohort of women treated with neoadjuvant chemotherapy and mastectomy for whom postmastectomy radiation therapy (PMRT) may be omitted according to the projected risk of local-regional failure (LRF). Methods and Materials: Seven breast cancer physicians from University of California cancer centers created 14 hypothetical clinical case scenarios, identified, reviewed, and abstracted the available literature (MEDLINE and Cochrane databases), and formulated evidence tables with endpoints of LRF, disease-free survival, and overall survival. Using the American College of Radiology appropriateness criteria methodology, appropriateness ratings for postmastectomy radiation were assigned for each scenario. Finally, an overall summary risk assessment table was developed. Results: Of 24 sources identified, 23 were retrospective studies from single institutions. Consensus on the appropriateness rating, defined as 80% agreement in a category, was achieved for 86% of the cases. Distinct LRF risk categories emerged. Clinical stage II (T1-2N0-1) patients, aged >40 years, estrogen receptor-positive subtype, with pathologic complete response or 0-3 positive nodes without lymphovascular invasion or extracapsular extension, were identified as having ≤10% risk of LRF without radiation. Limited data support stage IIIA patients with pathologic complete response as being low risk. Conclusions: In the absence of randomized trial results, existing data can be used to guide the use of PMRT in the neoadjuvant chemotherapy setting. Using available studies to inform appropriateness ratings for clinical scenarios, we found a high concordance of treatment recommendations for PMRT and were able to identify a cohort of women with a low risk of LRF without radiation. These low-risk patients will form the basis for future planned studies within University of California Athena Breast Health Network.

  10. Application of MR imaging to evaluation of neoadjuvant chemotherapy of breast cancer

    International Nuclear Information System (INIS)

    Objective: To investigate the advantage of magnetic resonance imaging (MRI) in evaluating the feasibility of neoadjuvant chemotherapy (NCT) for breast cancer. Methods: Seventy-six breast cancer patients were imaged with MRI before and after the neoadjuvant chemotherapy during less than three months. The maximum lesion diameter was about 10-92 mm. The MRI indexes of each lesion were compared respectively. Results: After NCT, the lesion's apparent diffusion coefficients (ADC) value was reduced from (0.94±0.18)×10-3 mm2/s to (1.16±0.30)×10-3 mm2/s, and the difference was statistically significant (S=1074.5, P<0.0001). Time-signal intensity curve (TIC) types shifted from type Ⅲ to type Ⅰ, and the difference was statistically significant (Hc=47.1845, P<0.0001). The diagnostic accuracy of the maximum diameter of lesions was 94.7% , and the diagnostic accuracy of the two different function indexes, TIC and ADC, was 81.6% and 76.3% , respectively. The diagnostic accuracy of the integrated function index was 89.5% , which had no significant difference from the diagnostic accuracy of the size (χ2=0.8143, P=0.3669>0.05) and was higher than the value of the diagnostic accuracy of ACD. Conclusion: After breast cancer patients receive NCT, lesions shrink. TIC changes from type Ⅲ and type Ⅰ and ADC is increased (P<0.05). In most cases, the change in the maximum diameter of lesions might represent the change in size in the evaluation of effects of NCT. Integrated functional indexes are better than an individual indicator in that they are close to the assessment accuracy of the maximum diameter of lesions. (authors)

  11. Combination of survivin siRNA with neoadjuvant chemotherapy enhances apoptosis and reverses drug resistance in breast cancer MCF-7 cells

    Directory of Open Access Journals (Sweden)

    Honglin Dong

    2015-01-01

    Conclusion: Survivin siRNA combined with the neoadjuvant chemotherapy can significantly enhance the sensitivity of MCF-7 cells to chemotherapeutics and cell apoptosis. This technology has important potential value in the therapeutic study of breast cancer.

  12. Sequential FDG-PET and induction chemotherapy in locally advanced adenocarcinoma of the Oesophago-gastric junction (AEG: The Heidelberg Imaging program in Cancer of the oesophago-gastric junction during Neoadjuvant treatment: HICON trial

    Directory of Open Access Journals (Sweden)

    Weichert Wilko

    2011-06-01

    Full Text Available Abstract Background 18-Fluorodeoxyglucose-PET (18F-FDG-PET can be used for early response assessment in patients with locally advanced adenocarcinomas of the oesophagogastric junction (AEG undergoing neoadjuvant chemotherapy. It has been recently shown in the MUNICON trials that response-guided treatment algorithms based on early changes of the FDG tumor uptake detected by PET are feasible and that they can be implemented into clinical practice. Only 40%-50% of the patients respond metabolically to therapy. As metabolic non-response is known to be associated with a dismal prognosis, metabolic non-responders are increasingly treated with alternative neoadjuvant chemotherapies or chemoradiation in order to improve their clinical outcome. We plan to investigate whether PET can be used as response assessment during radiochemotherapy given as salvage treatment in early metabolic non-responders to standard chemotherapy. Methods/Design The HICON trial is a prospective, non-randomized, explorative imaging study evaluating the value of PET as a predictor of histopathological response in metabolic non-responders. Patients with resectable AEG type I and II according to Siewerts classification, staged cT3/4 and/or cN+ and cM0 by endoscopic ultrasound, spiral CT or MRI and FDG-PET are eligible. Tumors must be potentially R0 resectable and must have a sufficient FDG-baseline uptake. Only metabolic non-responders, showing a 18FDG-PET scans will be performed before ( = Baseline and after 14 days of standard neoadjuvant therapy as well as after the first cycle of salvage docetaxel/cisplatin chemotherapy (PET 1 and at the end of radiochemotherapy (PET2. Tracer uptake will be assessed semiquantitatively using standardized uptake values (SUV. The percentage difference ΔSUV = 100 (SUVBaseline - SUV PET1/SUVBaseline will be calculated and assessed as an early predictor of histopathological response. In a secondary analysis, the association between the difference

  13. Non-randomized clinical study comparing chemotherapy plus radiotherapy with radiotherapy alone in neoadjuvant therapy for oral cancer

    International Nuclear Information System (INIS)

    Neoadjuvant therapy plays an important role for organ preservation and survival rate in the treatment of oral cancer. We clinically compared the effect of neoadjuvant radiotherapy and chemoradiotherapy in patients with oral cancer. We retrospectively examined 47 patients diagnosed with oral squamous cell carcinoma who underwent neoadjuvant therapy followed by curative surgery in the oral and maxillofacial surgery department of Ehime University Hospital. We divided them into two groups: radiotherapy alone (24 cases) and chemoradiotherapy (23 cases). The patients in the radiotherapy group underwent irradiation of 32.6±5.0 Gy (mean ±SD). The patients in the chemoradiotherapy group received a low-dose fraction of cisplatin (8 mg/mm2/day, 5 days a week; total dose: 139.4±67.1 mg) and 5-fluorouracil (300 mg/mm2/day, 5 days a week; total dose: 5,900±1,839.8 mg) combined with simultaneous irradiation of 31.0±3.2 Gy. None of the 24 patients had a complete response to radiotherapy alone and 12 (50%) had a partial response. Six (26%) of the 23 patients had a complete response to chemoradiotherapy and 12 (52%) had a partial response. The primary control rate (82.6%) to chemoradiotherapy was higher than that (67.5%) to radiotherapy alone although no significant difference was found. The 5-year survival rate was 64.3% in the radiotherapy group and 62.8% in the chemoradiotherapy group. The findings of the present study suggest that while the combination of radiation and cisplatin/5-fluorouracil in neoadjuvant therapy for oral cancer may not bring a significant benefit to improve survival rate, the primary local control rate is improved in comparison with radiotherapy alone. (author)

  14. Neoadjuvant chemotherapy for radioinduced osteosarcoma of the extremity: The Rizzoli experience in 20 cases

    International Nuclear Information System (INIS)

    Purpose: Evaluate treatment and outcome of 20 patients with radioinduced osteosarcoma (RIO). Because of previous primary tumor treatment, RIO protocols were different from others we used for non-RIO. Patients and Methods: Between 1983 and 1998, we treated 20 RIO patients, ages 4-36 years (mean 16 years), with chemotherapy (two cycles before surgery, three postoperatively). The first preoperative cycle consisted of high-dose Methotrexate (HDMTX)/Cisplatinum (CDP)/Adriamycin (ADM) and the second of HDMTX/CDP/Ifosfamide (IFO). The three postoperative treatments were performed with cycles of MTX/CDP; IFO was used as single agent per cycle repeated three times. Results: Two patients received palliative treatment because their osteosarcoma remained unresectable after preoperative chemotherapy. The remaining 18 patients had surgery (7 amputations, 11 resections); histologic response to preoperative chemotherapy was good in 8 patients, poor in 10. At a mean follow-up of 11 years (range, 7-22 years), 9 patients remained continuously disease-free, 10 died from osteosarcoma and 1 died from a third neoplasm (myeloid acute leukemia). These results are not significantly different from those achieved in 754 patients with conventional osteosarcoma treated in the same period with protocols used for conventional treatment. However, this later group had an 18% 3-year event-free survival after treatment of relapse vs. 0% in the RIO group. Conclusion: Treated with neoadjuvant chemotherapy RIO seem to have an outcome that is not significantly different from that of comparable patients with conventional primary high grade osteosarcoma (5-year event-free survival: 40% vs. 60%, p = NS; 5-year overall survival 40% vs. 67%, p < 0.01)

  15. Pathological complete response in breast cancer patients following neoadjuvant chemotherapy at a Comprehensive Cancer Center: The natural history of an elusive prognosticator

    OpenAIRE

    Fayanju, Oluwadamilola M.; NWAOGU, IHEOMA; Jeffe, Donna B.; Margenthaler, Julie A

    2015-01-01

    Given the prognostic significance of pathological complete response (pCR) to neoadjuvant chemotherapy, we sought to chronicle the clinical course of breast cancer patients whose tumors exhibited pCR at our institution. We retrospectively reviewed 5,533 cancer center patients treated for a first primary breast cancer between March, 1999 and September, 2010 to identify those who received neoadjuvant chemotherapy that resulted in pCR (i.e., no residual invasive malignancy in the breast or axilla...

  16. Clinical efficacy and safety of paclitaxel plus carboplatin as neoadjuvant chemotherapy prior to radical hysterectomy and pelvic lymphadenectomy for Stage IB2-IIB cervical cancer

    OpenAIRE

    Yang, Lu; Guo, Jianfeng; Shen, Yi; Cai, Jing; Xiong, Zhoufang; Dong, Weihong; Min, Jie; Wang, Zehua

    2015-01-01

    Objective: To assess the efficacy and toxicity of the combination of paclitaxel plus carboplatin as neoadjuvant chemotherapy (NACT) for locally advanced cervical cancer (LACC) prior to radical hysterectomy and pelvic lymphadenectomy. Methods: We reviewed patients with cervical cancer of the International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin followed by radical hysterectomy (NACT group) or on...

  17. Increased treatment-related mortality with additional cisplatin-based chemotherapy in patients with nasopharyngeal carcinoma treated with standard radiotherapy

    International Nuclear Information System (INIS)

    Background and purposes: We performed a meta-analysis of randomized controlled trials (RCTs) to determine the overall risk of treatment-related death associated with additional cisplatin-based chemotherapy in patients with nasopharyngeal carcinoma treated with standard radiotherapy. Material and methods: Eligible studies included RCTs in which cisplatin-based chemotherapy in combination with radiotherapy was compared with radiotherapy alone. Statistical analyses were conducted to calculate the summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) using fixed- or random-effects models based on the heterogeneity of included studies. Results: A total of 2829 patients from 13 RCTs were included in this study. The overall incidence for treatment-related death in chemoradiotherapy and radiotherapy treated patients was 1.7% and 0.8%. Compared to radiotherapy alone, radiotherapy plus cisplatin-based chemotherapy significantly increased the risk of treatment-related mortality. On subgroup analyses, no difference was found in treatment-related mortality between different timings of chemotherapy and chemotherapeutic agents. Adding cisplatin-based chemotherapy was associated with higher incidences of severe acute toxicity. Conclusions: Cisplatin-based chemotherapy plus radiotherapy increased the risk of treatment-related death and severe acute toxicity, compared with radiotherapy alone. Better management of treatment toxicity might improve the therapeutic gain in patients with nasopharyngeal carcinoma.

  18. Emmprin and survivin predict response and survival following cisplatin-containing chemotherapy in patients with advanced bladder cancer

    DEFF Research Database (Denmark)

    Als, Anne B; Dyrskjøt, Lars; von der Maase, Hans;

    2007-01-01

    and survival. EXPERIMENTAL DESIGN: Affymetrix GeneChip expression profiling was carried out using tumor material from 30 patients. A set of genes with an expression highly correlated to survival time after chemotherapy was identified. Two genes were selected for validation by immunohistochemistry in...... strong independent prognostic factors for response and survival after cisplatin-containing chemotherapy in patients with advanced bladder cancer.......PURPOSE: Cisplatin-containing chemotherapy is the standard of care for patients with locally advanced and metastatic transitional cell carcinoma of the urothelium. The response rate is approximately 50% and tumor-derived molecular prognostic markers are desirable for improved estimation of response...

  19. Monitoring breast masses with ultrasound tomography in patients undergoing neoadjuvant chemotherapy

    Science.gov (United States)

    Lupinacci, Jessica; Duric, Neb; Littrup, Peter; Wang, Ding; Li, Cuiping; Schmidt, Steven; Rama, Olsi; Bey-Knight, Lisa; Myc, Lukasz

    2009-02-01

    As part of an ongoing assessment of the in-vivo performance of a operator independent breast imaging device, based on acoustic tomography, we report on new results obtained with patients undergoing neoadjuvant chemotherapy. Five patients were examined with the prototype on multiple occasions corresponding in time to their chemotherapy sessions. Images of reflection, sound speed and attenuation, representing the entire volume of the breast, were reconstructed from the exam data and analyzed for time-dependent changes during the treatment period. It was found that changes in acoustic properties of the tumors could be measured directly from the images. The measured properties include reflectivity, sound speed and attenuation, leading to measurable changes in the volume, shape and internal attributes of the tumors. These measurements were used to monitor the response of the tumors to the therapy with the long term goal of correlating results with pathological and clinical outcomes. Comparisons with tumor size changes based on traditional US and MRI indicates potential for accurate, quantifiable tracking of tumor volume. Furthermore, our tentative results also show declines in internal properties of the tumors, possibly relating to a reduction in tissue stiffness and/or density. Future work will include an expansion of the study to a larger cohort of patients for determining the statistical significance of our findings.

  20. P-glycoprotein expression as a predictor of response to neoadjuvant chemotherapy in breast cancer

    Directory of Open Access Journals (Sweden)

    S Vishnukumar

    2013-01-01

    Full Text Available Background: Chemoresistance is an important factor determining the response of tumor to neoadjuvant chemotherapy (NACT. P-glycoprotein (P-gp expression-mediated drug efflux is one of the mechanisms responsible for multi-drug resistance. Our study was aimed to determine the role of P-gp expression as a predictor of response to NACT in locally advanced breast cancer (LABC patients. Materials and Methods: P-gp expression was performed by real-time quantitative polymerase chain reaction [qRT-PCR] in 76 patients with LABC. Response to adriamycin-based regimen was assessed both clinically and with contrast enhanced computed tomography (CECT scan before and after NACT. The significance of correlation between tumor and P-gp levels was determined with Chi-square test. Results: Twenty-one had high and 55 had low P-gp expression. On analyzing P-gp expression with response by World Health Organization (WHO criteria, statistical significance was obtained (P = 0.038. Similarly, assessment of P-gp expression with response by Response Evaluation in Solid Tumors (RECIST criteria in 48 patients showed statistical significance (P = 0.0005. Conclusion: This study proves that P-gp expression is a determinant factor in predicting response to NACT. Finally, detection of P-gp expression status before initiation of chemotherapy can be used as a predictive marker for NACT response and will also aid in avoiding the toxic side effects of NACT in non-responders.

  1. Clinical Application of Magnetic Resonance Imaging in Management of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Jeon-Hor Chen

    2013-01-01

    Full Text Available Neoadjuvant chemotherapy (NAC, also termed primary, induction, or preoperative chemotherapy, is traditionally used to downstage inoperable breast cancer. In recent years it has been increasingly used for patients who have operable cancers in order to facilitate breast-conserving surgery, achieve better cosmetic outcome, and improve prognosis by reaching pathologic complete response (pCR. Many studies have demonstrated that magnetic resonance imaging (MRI can assess residual tumor size after NAC, and that provides critical information for planning of the optimal surgery. NAC also allows for timely adjustment of administered drugs based on response, so ineffective regimens could be terminated early to spare patients from unnecessary toxicity while allowing other effective regimens to work sooner. This review article summarizes the clinical application of MRI during NAC. The use of different MR imaging methods, including dynamic contrast-enhanced MRI, proton MR spectroscopy, and diffusion-weighted MRI, to monitor and evaluate the NAC response, as well as how changes of parameters measured at an early time after initiation of a drug regimen can predict final treatment outcome, are reviewed. MRI has been proven a valuable tool and will continue to provide important information facilitating individualized image-guided treatment and personalized management for breast cancer patients undergoing NAC.

  2. MRI in diagnosis of pathological complete response in breast cancer patients after neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Graphical abstract: After NAC, the original tumor area still had residual enhancement which may be misdiagnosed to be residual tumor with the current standard. Under the new standards it can effectively be correctly identified as pCR. And the pathological analysis ensured the diagnosis of pCR after surgery. - Highlights: • The confirmation of complete pathological response (pCR) after Neo-adjuvant chemotherapy (NAC) of breast cancer patients can contribute to an optimal choice of surgical procedure. • The present study selected out effective indicators for diagnosis of pCR by MRI using non-pCR cases as the control. • The study established an appropriate diagnostic program to maximize the accuracy of detecting pCR by MRI. - Abstract: Objective: To select effective indicators for diagnosis of pathological complete response (pCR) by MRI and to establish an appropriate diagnostic program to maximize the accuracy of pCR detection by MRI. Materials and methods: Twenty-one pCR patients and 22 non-pCR randomly selected patients receiving neoadjuvant chemotherapy (NAC) and subsequent surgery were recruited for the study. All patients underwent breast MRIs both before and after chemotherapy. Changes in diameter, area and dynamic variables between the first and final MRI were compared between the two groups. Logistic and ROC analysis were performed to select effective indicators for predicting pCR on MRI. Results: Eleven out of 43 patients had no residual enhanced areas on MRI, and the sensitivity and specificity for predicting pCR on MRI under the current criterion was 52.38% and 100%, respectively. Logistic regression analysis revealed that changes in diameter, SIpeak and area were effective in predicting pCR by MRI. The latter two parameters had a greater impact on diagnosis than the diameter change. Two new independent criteria were established to predict pCR on MRI: (1) a reduction of ≥78% in area; and (2) a combination of a reduction of ≥27% in SIpeak and of

  3. A randomized, double-blind, multicentre study comparing daily 2 and 5 mg of tropisetron for the control of nausea and vomiting induced by low-dose cisplatin- or non-cisplatin-containing chemotherapy

    NARCIS (Netherlands)

    Wymenga, ANM; vanderGraaf, WTA; Wils, JA; vanHeukelom, LS; vanderLinden, GHM; DullemondWestland, AC; Nooy, M; vanderHeul, C; deBruijn, KM; deVries, EGE

    1996-01-01

    Background: This study compares efficacy safety and tolerability of 2 and 5 mg tropisetron in prevention of nausea and vomiting induced by low-dose cisplatin- or non-cisplatin-containing chemotherapy. Patients and methods: 152 chemotherapy-naive cancer patients were randomized in a double-blind mann

  4. Superior mesenteric artery syndrome following initiation of cisplatin-containing chemotherapy: a case report

    Directory of Open Access Journals (Sweden)

    Ushiki Atsuhito

    2012-01-01

    Full Text Available Abstract Introduction Superior mesenteric artery syndrome is a rare cause of upper intestinal obstruction resulting from compression of the duodenum by the superior mesenteric artery and abdominal aorta. Case presentation We describe a case of superior mesenteric artery syndrome in a 61-year-old Japanese man with non-small cell lung cancer who had been treated with cisplatin-containing chemotherapy and had lost 7 kg in weight. The diagnosis was confirmed by the typical findings of abdominal computed tomography showing distended stomach resulting from compression of the third portion of the duodenum and reduction of an aortomesenteric distance and aortomesenteric angle. Conclusions This case highlights the importance of considering the possibility of superior mesenteric artery syndrome in patients treated with chemotherapy, especially those presenting with a low body mass index and showing weight loss during chemotherapy.

  5. Clinical efficacy of including capecitabine in neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Qiuyun Li

    Full Text Available BACKGROUND: Capecitabine has proven effective as a chemotherapy for metastatic breast cancer. Though several Phase II/III studies of capecitabine as neoadjuvant chemotherapy have been conducted, the results still remain inconsistent. Therefore, we performed a meta-analysis to obtain more precise understanding of the role of capecitabine in neoadjuvant chemotherapy for breast cancer patients. METHODS: The electronic database PubMed and online abstracts from ASCO and SABCS were searched to identify randomized clinical trials comparing neoadjuvant chemotherapy with or without capecitabine in early/operable breast cancer patients without distant metastasis. Risk ratios were used to estimate the association between capecitabine in neoadjuvant chemotherapy and various efficacy outcomes. Fixed- or random-effect models were adopted to pool data in RevMan 5.1. RESULTS: Five studies were included in the meta-analysis. Neoadjuvant use of capecitabine with anthracycline and/or taxane based therapy was not associated with significant improvement in clinical outcomes including: pathologic complete response in breast (pCR; RR = 1.10, 95% CI 0.87-1.40, p = 0.43, pCR in breast tumor and nodes (tnpCR RR = 0.99, 95% CI 0.83-1.18, p = 0.90, overall response rate (ORR; RR = 1.00, 95% CI 0.94-1.07, p = 0.93, or breast-conserving surgery (BCS; RR = 0.98, 95% CI 0.93-1.04, p = 0.49. CONCLUSIONS: Neoadjuvant treatment of breast cancer involving capecitabine did not significantly improve pCR, tnpCR, BCS or ORR. Thus adding capecitabine to neoadjuvant chemotherapy regimes is unlikely to improve outcomes in breast cancer patients without distant metastasis. Further research is required to establish the condition that capecitabine may be useful in breast cancer neoadjuvant chemotherapy.

  6. Breast DCE-MRI Kinetic Heterogeneity Tumor Markers: Preliminary Associations With Neoadjuvant Chemotherapy Response

    Directory of Open Access Journals (Sweden)

    Ahmed Ashraf

    2015-06-01

    Full Text Available The ability to predict response to neoadjuvant chemotherapy for women diagnosed with breast cancer, either before or early on in treatment, is critical to judicious patient selection and tailoring the treatment regimen. In this paper, we investigate the role of contrast agent kinetic heterogeneity features derived from breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI for predicting treatment response. We propose a set of kinetic statistic descriptors and present preliminary results showing the discriminatory capacity of the proposed descriptors for predicting complete and non-complete responders as assessed from pre-treatment imaging exams. The study population consisted of 15 participants: 8 complete responders and 7 non-complete responders. Using the proposed kinetic features, we trained a leave-one-out logistic regression classifier that performs with an area under the receiver operating characteristic (ROC curve (AUC of 0.84 under the ROC. We compare the predictive value of our features against commonly used MRI features including kinetics of the characteristic kinetic curve (CKC, maximum peak enhancement (MPE, hotspot signal enhancement ratio (SER, and longest tumor diameter that give lower AUCs of 0.71, 0.66, 0.64, and 0.54, respectively. Our proposed kinetic statistics thus outperform the conventional kinetic descriptors as well as the classifier using a combination of all the conventional descriptors (i.e., CKC, MPE, SER, and longest diameter, which gives an AUC of 0.74. These findings suggest that heterogeneity-based DCE-MRI kinetic statistics could serve as potential imaging biomarkers for tumor characterization and could be used to improve candidate patient selection even before the start of the neoadjuvant treatment.

  7. Ki67, chemotherapy response, and prognosis in breast cancer patients receiving neoadjuvant treatment

    Directory of Open Access Journals (Sweden)

    Fasching Peter A

    2011-11-01

    Full Text Available Abstract Background The pathological complete response (pCR after neoadjuvant chemotherapy is a surrogate marker for a favorable prognosis in breast cancer patients. Factors capable of predicting a pCR, such as the proliferation marker Ki67, may therefore help improve our understanding of the drug response and its effect on the prognosis. This study investigated the predictive and prognostic value of Ki67 in patients with invasive breast cancer receiving neoadjuvant treatment for breast cancer. Methods Ki67 was stained routinely from core biopsies in 552 patients directly after the fixation and embedding process. HER2/neu, estrogen and progesterone receptors, and grading were also assessed before treatment. These data were used to construct univariate and multivariate models for predicting pCR and prognosis. The tumors were also classified by molecular phenotype to identify subgroups in which predicting pCR and prognosis with Ki67 might be feasible. Results Using a cut-off value of > 13% positively stained cancer cells, Ki67 was found to be an independent predictor for pCR (OR 3.5; 95% CI, 1.4, 10.1 and for overall survival (HR 8.1; 95% CI, 3.3 to 20.4 and distant disease-free survival (HR 3.2; 95% CI, 1.8 to 5.9. The mean Ki67 value was 50.6 ± 23.4% in patients with pCR. Patients without a pCR had an average of 26.7 ± 22.9% positively stained cancer cells. Conclusions Ki67 has predictive and prognostic value and is a feasible marker for clinical practice. It independently improved the prediction of treatment response and prognosis in a group of breast cancer patients receiving neoadjuvant treatment. As mean Ki67 values in patients with a pCR were very high, cut-off values in a high range above which the prognosis may be better than in patients with lower Ki67 values may be hypothesized. Larger studies will be needed in order to investigate these findings further.

  8. Evaluation of cisplatin plasma levels in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

    Science.gov (United States)

    Fleres, Francesco; Saladino, Edoardo; Catanoso, Rosaria; Arcoraci, Vincenzo; Mandolfino, Tommaso; Cucinotta, Eugenio; Macrì, Antonio

    2016-02-01

    Introduction Peritoneal surface malignancies have long been regarded as incurable, however, they can be treated with cytoreductive surgery in addition to hyperthermic intraperitoneal chemotherapy. This approach is associated with an increase in morbidity and mortality, unless hyperhydration is provided in a timely manner. Methods Cisplatin (CDDP) is the most widely used chemotherapeutic agent. Plasma levels of cisplatin (CDDP), a widely used chemotherapeutic agent, were measured before, during, and after the procedure. This was done in order to identify the window of highest risk as a function of drug concentrations, assuming a dose-dependent effect. Results Plasma levels of CDDP peak during perfusion. The concentration remains high until the 4th post-operative day and returns to pre-operative levels by the 7th post-operative day. Conclusions Our findings suggest that ensuring hyperhydration as well as infusing albumin and fresh frozen plasma may be of particular value for at least the first 4 days after the procedure. PMID:27385136

  9. Integration of diffusion weighted MRI data and a simple mathematical model to predict breast tumor cellularity during neoadjuvant chemotherapy

    OpenAIRE

    Atuegwu, Nkiruka C.; Arlinghaus, Lori R.; Li, Xia; BrianWelch, E.; Chakravarthy, Bapsi A.; John C Gore; Yankeelov, Thomas E.

    2011-01-01

    Diffusion-weighted magnetic resonance imaging (DW-MRI) data obtained early in the course of therapy can be used to estimate tumor proliferation rates, and the estimated rates can be used to predict tumor cellularity at the conclusion of therapy. Six patients underwent DW-MRI immediately before, after one cycle, and after all cycles of neoadjuvant chemotherapy. Apparent diffusion coefficient (ADC) values were calculated for each voxel and for a whole tumor region of interest (ROI). Proliferati...

  10. ERCC1 and CYP1B1 polymorphisms as predictors of response to neoadjuvant chemotherapy in estrogen positive breast tumors

    OpenAIRE

    Dumont, Aurélie; Pannier, Diane; Ducoulombier, Agnès; Tresch, Emmanuelle; Chen, Jinying; Kramar, Andrew; Révillion, Françoise; Peyrat, Jean-Philippe; Bonneterre, Jacques

    2015-01-01

    Purpose Neoadjuvant chemotherapy (NCT) using anthracyclines and taxanes is a standard treatment for locally advanced breast cancer. Efficacy of NCT is however variable among patients and predictive markers are expected to guide the selection of patients who will benefit from NCT. A promising approach stand with polymorphisms located in genes encoding drug transporters, drug metabolizing enzymes and target genes which can affect drug efficacy. Our study investigated the potential of 37 polymor...

  11. A new histological therapeutic classification system to predict eradicated and residual lymph nodes in breast cancer after neoadjuvant chemotherapy

    OpenAIRE

    MOROHASHI, SATOKO; YOSHIZAWA, TADASHI; SEINO, HIROKO; HIRAI, HIDEAKI; HAGA, TOSHIHIRO; OTA, RIE; Wu, Yunyan; Yoshida, Eri; HAKAMADA, KENICHI; Kijima, Hiroshi

    2016-01-01

    The indication for neoadjuvant chemotherapy (NAC) has recently broadened to include its use in the treatment of initial stage breast cancer. Axillary lymph node metastasis after NAC in breast cancer is a poor prognostic factor. Thus, the prediction of lymph node metastasis is important to estimate the prognosis of breast cancer patients after NAC. Therefore, we focused on residual carcinoma patterns of primary breast tumors after NAC and examined the correlation between the patterns and lymph...

  12. Tumor-infiltrating immune cell profiles and their change after neoadjuvant chemotherapy predict response and prognosis of breast cancer

    OpenAIRE

    García-Martínez, Elena; Gil, Ginés Luengo; Benito, Asunción Chaves; González-Billalabeitia, Enrique; Conesa, María Angeles Vicente; García, Teresa García; García-Garre, Elisa; Vicente, Vicente; de la Peña, Francisco Ayala

    2014-01-01

    Introduction Tumor microenvironment immunity is associated with breast cancer outcome. A high lymphocytic infiltration has been associated with response to neoadjuvant chemotherapy, but the contribution to response and prognosis of immune cell subpopulations profiles in both pre-treated and post-treatment residual tumor is still unclear. Methods We analyzed pre- and post-treatment tumor-infiltrating immune cells (CD3, CD4, CD8, CD20, CD68, Foxp3) by immunohistochemistry in a series of 121 bre...

  13. A meta-analysis: neoadjuvant chemotherapy versus primary surgery in ovarian carcinoma FIGO stageIII and IV

    OpenAIRE

    Dai-yuan, Ma; Bang-xian, Tan; Xian-fu, Li; Ye-qin, Zhou; Hong-Wei, Cai

    2013-01-01

    Background The purpose of the current study is to analyze the existing data comparing neoadjuvant chemotherapy with primary debulking surgery (PDS) in patients with advanced ovarian carcinoma. Methods Patients with stage IIIC and IV ovarian cancer were identified from articles in Medline, PubMed, Cochrane Library, and EMBASE database (1989 to February 2013). Two authors independently extracted the data. To assess the risk of bias of included literatures, Cochrane Collaboration’s risk of bias ...

  14. Decreased FOXP3+ and GARP+ Tregs to neoadjuvant chemotherapy associated with favorable prognosis in advanced gastric cancer

    OpenAIRE

    Li K; Chen F; Xie H.

    2016-01-01

    Kai Li,1 Fuchao Chen,2 Huijuan Xie3 1Department of Pathology, 2Department of Clinical Pharmacy, 3Department of Hyperbaric Oxygen, Dongfeng Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China Abstract: Neoadjuvant chemotherapy (NACT) has been an increasingly used therapeutic strategy to improve the outcome of advanced gastric cancer (GC) over the past few decades. Lymphocytic infiltration has been reported to be associated with response to NACT, but the immun...

  15. Expression of Immunohistochemical Markers before and after Neoadjuvant Chemotherapy in Breast Carcinoma, and Their Use as Predictors of Response

    OpenAIRE

    Lee, Ho-Chang; Ko, Hyoungsuk; Seol, Hyesil; Noh, Dong-Young; Han, Wonshik; Kim, Tae-You; Im, Seock-Ah; Park, In Ae

    2013-01-01

    Purpose For patients with breast carcinoma, immunohistochemical markers are important factors in determining the breast cancer subtype and for establishing a therapeutic plan, including the use of neoadjuvant chemotherapy (NACT). However, it is not clear whether the expression of certain markers changes after NACT. Methods We assessed estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, p53, and Bcl-2 expression in specimens from 345 brea...

  16. Could the Extent of Lymphadenectomy Be Modified by Neoadjuvant Chemotherapy in Cervical Cancer? A Large-Scale Retrospective Study

    OpenAIRE

    Ting Hu; Xiong Li; Qinghua Zhang; Kecheng Huang; Yao Jia; Ru Yang; Fangxu Tang; Qiang Tian; Ding Ma; Shuang Li

    2015-01-01

    Background The effect of neoadjuvant chemotherapy (NACT) on topographical distribution patterns of lymph node metastasis in cervical cancer was unknown. Methods Patients with FIGO stage IB1-IIB who underwent radical surgery with or without NACT were enrolled (3527 patients). A matched-case comparison design was used to compare the effects of NACT on lymph node metastasis. Results We analyzed groups of 167 and 140 patients who were diagnosed with lymph node metastasis in the matched primary su...

  17. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone

    OpenAIRE

    Poonam Joshi; Amit Joshi; Kumar Prabhash; Vanita Noronha; Pankaj Chaturvedi

    2015-01-01

    Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT) in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and Methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were inc...

  18. Elastography, a sensitive tool for the evaluation of neoadjuvant chemotherapy in patients with high-grade serous ovarian carcinoma

    OpenAIRE

    Xie, Meng; ZHANG, XUYIN; JIA, ZHAN; Ren, Yunyun; Wang, Wenping

    2014-01-01

    The aim of the present study was to evaluate tumor stiffness by ultrasound elastography, which has the potential to provide additional information that is useful in predicting the response to neoadjuvant chemotherapy (NACT) in high-grade serous ovarian carcinoma (HGSC) patients. In total, 32 patients with International Federation of Gynecology and Obstetrics stage III and IV epithelial ovarian cancer treated with NACT underwent transvaginal and transabdominal sonography, followed by elastogra...

  19. Exploratory Cost-Effectiveness Analysis of Response-Guided Neoadjuvant Chemotherapy for Hormone Positive Breast Cancer Patients

    OpenAIRE

    Anna Miquel-Cases; Retèl, Valesca P; Bianca Lederer; Gunter von Minckwitz; Steuten, Lotte M.G.; van Harten, Wim H

    2016-01-01

    Purpose Guiding response to neoadjuvant chemotherapy (guided-NACT) allows for an adaptative treatment approach likely to improve breast cancer survival. In this study, our primary aim is to explore the expected cost-effectiveness of guided-NACT using as a case study the first randomized controlled trial that demonstrated effectiveness (GeparTrio trial). Materials and Methods As effectiveness was shown in hormone-receptor positive (HR+) early breast cancers (EBC), our decision model compared t...

  20. MRI volumetry for prediction of tumour response to neoadjuvant chemotherapy followed by chemoradiotherapy in locally advanced rectal cancer

    OpenAIRE

    2015-01-01

    Objective: To investigate if MRI-assessed tumour volumetry correlates with histological tumour response to neoadjuvant chemotherapy (NACT) and subsequent chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). Methods: Data from 69 prospectively enrolled patients with LARC receiving NACT followed by CRT and radical surgery were analysed. Whole-tumour volumes were contoured in T2 weighted MR images obtained pre-treatment (VPRE), after NACT (VNACT) and after the full course of NACT...

  1. Early response to neoadjuvant chemotherapy in advanced esophageal cancer evaluated by computed tomography predicts the utility of a second cycle of chemotherapy

    OpenAIRE

    MOTOORI, MASAAKI; Yano, Masahiko; Yasuda, Takushi; Miyata, Hiroshi; PENG, YINGFENG; YAMASAKI, MAKOTO; SHIRAISHI, OSAMU; Tanaka, Koji; Ishikawa, Osamu; SHIOZAKI, HITOSHI; Doki, Yuichiro

    2013-01-01

    Multi-course neoadjuvant chemotherapy (NACT) followed by surgery is a promising treatment for advanced esophageal cancer. However, non-responders may continue to receive ineffective treatment, since there are no definitive criteria for early discontinuation of NACT. In this study, we analyzed 103 advanced esophageal cancer patients treated with 2 cycles of NACT followed by surgery. Patients with >20% decrease in the size of the primary tumor as evaluated by computed tomography (CT) following ...

  2. D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy

    Directory of Open Access Journals (Sweden)

    Shrikhande Shailesh V

    2013-02-01

    Full Text Available Abstract Background Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature. Methods Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperative outcomes and histopathological responses to NACT were analyzed. The data is presented and compared to a cohort of patients undergoing upfront surgery in the same time period. Results In this study, 139 patients (42 female and 97 male patients, median age 53 years with gastric adenocarcinoma received NACT. Chemotherapy-related toxicity was noted in 32% of patients. Of the 139 patients, 129 underwent gastrectomy with D2 lymphadenectomy, with 12% morbidity and no mortality. Major pathological response of primary tumor was noted in 22 patients (17%. Of these 22 patients, lymph node metastases were noted in 12 patients. The median blood loss and lymph node yield was not significantly different to the 62 patients who underwent upfront surgery. Patients who underwent upfront surgery were older (58 vs. 52 years, P P P  Conclusions Perioperative outcomes of gastrectomy with D2 lymphadenectomy for locally advanced, resectable gastric cancer were not influenced by NACT. The number of lymph nodes harvested was unaltered by NACT but, more pertinently, metastases to lymph nodes were noted even in patients with a major pathological response of the primary tumor. D2 lymphadenectomy should be performed in all patients irrespective of the degree of response to NACT.

  3. Neoadjuvant chemotherapy and hypofractionated irradiation in the treatment of head and neck cancers

    International Nuclear Information System (INIS)

    A study has been initiated to assess the feasibility and efficacy of combining chemotherapy with irradiation in head and neck cancers. A total of 151 consecutive patients were enrolled, all recently diagnosed and previously untreated. There were 118 males and 33 females, ranging in age from 27 to 91 years. The predominant sites were: oropharynx (58), oral cavity (31), larynx (29) and hypopharynx (18). Most tumours were locally advanced (21 T1, 40 T2, 54 T3, 34 T4) with frequent lymph node involvement (77 No, 23 N1, 5 N2, 44 N3). Squamous cell carcinoma was present in 144 cases. The chemotherapy consisted of a low dose combination of bleomycin (10 mg), etoposide (100 mg) and cis-platinum (15 mg) given on days 1, 3, 5 and 15, 17, 19. A major response rate of 70% was obtained (11% complete response + 59% partial response). Primary tumours regressed in 86% of cases and nodes in 58%. Side effects were minimal: 85% nausea, 50% vomiting, 10% mild haematologic depression, 20% alopecia. A total of 122 cases received exclusive radiotherapy. The treatment was initiated with a mean interval of 14 days. A split-course modality was used, consisting of two treatment periods separated by a 15 day rest interval; each irradiation sequence comprised 6 fractions over 2 weeks. The tumour dose per fraction amounts to 4 Gy, the total dose being 48 Gy with a TDF of 103. Eighty-eight per cent of primary tumours and 54% of lymph nodes had completely regressed at the end of irradiation. Acute side effects remained acceptable and patient compliance amounted to 100%. Late complications were infrequent and no cumulative toxic effect was observed. Two year survival rates for 36 stage III and 64 stage IV patients are 57 and 50%, respectively. Results at 3 years indicate 48 and 31% survival. Preliminary comparison with historical controls only shows trends in favour of neoadjuvant chemotherapy

  4. MCL-1 is the key target of adjuvant chemotherapy to reverse the cisplatin-resistance in NSCLC.

    Science.gov (United States)

    Ma, Jun; Zhao, Zhenxian; Wu, Kaiming; Xu, Zhe; Liu, Kuanzhi

    2016-08-10

    Cisplatin is one of the most effective chemotherapeutic agents for the treatment of lung cancer. However, the acquired resistance occurred in cancer cells limits the clinical application of cisplatin. MCL-1, which is an important member in the pro-survival Bcl-2 family, plays a critical role in multidrug resistance (MDR). The aim of the present study is to investigate the value of Pan-Bcl-2 inhibitor as sensitizer for the chemotherapy of cisplatin-resistant non-small cell lung cancer (NSCLC) cells. We found the obatoclax but not the ABT-737 significantly decreased the IC50 (half maximal inhibitory concentration) of cisplatin in cisplatin-resistant NSCLC cells. Furthermore, we demonstrated that the mechanism of obatoclax-promoted cell death induced by cisplatin was dependent on the inhibition of MCL-1, which couldn't be inhibited by ABT-737 but is the target of obatoclax. Moreover, inhibition of MCL-1 recovered the function of NOXA and BAK in cisplatin-resistant NSCLC cells, leading to the promotion of mitochondrial apoptosis induced by cisplatin. Interestingly, our date indicated the obatoclax also reversed the cross-resistance in cisplatin-resistant NSCLC cells. Therefore, we demonstrated that the targeted therapy with MCL-1 inhibitors, such as obatoclax, may represent a novel strategy for cancer therapy. PMID:27138804

  5. An upconversion nanoplatform for simultaneous photodynamic therapy and Pt chemotherapy to combat cisplatin resistance.

    Science.gov (United States)

    Ai, Fujin; Sun, Tianying; Xu, Zoufeng; Wang, Zhigang; Kong, Wei; To, Man Wai; Wang, Feng; Zhu, Guangyu

    2016-08-16

    Platinum-based antineoplastic drugs are among the first-line chemotherapeutic agents against a variety of solid tumors, but toxic side-effects and drug resistance issues limit their clinical optimization. Novel strategies and platforms to conquer cisplatin resistance are highly desired. Herein, we assembled a multimodal nanoplatform utilizing 808 nm-excited and biocompatible core-shell-shell upconversion nanoparticles (UCNPs) [NaGdF4:Yb/Nd@NaGdF4:Yb/Er@NaGdF4] that were covalently loaded with not only photosensitizers (PSs), but also Pt(iv) prodrugs, which were rose bengal (RB) and c,c,t-[Pt(NH3)2Cl2(OCOCH2CH2NH2)2], respectively. The UCNPs had the capability to convert near infrared (NIR) light to visible light, which was further utilized by RB to generate singlet oxygen. At the same time, the nanoplatform delivered the Pt(iv) prodrug into cancer cells. Thus, this upconversion nanoplatform was able to carry out combined and simultaneous photodynamic therapy (PDT) and Pt chemotherapy. The nanoplatform was well characterized and the energy transfer efficiency was confirmed. Compared with free cisplatin or UCNPs loaded with RB only, our nanoplatform showed significantly improved cytotoxicity upon 808 nm irradiation in both cisplatin-sensitive and -resistant human ovarian cancer cells. A mechanistic study showed that the nanoparticles efficiently delivered the Pt(iv) prodrug into cancer cells, resulting in Pt-DNA damage, and that the nanoplatform generated cellular singlet oxygen to kill cancer cells. We, therefore, provide a comprehensive strategy to use UCNPs for combined Pt chemotherapy and PDT against cisplatin resistance, and our nanoplatform can also be used as a theranostic tool due to its NIR bioimaging capacity. PMID:27430044

  6. {sup 18}F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Duch, Joan; Fuster, David; Munoz, Montserrat; Fernandez, Pedro Luis; Paredes, Pilar; Fontanillas, Montserrat; Guzman, Flavia; Rubi, Sebastia; Lomena, Francisco Juan; Pons, Francesca [Hospital Clinic de Barcelona, Nuclear Medicine Department, Barcelona (Spain)

    2009-10-15

    The aim of this study was to prospectively evaluate {sup 18}F-FDG PET/CT in predicting response to neoadjuvant chemotherapy in large primary breast cancer. Fifty consecutive patients underwent PET/CT at baseline and after the second cycle. Baseline MRI was performed to establish tumour size. All findings were confirmed by histopathological analysis. Changes in maximum standardized uptake value (SUV{sub max}) between baseline study and after two cycles of neoadjuvant chemotherapy (epirubicin + cyclophosphamide + taxanes) were compared using response evaluation criteria in solid tumours (RECIST) criteria and the Miller and Payne (M and P) scale. The mean tumour size was 4.3 {+-} 1.4 cm. Forty patients were considered responders and ten as non-responders. SUV{sub max} changes in patients with good prognosis (M and P grades 4-5) were higher than in patients with bad prognosis (M and P grades 1-3) (p = 0.025). SUV{sub max} changes between responders and non-responders following RECIST criteria were also statistically significant (p = 0.0028). A cut-off {delta}SUV value of 40% differentiates both groups, with a sensitivity of 77% and a specificity of 80%. {sup 18}F-FDG PET/CT can predict response to neoadjuvant chemotherapy at an early stage. (orig.)

  7. Neoadjuvant hormonal therapy is associated with comparable outcomes to neoadjuvant chemotherapy in post-menopausal women with estrogen receptor-positive breast cancer

    Directory of Open Access Journals (Sweden)

    David M. Marcus

    2013-12-01

    Full Text Available Objectives: We compared outcomes in post-menopausal estrogen receptor-positive (ER+ breast cancer patients treated with neoadjuvant hormonal therapy (NAHT or neoadjuvant chemotherapy (NACT.Methods: We retrospectively identified post-menopausal women who received either NAHT or NACT for non-metastatic, non-inflammatory, ER+, Her2neu negative breast cancer from 2004 to 2011. We compared long-term rates of locoregional relapse free survival (LRFS, distant metastasis free survival (DMFS, and overall survival (OS using the Kaplan-Meier method. The Cox proportional hazards model was used to identify patient and disease factors significantly associated with these endpoints. Results: We identified 99 patients in our study, including 27 who received NAHT and 72 who received NACT. There were no differences in 4-year LRFS, DMFS, or OS between groups. On Cox proportional hazards modeling, the type of systemic therapy (NAHT vs. NACT was not associated with OS. However, patients with progesterone receptor (PR positive disease had a 92% lower risk of death compared to patients with PR negative disease.Conclusions: Our data suggest that outcomes are not adversely affected by NAHT in post-menopausal women with ER+ breast cancer. Therefore, NAHT is a viable and potentially less toxic option than NACT in appropriately selected patients. Furthermore, although PR negative disease appears to be associated with poor prognosis, intensification of systemic treatment with chemotherapy may not be associated with improvement of disease-related outcomes in this patient population.

  8. Noninvasive assessment of response to neoadjuvant chemotherapy in osteosarcoma of long bones with diffusion-weighted imaging: an initial in vivo study.

    Directory of Open Access Journals (Sweden)

    Cheng-Sheng Wang

    Full Text Available OBJECTIVES: The purpose of our study is to investigate whether diffusion-weighted imaging (DWI is useful for monitoring the therapeutic response after neoadjuvant chemotherapy in osteosarcoma of long bones. MATERIALS AND METHODS: Conventional magnetic resonance imaging (MRI and DWI were obtained from 35 patients with histologically proven osteosarcomas. MR examinations were performed in all patients before and after 4 courses of preoperative neoadjuvant chemotherapy. Apparent diffusion coefficients (ADC were measured. The degree of tumor necrosis was assessed macroscopically and histologically by two experienced pathologists after operation. Student's t test was performed for testing changes in ADC value. Pearson's correlation coefficient was used to estimate the correlation between necrosis rate and post- neoadjuvant chemotherapy ADC values. P<0.05 was considered to denote a significant difference. RESULTS: The difference of the whole osteosarcoma between pre- neoadjuvant chemotherapy ADC value (1.24±0.17×10(-3 mm(2/s and post- (1.93±0.39×10(-3 mm(2/s was significant difference (P<0.01. Regarding in patients with good response, the post- neoadjuvant chemotherapy values were significantly higher than the pre- neoadjuvant chemotherapy values (P<0.01. The post- neoadjuvant chemotherapy ADC value in patients with good response was higher than that of poor response (t = 8.995, P<0.01. The differences in post- neoadjuvant chemotherapy ADC between viable (1.03±0.17×10(-3 mm(2/s and necrotic (2.38±0.25×10(-3 mm(2/s tumor was highly significant (t = 23.905, P<0.01. A positive correlation between necrosis rates and the whole tumor ADC values (r = 0.769, P<0.01 was noted, but necrosis rates were not correlated with the ADC values of necrotic (r = -0.191, P = 0.272 and viable tumor areas (r = 0.292, P = 0.089. CONCLUSIONS: DWI can identify residual viable tumor tissues and tumor necrosis induced by neoadjuvant

  9. Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer – the RAPIDO trial

    International Nuclear Information System (INIS)

    Current standard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy, and, variably per institution, postoperative adjuvant chemotherapy. Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both randomized and observational studies. The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer, hepatic metastases from colorectal cancer and is currently tested in primary colon cancer. Patients with rectal cancer with high risk features for local or systemic failure on magnetic resonance imaging are randomized to either a standard arm or an experimental arm. The standard arm consists of chemoradiation (1.8 Gy x 25 or 2 Gy x 25 with capecitabine) preoperatively, followed by selective postoperative adjuvant chemotherapy. Postoperative chemotherapy is optional and may be omitted by participating institutions. The experimental arm includes short-course radiotherapy (5 Gy x 5) followed by full-dose chemotherapy (capecitabine and oxaliplatin) in 6 cycles before surgery. In the experimental arm, no postoperative chemotherapy is prescribed. Surgery is performed according to TME principles in both study arms. The hypothesis is that short-course radiotherapy with neo-adjuvant chemotherapy increases disease-free and overall survival without compromising local control. Primary end-point is disease-free survival at 3 years. Secondary endpoints include overall survival, local control, toxicity profile, and treatment completion rate, rate of pathological complete response and microscopically radical resection, and quality of life. Following the advances in rectal cancer management, increased focus on survival rather than only on local control is now justified. In an experimental arm, short-course radiotherapy is combined with full-dose chemotherapy preoperatively, an alternative that offers advantages compared to concomitant chemoradiotherapy with or without postoperative

  10. Combination of Taxanes, Cisplatin and Fluorouracil as Induction Chemotherapy for Locally Advanced Head and Neck Cancer: A Meta-Analysis

    OpenAIRE

    Hao Qin; Jie Luo; Yuan-Ping Zhu; Hai-Li Xie; Wei-Qiang Yang; Wen-Bin Lei

    2012-01-01

    BACKGROUND: Some investigations have suggested that induction chemotherapy with a combination of taxanes, cisplatin and fluorouracil (TPF) is effective in locally advanced head and neck cancer. However, other trials have indicated that TPF does not improve outcomes. The objective of this study was to compare the efficacy and safety of TPF with a cisplatin and fluorouracil (PF) regimen through a meta-analysis. METHODS: Four randomized clinical trials were identified, which included 1,552 patie...

  11. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer. Results of the first prospective randomized phase II trial

    International Nuclear Information System (INIS)

    In nonrandomized trials, neoadjuvant treatment was reported to prolong survival in patients with pancreatic cancer. As neoadjuvant chemoradiation is established for the treatment of rectal cancer we examined the value of neoadjuvant chemoradiotherapy in pancreatic cancer in a randomized phase II trial. Radiological staging defining resectability was basic information prior to randomization in contrast to adjuvant therapy trials resting on pathological staging. Patients with resectable adenocarcinoma of the pancreatic head were randomized to primary surgery (Arm A) or neoadjuvant chemoradiotherapy followed by surgery (Arm B), which was followed by adjuvant chemotherapy in both arms. A total of 254 patients were required to detect a 4.33-month improvement in median overall survival (mOS). The trial was stopped after 73 patients; 66 patients were eligible for analysis. Twenty nine of 33 allocated patients received chemoradiotherapy. Radiotherapy was completed in all patients. Chemotherapy was changed in 3 patients due to toxicity. Tumor resection was performed in 23 vs. 19 patients (A vs. B). The R0 resection rate was 48 % (A) and 52 % (B, P = 0.81) and (y)pN0 was 30 % (A) vs. 39 % (B, P = 0.44), respectively. Postoperative complications were comparable in both groups. mOS was 14.4 vs. 17.4 months (A vs. B; intention-to-treat analysis; P = 0.96). After tumor resection, mOS was 18.9 vs. 25.0 months (A vs. B; P = 0.79). This worldwide first randomized trial for neoadjuvant chemoradiotherapy in pancreatic cancer showed that neoadjuvant chemoradiation is safe with respect to toxicity, perioperative morbidity, and mortality. Nevertheless, the trial was terminated early due to slow recruiting and the results were not significant. ISRCTN78805636; NCT00335543. (orig.)

  12. [A CASE OF UROTHELIAL CARCINOMA OF THE URINARY BLADDER WITH SQUAMOUS DIFFERENTIATION RESPONDING TO PACLITAXEL AND CARBOPLATIN NEOADJUVANT CHEMOTHERAPY].

    Science.gov (United States)

    Banno, Eri; Nishino, Aki; Nagai, Yasuharu; Yasuda, Muneo; Tahara, Hideo; Kino, Shigeo; Kanno, Norihumi

    2015-07-01

    A 42-year-old man was referred to our hospital for macrohematuria. Computer tomography and magnetic resonance imaging revealed right hydronephrosis and a retroperitoneal mass, located next to right side of the bladder. Cystoscopy showed a protruded lesion covered with normal mucosa at the right lateral wall. The patient underwent transurethral resection of the bladder tumor and biopsies of the bladder wall. Histological examination showed squamous cell carcinoma. Neoadjuvant chemotherapy using paclitaxel and carboplatin (TC) was performed. A total cystectomy, right nephroureterectomy and construction of the ileal conduit were performed after one course of systemic chemotherapy. Histological examination showed urothelial carcinoma with squamous cell differentiation. Unexpectedly, a small amount of CIS was detected only in the vicinity of the TUR scar. The patient received 2 cycles of TC chemotherapy as adjuvant chemotherapy. Unfortunately, 11 months later, local recurrence and liver metastasis were detected. He died 17 months after the surgery. PMID:26419080

  13. Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer

    International Nuclear Information System (INIS)

    Neoadjuvant stereotactic body radiotherapy (SBRT) has potential applicability in the management of borderline resectable and locally-advanced pancreatic adenocarcinoma. In this series, we report the pathologic outcomes in the subset of patients who underwent surgery after neoadjuvant SBRT. Patients with borderline resectable or locally-advanced pancreatic adenocarcinoma who were treated with SBRT followed by resection were included. Chemotherapy was to the discretion of the medical oncologist and preceded SBRT for most patients. Twelve patients met inclusion criteria. Most (92%) received neoadjuvant chemotherapy, and gemcitabine/capecitabine was most frequently utilized (n = 7). Most were treated with fractionated SBRT to 36 Gy/3 fractions (n = 7) and the remainder with single fraction to 24 Gy (n = 5). No grade 3+ acute toxicities attributable to SBRT were found. Two patients developed post-surgical vascular complications and one died secondary to this. The mean time to surgery after SBRT was 3.3 months. An R0 resection was performed in 92% of patients (n = 11/12). In 25% (n = 3/12) of patients, a complete pathologic response was achieved, and an additional 16.7% (n = 2/12) demonstrated <10% viable tumor cells. Kaplan-Meier estimated median progression free survival is 27.4 months. Overall survival is 92%, 64% and 51% at 1-, 2-, and 3-years. This study reports the pathologic response in patients treated with neoadjuvant chemotherapy and SBRT for borderline resectable and locally-advanced pancreatic cancer. In our experience, 92% achieved an R0 resection and 41.7% of patients demonstrated either complete or extensive pathologic response to treatment. The results of a phase II study of this novel approach will be forthcoming

  14. Phase II trial of neoadjuvant pemetrexed plus cisplatin followed by surgery and radiation in the treatment of pleural mesothelioma

    International Nuclear Information System (INIS)

    Malignant pleural mesothelioma is an aggressive tumor that has a poor prognosis and is resistant to unimodal approaches. Multimodal treatment has provided encouraging results. Phase II, open-label study of the combination of chemotherapy (pemetrexed 500 mg/m2+cisplatin 75 mg/m2 IV every 21 days × 3 cycles), followed by surgery (en-bloc extrapleural pneumonectomy, 3–8 weeks after chemotherapy) and hemithoracic radiation (total radiation beam 54 Gy, received 4–8 weeks post-surgery). The primary endpoint was event-free survival, defined as the time from enrollment to time of first observation of disease progression, death due to any cause, or early treatment discontinuation. Fifty-four treatment-naïve patients with T1-3 N0-2 malignant pleural mesothelioma were enrolled, 52 (96.3%) completed chemotherapy, 45 (83.3%) underwent surgery, 22 (40.7%) completed the whole treatment including 90-day post-radiation follow-up. The median event-free survival was 6.9 months (95%CI: 5.0-10.5), median overall survival was 15.5 months (95%CI 11.0-NA) while median time-to-tumor response was 4.8 months (95%CI: 2.5-8.0). Eighteen (33.3%) and 13 (24.1%) patients were still event-free after 1 and 2 years, respectively. The most common treatment-emergent adverse events were nausea (63.0%), anemia (51.9%) and hypertension (42.6%). Following two cardiopulmonary radiation-related deaths the protocol was amended (21 [38.9%] patients were already enrolled in the study): the total radiation beam was reduced from 54 Gy to 50.4 Gy and a more accurate selection of patients was recommended. The combination of pemetrexed plus cisplatin followed by surgery and hemithoracic radiation is feasible and has a manageable toxicity profile in carefully selected patients. It may be worthy of further investigation. Clinicaltrial.com registrationID #NCT00087698

  15. Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Dhanya Vasudevan

    2015-01-01

    Full Text Available Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT in the setting of locally advanced breast cancer (LABC can render inoperable tumor (T4, N2/N3 resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response. Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n=48 were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier’s system which graded the responses into pathological complete response (pCR, pathological partial response (pPR, and pathological no response (pNR. Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2–5 cms and Bloom Richardson’s grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed. Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.

  16. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial

  17. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bondiau, Pierre-Yves, E-mail: pierre-yves.bondiau@nice.unicancer.fr [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Courdi, Adel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Bahadoran, Phillipe [Department of Dermatology, University Hospital of Nice, Nice (France); Chamorey, Emmanuel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Queille-Roussel, Catherine [Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice (France); Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial.

  18. Neoadjuvant chemotherapy for triple-negative breast cancer:a meta-analysis with 7168 cases

    Institute of Scientific and Technical Information of China (English)

    Guojing Zhang; Xiaodong Xie; Wanqing Xie Co-first author; Chao Lin; Zhaozhe Liu; Long Xu; Guanzhong Zhang; Fang Guo; Yaling Han; Hongxin Zheng

    2014-01-01

    Objective:The pathological complete response (pCR) rates of neoadjuvant chemotherapy (NAC) in triple-nega-tive breast cancer (TNBC) was reported higher than that in non-TNBC but ranged from 12%to 48%. pCR was reported to be a predictor of long overal survival and exact pCR rate of NAC in TNBC would give us some hints on how to improve outcomes of TNBC patients. The meta-analysis was conducted to estimate the pCR rate of NAC for TNBC through contrasting the pCR rates of TNBC and non-TNBC tumors in NAC. Methods:Studies were selected from the PubMed database and Cochrane Col aboration Library. pCR rates were col ected in groups of TNBC and non-TNBC tumors. Review Manager 4.2 was used to perform forest plots and funnel plots. Results:The analysis included 22 studies with 7168 patients, the aggregate pCR rate was 29.5%in TNBC group, which was 17.7%higher than non-TNBC. The summary relative risk (RR) for pCR rate of TNBC group with that of non-TNBC group was 2.55. No obvious statistical heterogeneity and publication bias was detected. Conclu-sion:This meta-analysis demonstrated that NAC showed a higher pCR rate in TNBC than non-TNBC.

  19. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

    Directory of Open Access Journals (Sweden)

    Tomofumi Tsuboi

    2016-01-01

    Full Text Available Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC. Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01. The complication rates due to biliary drainage were 0% (0/9 with metallic stents and 72.7% (8/11 with plastic stents (p=0.01. Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p=0.012. There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

  20. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

    Science.gov (United States)

    Tsuboi, Tomofumi; Sasaki, Tamito; Serikawa, Masahiro; Ishii, Yasutaka; Mouri, Teruo; Shimizu, Akinori; Kurihara, Keisuke; Tatsukawa, Yumiko; Miyaki, Eisuke; Kawamura, Ryota; Tsushima, Ken; Murakami, Yoshiaki; Uemura, Kenichiro; Chayama, Kazuaki

    2016-01-01

    Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC). Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p = 0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p = 0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p = 0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC. PMID:26880897

  1. Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response

    International Nuclear Information System (INIS)

    To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC). One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1 = minimal, 2 = mild, 3 = moderate, 4 = marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared. The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen's kappa showed substantial agreement (k = 0.73-0.77) before and moderate agreement (k = 0.43-0.60) after NAC and moderate agreement (k = 0.62-0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r = -0.24, p = 0.03). BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response. (orig.)

  2. Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response

    Energy Technology Data Exchange (ETDEWEB)

    Preibsch, H.; Wanner, L.; Bahrs, S.D.; Wietek, B.M.; Nikolaou, K.; Wiesinger, B. [University Hospital Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany); Siegmann-Luz, K.C. [Diagnostic Center for Breast Cancer and Screening Mammography Brandenburg Ost, Koenigs Wusterhausen (Germany); Oberlecher, E.; Hahn, M. [University Hospital Tuebingen, Department of Gynecology and Obstetrics, Tuebingen (Germany); Staebler, A. [University Hospital Tuebingen, Institute of Pathology and Neuropathology, Tuebingen (Germany)

    2016-06-15

    To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC). One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1 = minimal, 2 = mild, 3 = moderate, 4 = marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared. The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen's kappa showed substantial agreement (k = 0.73-0.77) before and moderate agreement (k = 0.43-0.60) after NAC and moderate agreement (k = 0.62-0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r = -0.24, p = 0.03). BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response. (orig.)

  3. Neoadjuvant Chemotherapy Use in Bladder Cancer: A Survey of Current Practice and Opinions

    Directory of Open Access Journals (Sweden)

    N. G. Cowan

    2014-01-01

    Full Text Available Objectives. Level 1 evidence supports the use of neoadjuvant chemotherapy (NAC to improve overall survival in muscle invasive bladder cancer; however utilization rates remain low. The aims of our study were to determine factors associated with NAC use, to more clearly define reasons for low utilization, and to determine the current rate of NAC use among urologic oncologists. Materials and Methods. Active members of the Society for Urologic Oncology were provided a 20-question survey. Descriptive statistical analysis was conducted for each question and univariate analysis was performed. Results. We achieved a response rate of 21%. Clinical T3/T4 disease was the most often selected reason for recommending NAC (87%. Concerns with recommending NAC were age and comorbidities (54% followed by delay in surgery (35%. An association was identified between urologic oncologists who discussed NAC with >90% of their patients and medical oncologists “always” recommending NAC (P=0.0009. NAC utilization rate was between 30 and 57%. Conclusions. Amongst this highly specialized group of respondents, clinical T3-T4 disease was the most common reason for implementation of NAC. Respondents who frequently discussed NAC were more likely to report their medical oncologist always recommending NAC. Reported NAC use was higher in this surveyed group (30–57% compared with recently published rates.

  4. Neoadjuvant chemotherapy for advanced ovarian cancer: literature data and in vitro studies

    Directory of Open Access Journals (Sweden)

    S. A. Kuznetsov

    2015-01-01

    Full Text Available This paper analyzes large amounts of literature data on studies of the efficiency of neoadjuvant chemotherapy (NCT for advanced ovarian cancer (OC, which is performed prior to standard surgery. Clinical trials have demonstrated that a NCT regimen followed by cytoreductive surgery is less effective than primary cytoreductive one; however, evidence for the benefit of NCT is lacking so far. The authors conducted investigations using the intraoperative material obtained from 17 patients with T3a–cNxM0 OC, who were divided for a comparative examination into 2 groups. Group 1 included OC patents who received NCT; Group 2 comprised OC patients who did not. The tumor cells obtained from the intraoperative material of both groups were able to generate a well-proliferating culture in in vitro experiments. The cultured OC cells were characterized, by analyzing cytological specimens and the functional activity of these cells. It was ascertained that 35 % of the cultured tumor cells from OC retained their resistance to the cytotoxic action of effector cells (autologous lymphocytes at a target cell/effector cell ratio of 1:5. Thus, both the literature and the experiment provide no unambiguous evidence supporting the fact that NCT before cytoreductive surgery is a better approach than primary surgical treatment. The optimal regimen of NCT, which would be able to enhance its efficiency, remains important. 

  5. Tissue Biomarkers in Prognostication of Serous Ovarian Cancer following Neoadjuvant Chemotherapy

    Directory of Open Access Journals (Sweden)

    Binny Khandakar

    2014-01-01

    Full Text Available Serous ovarian cancer (SOC is a significant cause of morbidity and mortality in females with poor prognosis because of advanced stage at presentation. Recently, neoadjuvant chemotherapy (NACT is being used for management of advanced SOC, but role of tissue biomarkers in prognostication following NACT is not well established. The study was conducted on advanced stage SOC patients (n=100 that were treated either conventionally (n=50 or with NACT (n=50, followed by surgery. In order to evaluate the expression of tissue biomarkers (p53, MIB1, estrogen and progesterone receptors, Her-2/neu, E-cadherin, and Bcl2, immunohistochemistry and semiquantitative scoring were done following morphological examination. Following NACT, significant differences in tumor histomorphology were observed as compared to the native neoplasms. MIB 1 was significantly lower in cases treated with NACT and survival outcome was significantly better in cases with low MIB 1. ER expression was associated with poor overall survival. No other marker displayed any significant difference in expression or correlation with survival between the two groups. Immunophenotype of SOC does not differ significantly in samples from cases treated with NACT, compared to upfront surgically treated cases. The proliferating capacity of the residual tumor cells is less, depicted by low mean MIB1 LI. MIB 1 and ER inversely correlate with survival.

  6. Assessment of breast cancer response to neoadjuvant chemotherapy: Is volumetric MRI a reliable tool?

    Energy Technology Data Exchange (ETDEWEB)

    Lorenzon, Michele [Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine (Italy)], E-mail: michele.lorenzon@gmail.com; Zuiani, Chiara [Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine (Italy)], E-mail: zuiani.chiara@aoud.sanita.fvg.it; Londero, Viviana [Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine (Italy)], E-mail: vlondero@sirm.org; Linda, Anna [Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine (Italy)], E-mail: annalinda33@gmail.com; Furlan, Alessandro [Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine (Italy)], E-mail: ali.furlan@gmail.com; Bazzocchi, Massimo [Institute of Radiology, University of Udine, via Colugna 50, 33100 Udine (Italy)], E-mail: bazzocchi.massimo@aoud.sanita.fvg.it

    2009-07-15

    The purpose of this study was to evaluate the reliability of volumetric magnetic resonance imaging (MRI) in breast cancer size assessment before, during and after neoadjuvant chemotherapy (NAC). Volumetric MRI measures performed on 15 patients with breast cancer were compared with volumes reckoned upon mean lesional diameters, using the same MRI data. Concordance correlation coefficient (CCC), Bland and Altman plots, RECIST evaluation and Cohen's Kappa were assessed, to evaluate the agreement between the two methods. CCC was computed before (0.9357), during (0.8053) and after (0.7499) NAC, in all examinations pooled together (0.8617), and on final tumor volume as a percentage of baseline volume (0.9224). In 2/15 (13.3%) cases RECIST assessment was different. Cohen's Kappa was 0.787 (CI{sub 95%} = 0.513-1.062). In summary, volumetric MRI is a reliable tool to assess breast cancer size before, during and after NAC. Further investigations are needed to understand whether improvements in surgical planning are feasible.

  7. Mesoporous Silica Nanoparticles Loaded with Cisplatin and Phthalocyanine for Combination Chemotherapy and Photodynamic Therapy in vitro

    Directory of Open Access Journals (Sweden)

    Juan L. Vivero-Escoto

    2015-12-01

    Full Text Available Mesoporous silica nanoparticles (MSNs have been synthesized and loaded with both aluminum chloride phthalocyanine (AlClPc and cisplatin as combinatorial therapeutics for treating cancer. The structural and photophysical properties of the MSN materials were characterized by different spectroscopic and microscopic techniques. Intracellular uptake and cytotoxicity were evaluated in human cervical cancer (HeLa cells by confocal laser scanning microscopy (CLSM and 3-(4,5-dimethylthiazol-2-yl-5-(3-carboxymethoxyphenyl-2-(4-sulfophenyl-2H-tetrazolium (MTS assays, respectively. The CLSM experiments showed that the MSN materials can be readily internalized in HeLa cells. The cytotoxic experiments demonstrated that, after light exposure, the combination of both AlClPc and cisplatin compounds in the same MSN platform potentiate the toxic effect against HeLa cells in comparison to the control AlClPc-MSN and cisplatin-MSN materials. These results show the potential of using MSN platforms as nanocarriers for combination photodynamic and chemotherapies to treat cancer.

  8. [Transarterial infusion chemotherapy using fine-powder cisplatin in patients with advanced hepatocellular carcinoma].

    Science.gov (United States)

    Hatanaka, Takeshi; Kakizaki, Satoru; Ueno, Takashi; Takeuchi, Suguru; Takizawa, Daichi; Katakai, Kenji

    2014-02-01

    We investigated the therapeutic effects and safety of fine powder cisplatin for patients with advanced hepatocellular carcinoma( HCC). From January 2006 to March 2012, 123 patients with advanced HCC were treated by transarterial infusion chemotherapy(TAI)with fine-powder cisplatin(IA-call®, Nippon Kayaku Co. Ltd., Tokyo, Japan). The drug was infused into the liver through the feeding artery at a dose of 65 mg/m2. The treatment was repeated every 4 to 8 weeks until evidence of either tumor progression or unacceptable toxicity appeared. Treatment responses were classified as complete response(CR), partial response(PR), stable disease(SD), and progressive disease(PD)in 3.2%, 12.0%, 32.2%, and 52.4% of patients, respectively. The median survival durations were as follows: overall, 12.2 months; CR/PR patients, 23.8 months; and SD/PD patients, 10.6 months. The cumulative survival rates of CR/PR patients were significantly higher than those of SD/PD patients (pPIVKA- II )were predictive factors of survival duration. Problematic adverse events were not observed in any of the patients. Our results suggest that TAI using fine-powder cisplatin can be safely administered for advanced HCC and can improve the prognosis of patients with advanced disease. PMID:24743198

  9. Combination of radiotherapy with chemotherapy using cisplatin of advanced esophageal carcinoma

    International Nuclear Information System (INIS)

    Of 38 patients with esophageal carcinoma who were treated at the Department of Radiology, Tokushima University Hospital between 1983 and 1987, 13 (34 %) received a combination of radiation and chemotherapy of cisplatin-based combination regimens. Twelve patients with squamous cell carcinoma and one with adenocarcinoma were treated by a 6 MV linear accelerater. They received a cummulative dose ranging from 18 to 68 Gy (average dose : 50.5 Gy), in 2 Gy fractions. The response rate was 62 % (CR 1, PR 7). Two of the six patients with Stage III survived more than three years. Median survival time was 11.4 months for patients with Stage III and 4.7 months for Stage IV. Chemotherapy improved median survival duration for patients with advanced esophageal carcinoma but did not produce a significant improvement in survival, as reported in other recent series. (author)

  10. Conservative treatment for invasive bladder cancer: neo-adjuvant chemotherapy and radiotherapy; Traitement conservateur des cancers infiltrants de la vessie: chimiotherapie neoadjuvante et radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Prie, L.; Gaston, R.; Richaud, P.; Brui, B.N. [Institut Bergonie, Centre Regional de Lutte Contre le Cancer, 33 - Bordeaux (France); Ferriere, J.M.; Le Guillou, M. [Hopital Pellegrin, 33 - Bordeaux (France)

    1998-04-01

    Retrospective evaluation of tolerance and efficiency of a combination of chemotherapy and radiotherapy in non metastatic invasive cancer of the bladder. Neo-adjuvant chemotherapy leads to CR in 44 % of patients and CR is observed in 64 % of the patients after radiation therapy. However, the survival rate at 5 years is insufficient, even if the rate of bladder conservation is high. (author)

  11. 18F-fluorodeoxyglucose positron emission tomography optimizes neoadjuvant chemotherapy for primary breast cancer to achieve pathological complete response

    International Nuclear Information System (INIS)

    The background of this study was to assess the usefulness of positron emission tomography combined with computed tomography using 18F-fluorodeoxyglucose (FDG positron emission tomography (PET)/CT) for optimizing chemotherapy during neoadjuvant chemotherapy for primary breast cancer. One hundred and eight patients (110 tumors) with breast cancer (≥2 cm, stages II and III) received neoadjuvant chemotherapy consisting of an anthracycline-based regimen and taxane. The maximal value of the baseline standardized uptake value (SUV) and the change in SUV after four cycles of an anthracycline-based regimen relative to baseline SUV were assessed for predicting pathological complete response (pCR) after sequential taxane. Tumors with pCR had significantly higher baseline SUV (9.3±3.7 SD) compared to those with non-pCR (7.2±3.8 SD) (p=0.02), but there was a considerable overlap between two groups. On PET scan after four cycles of chemotherapy, thirty-three patients (33.7%) with a 72.1% or greater reduction in SUV were considered as responders and the performance in predicting pCR had a sensitivity of 88.9% and specificity of 78.7%. The baseline SUV could not be a useful indicator for predicting pCR due to the wide range in sensitivity. On the other hand, a relative change in SUV after completion of an anthracycline-based regimen could be useful for predicting pCR. (author)

  12. {sup 18}F-FDG PET response to neoadjuvant chemotherapy for Ewing sarcoma and osteosarcoma are different

    Energy Technology Data Exchange (ETDEWEB)

    Gaston, Louie L. [Philippine General Hospital, Department of Orthopedics, Manila (Philippines); Di Bella, Claudia [Saint Vincent' s Hospital, Department of Orthopedics, East Melbourne, VIC (Australia); Peter MacCallum Cancer Centre, Bone and Soft Tissue Sarcoma Service, East Melbourne, VIC (Australia); Slavin, John [Saint Vincent' s Hospital, Department of Pathology, Melbourne (Australia); Hicks, Rodney J. [The Peter MacCallum Cancer Centre, Centre for Cancer Imaging, Translational Research Group, Molecular Imaging and Targeted Therapeutics Laboratory, East Melbourne, VIC (Australia); Choong, Peter F.M. [Saint Vincent' s Hospital, Department of Orthopedics, East Melbourne, VIC (Australia); Peter MacCallum Cancer Centre, Bone and Soft Tissue Sarcoma Service, East Melbourne, VIC (Australia); University of Melbourne, Department of Surgery, Melbourne (Australia)

    2011-08-15

    Ewing sarcoma (ES) and osteosarcoma (OS) have different biological characteristics and respond differently to chemotherapy. We reviewed {sup 18}F-FDG PET imaging characteristics of ES and OS patients at baseline and following treatment to determine whether this biological variation is reflected in their imaging phenotype. A retrospective review of ES and OS patients treated with neoadjuvant chemotherapy and surgery was done, correlating PET results with histologic response to chemotherapy. Change in the maximum standardized uptake value (SUVmax) between baseline and post-treatment scanning was not significantly associated with histologic response for either ES or OS. Metabolic tumor volume (MTV) and the percentage of injected {sup 18}F-FDG dose (%ID) in the primary tumor were found to be different for ES and OS response subgroups. A 50% reduction in MTV (MTV2:1 < 0.5) was found to be significantly associated with favorable histologic response in OS. Using the same criteria for ES incorrectly predicted good responders. Increasing the cut-off values for ES to a 90% reduction in MTV (MTV2:1 < 0.1) resulted in association with favorable histologic response. Response to neoadjuvant chemotherapy as reflected by changes in PET characteristics should be interpreted differently for ES and OS. (orig.)

  13. Transarterial infusion chemotherapy with cisplatin plus S-1 for hepatocellular carcinoma treatment: a phase I trial

    International Nuclear Information System (INIS)

    In Japan, transarterial infusion chemotherapy using cisplatin (CDDP-TAI) is frequently used for advanced hepatocellular carcinoma (HCC). Moreover, oral chemotherapy with S-1, an oral fluoropyrimidine derivative, has also elicited promising responses in HCC patients. We determined the recommended dosage for CDDP-TAI plus S-1 combination therapy for advanced HCC. Twelve Child–Pugh class A or B patients with advanced HCC who met the eligibility criteria were enrolled in this phase I trial. Patients received CDDP-TAI (infusion, day 1) plus S-1 (oral administration, days 1–21) every 5 weeks until disease progression. Cisplatin (65 mg/m2) was administered with S-1 at 50 mg · m-2 day-1 (level 1, 3 patients), 60 mg · m-2 day-1 (level 2, 3 patients), or 80 mg · m-2 day-1 (level 3, 6 patients). The total number of treatment courses was 25 (median, 2 courses/patient; range, 1–6 courses). Dose-limiting toxicity was not observed in any patient at any level; therefore, the recommended dosage for cisplatin and S-1 in combination was level 3. Grade 3 adverse events were elevated alanine aminotransferase levels (2 patients), elevated aspartate aminotransferase levels (2 patients), anemia (1 patient), and decreased platelet counts (1 patient). Median progression-free survival and overall survival were 73 days and 328 days, respectively. The disease control rate was 58% (7/12); 17% (2/12) of patients achieved partial response and 42% (5/12) achieved stable disease. CDDP-TAI plus S-1 is safe for the treatment of HCC. The recommended dosage for further evaluation of this combination therapy in phase II studies is 65 mg/m2 CDDP and 80 mg/m2 S-1. UMIN; number: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function

  14. Short-term Intensive Neoadjuvant Chemotherapy Improving 10-year Survival for Patients with Stage Ⅱ and Operable Stage Ⅲ Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    BinZhang; YueCai; QiZhang; ZiweiYing; ShulingJiang; HongXu; YongxueZheng; DaqingJiang

    2004-01-01

    OBJECTIVE To evaluate the 10-year curative effects of short-term intensive neoadjuvant chemotherapy for operable breast cancer. METHODS A total of 510 patients with stagell and operable stagelll breast cancer were divided into group A (preoperative neoadjuvant chemotherapy 251 cases) and group B (postoperative adjuvant chemotherapy 259 cases). The patients in group A received short-term and intensive neoadjuvant chemotherapy for 4 weeks followed by modified radical mastectomy two weeks after the chemotherapy. The postoperative adjuvant chemotherapy began within two weeks after surgery. The same chemotherapeutic regimen was used for both groups. RESULTS For stage Ⅲ in group A the 5-year overall survival rate (OS) and disease-free survival rate (DFS) were 59.2% and 54.9% respectively which were higher than those in group B (28.3% and 20.8% respectively, P<0.05). The 10-year OS and DFS were 78.1% and 73.5% respectively for stage Ⅱ in group A which were higher than those in group B (68.4% and 60.7%, P<0.05). The 10-year OS and DFS were 42.3% and 40.4% respectively forstage Ⅲ in group A which were higher than those in group B (20.4% and 18.4% respectively, P<0.05). CONCLUSION The results showed that intensive neoadjuvant chemotherapy can improve the 10-year survival for patients with stage Ⅱ and operablestage Ⅲ breast cancer.

  15. Efficacy of neoadjuvant chemotherapy in down staging locally advanced pre-menopausal breast cancer in Eastern Nigeria: Is four courses adequate?

    OpenAIRE

    Ochonma Amobi Egwuonwu; Stanley Nnamdi Anyanwu; Alexander Maduaburochukwu Nwofor

    2013-01-01

    Context: Breast cancer is the most frequent cancer among women in most part of the world and in Nigeria. Neoadjuvant chemotherapy (NAC) has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer (LABC). Aims: To determine if the use of four courses of doxorubicin based neoadjuvant chemotherapeutic regimen will result in significant primary tumor down-staging. Settings and Design: One year prospective study of premenopausal breast cancer patients pres...

  16. CA-125 cut-off value as a predictor for complete interval debulking surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer

    OpenAIRE

    Furukawa, Naoto; Sasaki, Yoshikazu; Shigemitsu, Aiko; AKASAKA, JURIA; Kanayama, Seiji; Kawaguchi, Ryuji; Kobayashi, Hiroshi

    2013-01-01

    Objective In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. Methods This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinu...

  17. HER2 and topoisomerase Ⅱα : possible predictors of response to neoadjuvant chemotherapy for breast cancer patients

    Institute of Scientific and Technical Information of China (English)

    ZHU Li; LI Ya-fen; CHEN Wei-guo; HE Jian-rong; PENG Chen-hong; ZHU Zheng-gang; LI Hong-wei

    2008-01-01

    Background Surrogate markers may be used to assess the response to neoadjuvant treatment. The association between HER2 overexpression and favorable response to specific therapy in breast cancer is controversial, and the mechanism unclear. The purpose of the study was to evaluate HER2 and topoisomerase lla (Topo Ⅱα ) as candidates for predicting the response to neoadjuvant chemotherapy in breast cancer patients.Methods Between 1999 and 2006, seventy-six breast cancer patients who had received neoadjuvant chemotherapy were studied. Regimens including either CEF (cyclophosphamide, epirubicin, 5-fluorouracil) or CMF (cyclophosphamide, methotrexate, 5-fluorouracil) were given in more than three cycles to this group of patients. Protein expression of HER2 and Topo lla were determined by immunohistochemistry. The primary endpoint was pathological and clinical response. Results Of 76 primary breast cancer samples, 27 (35.5%) showed overexpression of either HER2 (25%) or Topo Ⅱα protein (10.5%), whereas in 7 tumors (9.2%) both proteins were found to be overexpressed. Ten patients (13.2%) had a clinical complete response and 21 (27.6%) had a clinical partial response. Five women (6.6%) had a pathological complete response, 5 (6.6%) had microscopic residual disease, and 46 (60.5%) had macroscopic residual disease. HER2 and Topo lla overexpression was significantly associated with a favorable response (P <0.001 and P=0.005 respectively).Conclusion Our study suggests that HER2 and Topo Ⅱα overexpression could be predictors of the response to neoadjuvant chemothrapy in both the CEF and CMF arms.

  18. Is Tc99m-MIBI scintigraphy a predictor of response to pre-operative neoadjuvant chemotherapy in Osteosarcoma?

    Directory of Open Access Journals (Sweden)

    Vahidreza Dabbagh Kakhki

    2013-10-01

    Full Text Available Objectives: Multidrug resistance (MDR, which may be due to the over expression of P-glycoprotein (Pgp and/or MRP, is a major problem in neoadjuvant chemotherapy of osteosarcoma. The aim of this study was to investigate the role of Tc-99m MIBI scan for predicting the response to pre-operative chemotherapy. Materials and Methods: Twenty-five patients (12 males and 13 females, aged between 8 and 52y with osteosarcoma were studied. Before the chemotherapy, planar 99mTc-MIBI anterior and posterior images were obtained 10-min [tumor-to-background ratio: (T1/B110min] and 3-hr after tracer injection. After completion of chemotherapy, again 99mTc-MIBI scan was performed at 10-min after tracer injection. In addition to calculation of decay corrected tumor to background (T/B ratios ,  using the 10-min and 3-hr images of the pre-chemotherapy scintigraphy , percent wash-out rate (WR% of 99mTc-MIBI was calculated. Using the 10-min images of the pre- and post-chemotherapy scans, the percent reduction in uptake at the tumor site after treatment (Red% was also calculated. Then after surgical resection, tumor response was assessed by percentage of necrosis. Results: All patients showed significant 99mTc-MIBI uptake in early images. Only 9 patients showed good response to chemotherapy (necrosis≥90% while 16 patients were considered as non-responder (necrosis

  19. Neo-adjuvant chemotherapy followed by surgery and chemotherapy or by surgery and chemoradiotherapy for patients with resectable gastric cancer (CRITICS)

    International Nuclear Information System (INIS)

    Radical surgery is the cornerstone in the treatment of resectable gastric cancer. The Intergroup 0116 and MAGIC trials have shown benefit of postoperative chemoradiation and perioperative chemotherapy, respectively. Since these trials cannot be compared directly, both regimens are evaluated prospectively in the CRITICS trial. This study aims to obtain an improved overall survival for patients treated with preoperative chemotherapy and surgery by incorporating radiotherapy concurrently with chemotherapy postoperatively. In this phase III multicentre study, patients with resectable gastric cancer are treated with three cycles of preoperative ECC (epirubicin, cisplatin and capecitabine), followed by surgery with adequate lymph node dissection, and then either another three cycles of ECC or concurrent chemoradiation (45 Gy, cisplatin and capecitabine). Surgical, pathological, and radiotherapeutic quality control is performed. The primary endpoint is overall survival, secondary endpoints are disease-free survival (DFS), toxicity, health-related quality of life (HRQL), prediction of response, and recurrence risk assessed by genomic and expression profiling. Accrual for the CRITICS trial is from the Netherlands, Sweden, and Denmark, and more countries are invited to participate. Results of this study will demonstrate whether the combination of preoperative chemotherapy and postoperative chemoradiotherapy will improve the clinical outcome of the current European standard of perioperative chemotherapy, and will therefore play a key role in the future management of patients with resectable gastric cancer. clinicaltrials.gov http://www.clinicaltrials.gov/ct2/show/NCT00407186

  20. Factor V Leiden mutation triggering four major complications to standard dose cisplatin-chemotherapy for testicular seminoma: a case report

    OpenAIRE

    Dieckmann, Klaus-Peter; Anheuser, Petra; Gehrckens, Ralf; Aries, Sven Philip; Ikogho, Raphael; Hollburg, Wiebke

    2015-01-01

    Background Major life-threatening complications secondary to cisplatin-based chemotherapy are rare in patients with testicular germ cell tumour (GCT). The incidence of complications increases with dosage of chemotherapy and with a variety of patient-related as well as disease-related conditions. We here report the first case of GCT experiencing as many as four major complications most of which can be explained by the conjunction of several predispositions. Case presentation A 48 year old pati...

  1. Evaluation of the synergetic radio-chemotherapy effects of the radio labelled cisplatin for the treatment of glioma

    International Nuclear Information System (INIS)

    The proposal of this work was to investigate the effect of the radioactive (NH3)2PtCl2, cis-diamminedichloroplatinum (II) or CDDP* on malignant glioma cells and verify if the low-dose continuous internal radio-chemotherapy would be able to produce additive effects. The antitumoral activity of CDDP* and the non labeled cisplatin, CDDP, were evaluated in glioblastoma. Cisplatin was cytotoxic for glioblastoma cells in a dose dependent manner. Treatment with CDDP*, (IC50 = 1.75 ± 0.07 μM), proved to be more potent than using just CDDP, (IC50 = 4.96 ± 0.40 μM). These results suggest that cisplatin is a very potent radiosensitizer evoking a supra additive effect. Internal radio-chemotherapy treatment based on CDDP* may be useful alternative to reduce the drug concentration required for effective inhibition of glioblastoma growth. (author)

  2. A phase II trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis

    OpenAIRE

    Wang, Yan; Yu, Yi-yi; Li, Wei; Feng, Yi; Hou, Jun; Ji, Yuan; Sun, Yi-Hong; Shen, Kun-Tang; Shen, Zhen-Bin; Qin, Xin-Yu; Liu, Tian-shu

    2014-01-01

    Purpose Gastric cancer with para-aortic lymph node (PAN) involvement is regarded as advanced disease, and only chemotherapy is recommended from the guidelines. In unresectable cases, neoadjuvant chemotherapy could prolong survival if conversion to resectability could be achieved. Methods The study was a single-arm phase II trial. Patients who were diagnosed with gastric cancer and PAN involvement (Stations No. 16a2/16b1) were treated with capecitabine and oxaliplatin combination chemotherapy ...

  3. Assessment of breast cancer response to neoadjuvant chemotherapy with time-intensity curve parameters in MRI

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical value of the type and the steepest slope of tumor's time-intensity curve (TIC) in assessing the pathologic response of locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: Thirty-six patients with pathologically confirmed locally advanced breast cancer who finished four courses of neoadjuvant chemotherapy underwent preoperative breast MRI three times during the NAC. Pathologic response was assessed according Miller-Payne grading system, grade 4 and 5 were defined as major histological response (MHR, n=16) group, and grade 1 to 3 as non- major histological response(NMHR, n=20)group. The type and the steepest slope of tumor's TIC were compared between two groups before NAC, after the second cycle and after the fourth cycle of NAC. ROC analysis was carded out to assess the clinical value of the TIC parameters. Results: After the second cycle of NAC, the steepest slope of TIC and its first change rate were different between the MHR group [(1.93± 0.88)%/s, median 35.6%] and NMHR group [(2.73±1.22)%/s, median -11.4%] (P= 0.045 and 0.01, t=1.09, Z=-3.64). After the fourth cycle, the proportion of type I in MHR group (62.5%, 10/16) was significantly higher than that in NMHR group (10.0%, 2/20, P=0.01, Z=-2.02), and the proportion of type III in MHR group (6.2%, 1/16) was significantly lower than that in NMH1R group (60.0%, 12/20, P=0.01, Z=-1.48). The steepest slope and its second change rate were different between the MHR group [(1.33±0.52)%/s, median 56.8%] and NMHR group [(2.33± 0.94)%/s, median 15.8%] (P<0.01, t=1.82, Z=-3.58). After the second cycle, the area under curve of the steepest slope of TIC and its first change rate were 0.70 (P=0.04), 0.80 (P=0.01), respectively. After the fourth cycle, the area under curve of the type I , the type I + II, the steepest slope and its second change were 0.78 (P=0.03), 0.69 (P=0.06), 0.82 (P=0.01), 0.92 (P=0.01), respectively. Conclusion: The steepest

  4. A randomized trial comparing adjuvant chemotherapy with gemcitabine plus cisplatin with docetaxel plus cisplatin in patients with completely resected non-small-cell lung cancer with quality of life as the primary objective

    OpenAIRE

    Barlesi, Fabrice; Chouaid, Christos; Crequit, Jacky; Le Caer, Hervé; Pujol, Jean Louis; Legodec, Julien; Vergnenegre, Alain; Le Treut, Jacques; Fabre-Guillevin, Elizabeth; Loundou, Anderson; Auquier, Pascal; Simeoni, Marie-Claude; Thomas, Pascal A

    2015-01-01

    International audience OBJECTIVES: Adjuvant chemotherapy with vinorelbine plus cisplatin (VC) improves survival in resected non-small-cell lung cancer (NSCLC), but has negative impact on quality of life (QoL). In advanced NSCLC, gemcitabine plus cisplatin (GC) and docetaxel plus cisplatin (DC) exhibit comparable efficacy, with possibly superior QoL compared to VC. This trial investigated these regimens in the adjuvant setting. METHODS: Patients with Stage IB to III NSCLC were eligible foll...

  5. Prognostic value of metabolic response in breast cancer patients receiving neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Today's clinical diagnostic tools are insufficient for giving accurate prognosis to breast cancer patients. The aim of our study was to examine the tumor metabolic changes in patients with locally advanced breast cancer caused by neoadjuvant chemotherapy (NAC), relating these changes to clinical treatment response and long-term survival. Patients (n = 89) participating in a randomized open-label multicenter study were allocated to receive either NAC as epirubicin or paclitaxel monotherapy. Biopsies were excised pre- and post-treatment, and analyzed by high resolution magic angle spinning magnetic resonance spectroscopy (HR MAS MRS). The metabolite profiles were examined by paired and unpaired multivariate methods and findings of important metabolites were confirmed by spectral integration of the metabolite peaks. All patients had a significant metabolic response to NAC, and pre- and post-treatment spectra could be discriminated with 87.9%/68.9% classification accuracy by paired/unpaired partial least squares discriminant analysis (PLS-DA) (p < 0.001). Similar metabolic responses were observed for the two chemotherapeutic agents. The metabolic responses were related to patient outcome. Non-survivors (< 5 years) had increased tumor levels of lactate (p = 0.004) after treatment, while survivors (≥ 5 years) experienced a decrease in the levels of glycine (p = 0.047) and choline-containing compounds (p ≤ 0.013) and an increase in glucose (p = 0.002) levels. The metabolic responses were not related to clinical treatment response. The differences in tumor metabolic response to NAC were associated with breast cancer survival, but not to clinical response. Monitoring metabolic responses to NAC by HR MAS MRS may provide information about tumor biology related to individual prognosis

  6. Early Prediction and Evaluation of Breast Cancer Response to Neoadjuvant Chemotherapy Using Quantitative DCE-MRI.

    Science.gov (United States)

    Tudorica, Alina; Oh, Karen Y; Chui, Stephen Y-C; Roy, Nicole; Troxell, Megan L; Naik, Arpana; Kemmer, Kathleen A; Chen, Yiyi; Holtorf, Megan L; Afzal, Aneela; Springer, Charles S; Li, Xin; Huang, Wei

    2016-02-01

    The purpose is to compare quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) metrics with imaging tumor size for early prediction of breast cancer response to neoadjuvant chemotherapy (NACT) and evaluation of residual cancer burden (RCB). Twenty-eight patients with 29 primary breast tumors underwent DCE-MRI exams before, after one cycle of, at midpoint of, and after NACT. MRI tumor size in the longest diameter (LD) was measured according to the RECIST (Response Evaluation Criteria In Solid Tumors) guidelines. Pharmacokinetic analyses of DCE-MRI data were performed with the standard Tofts and Shutter-Speed models (TM and SSM). After one NACT cycle the percent changes of DCE-MRI parameters K(trans) (contrast agent plasma/interstitium transfer rate constant), ve (extravascular and extracellular volume fraction), kep (intravasation rate constant), and SSM-unique τi (mean intracellular water lifetime) are good to excellent early predictors of pathologic complete response (pCR) vs. non-pCR, with univariate logistic regression C statistics value in the range of 0.804 to 0.967. ve values after one cycle and at NACT midpoint are also good predictors of response, with C ranging 0.845 to 0.897. However, RECIST LD changes are poor predictors with C = 0.609 and 0.673, respectively. Post-NACT K(trans), τi, and RECIST LD show statistically significant (P < .05) correlations with RCB. The performances of TM and SSM analyses for early prediction of response and RCB evaluation are comparable. In conclusion, quantitative DCE-MRI parameters are superior to imaging tumor size for early prediction of therapy response. Both TM and SSM analyses are effective for therapy response evaluation. However, the τi parameter derived only with SSM analysis allows the unique opportunity to potentially quantify therapy-induced changes in tumor energetic metabolism. PMID:26947876

  7. Neoadjuvant chemotherapy for locally advanced cervical cancer reduces surgical risks and lymph-vascular space involvement

    Institute of Scientific and Technical Information of China (English)

    Yue Wang; Guang Wang; Li-Hui Wei; Ling-Hui Huang; Jian-Liu Wang; Shi-Jun Wang; Xiao-Ping Li

    2011-01-01

    Neoadjuvant chemotherapy (NACT),which can reduce the size and therefore increase the resectability of tumors,has recently evolved as a treatment for locally advanced cervical cancer.NACT has been reported to decrease the risk of pathologic factors related to prognosis of cervical cancer.To further assess the effects of NACT on surgery and the pathologic characteristics of cervicat cancer,we reviewed 110 cases of locally advanced cervical cancer treated with radical hysterectomy with or without NACT at the People's Hospital of Peking University between January 2006 and December 2010.Of 110 patients,68 underwent platinum-based NACT prior to surgery (NACT group) and 42 underwent pdmary surgery treatment (PST group).Our results showed 48 of 68 (70.6%) patients achieved a complete response or partial response to NACT.Estimated blood loss,operation time,and number of removed lymph nodes during surgery,as well as complication rates during and after surgery were not significantly different between the NACT group and the PST group.The rates of deep stromal invasion,positive parametria,positive surgical vaginal margins,and lymph node metastasis were not significantly different between the two groups.However,the rate of lymph-vascular space involvement (LVSI) was significantly lower in the NACT group than in the PST group (P = 0.021).In addition,the response rate of NACT was significantly higher in the patients with chemotherapeutic drugs administrated via artery than via vein.Our results suggest that NACT is a safe and effective treatment for locally advanced cervical cancer and significantly decreases the rate of LVSI.

  8. Early Prediction and Evaluation of Breast Cancer Response to Neoadjuvant Chemotherapy Using Quantitative DCE-MRI

    Directory of Open Access Journals (Sweden)

    Alina Tudorica

    2016-02-01

    Full Text Available The purpose is to compare quantitative dynamic contrast-enhanced (DCE magnetic resonance imaging (MRI metrics with imaging tumor size for early prediction of breast cancer response to neoadjuvant chemotherapy (NACT and evaluation of residual cancer burden (RCB. Twenty-eight patients with 29 primary breast tumors underwent DCE-MRI exams before, after one cycle of, at midpoint of, and after NACT. MRI tumor size in the longest diameter (LD was measured according to the RECIST (Response Evaluation Criteria In Solid Tumors guidelines. Pharmacokinetic analyses of DCE-MRI data were performed with the standard Tofts and Shutter-Speed models (TM and SSM. After one NACT cycle the percent changes of DCE-MRI parameters Ktrans (contrast agent plasma/interstitium transfer rate constant, ve (extravascular and extracellular volume fraction, kep (intravasation rate constant, and SSM-unique τi (mean intracellular water lifetime are good to excellent early predictors of pathologic complete response (pCR vs. non-pCR, with univariate logistic regression C statistics value in the range of 0.804 to 0.967. ve values after one cycle and at NACT midpoint are also good predictors of response, with C ranging 0.845 to 0.897. However, RECIST LD changes are poor predictors with C = 0.609 and 0.673, respectively. Post-NACT Ktrans, τi, and RECIST LD show statistically significant (P < .05 correlations with RCB. The performances of TM and SSM analyses for early prediction of response and RCB evaluation are comparable. In conclusion, quantitative DCE-MRI parameters are superior to imaging tumor size for early prediction of therapy response. Both TM and SSM analyses are effective for therapy response evaluation. However, the τi parameter derived only with SSM analysis allows the unique opportunity to potentially quantify therapy-induced changes in tumor energetic metabolism.

  9. Predicting Response to Neoadjuvant Chemotherapy with PET Imaging Using Convolutional Neural Networks.

    Science.gov (United States)

    Ypsilantis, Petros-Pavlos; Siddique, Musib; Sohn, Hyon-Mok; Davies, Andrew; Cook, Gary; Goh, Vicky; Montana, Giovanni

    2015-01-01

    Imaging of cancer with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) has become a standard component of diagnosis and staging in oncology, and is becoming more important as a quantitative monitor of individual response to therapy. In this article we investigate the challenging problem of predicting a patient's response to neoadjuvant chemotherapy from a single 18F-FDG PET scan taken prior to treatment. We take a "radiomics" approach whereby a large amount of quantitative features is automatically extracted from pretherapy PET images in order to build a comprehensive quantification of the tumor phenotype. While the dominant methodology relies on hand-crafted texture features, we explore the potential of automatically learning low- to high-level features directly from PET scans. We report on a study that compares the performance of two competing radiomics strategies: an approach based on state-of-the-art statistical classifiers using over 100 quantitative imaging descriptors, including texture features as well as standardized uptake values, and a convolutional neural network, 3S-CNN, trained directly from PET scans by taking sets of adjacent intra-tumor slices. Our experimental results, based on a sample of 107 patients with esophageal cancer, provide initial evidence that convolutional neural networks have the potential to extract PET imaging representations that are highly predictive of response to therapy. On this dataset, 3S-CNN achieves an average 80.7% sensitivity and 81.6% specificity in predicting non-responders, and outperforms other competing predictive models. PMID:26355298

  10. Predicting Response to Neoadjuvant Chemotherapy with PET Imaging Using Convolutional Neural Networks.

    Directory of Open Access Journals (Sweden)

    Petros-Pavlos Ypsilantis

    Full Text Available Imaging of cancer with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET has become a standard component of diagnosis and staging in oncology, and is becoming more important as a quantitative monitor of individual response to therapy. In this article we investigate the challenging problem of predicting a patient's response to neoadjuvant chemotherapy from a single 18F-FDG PET scan taken prior to treatment. We take a "radiomics" approach whereby a large amount of quantitative features is automatically extracted from pretherapy PET images in order to build a comprehensive quantification of the tumor phenotype. While the dominant methodology relies on hand-crafted texture features, we explore the potential of automatically learning low- to high-level features directly from PET scans. We report on a study that compares the performance of two competing radiomics strategies: an approach based on state-of-the-art statistical classifiers using over 100 quantitative imaging descriptors, including texture features as well as standardized uptake values, and a convolutional neural network, 3S-CNN, trained directly from PET scans by taking sets of adjacent intra-tumor slices. Our experimental results, based on a sample of 107 patients with esophageal cancer, provide initial evidence that convolutional neural networks have the potential to extract PET imaging representations that are highly predictive of response to therapy. On this dataset, 3S-CNN achieves an average 80.7% sensitivity and 81.6% specificity in predicting non-responders, and outperforms other competing predictive models.

  11. Influences of neoadjuvant chemotherapy for serum tumor markers, invasion and metastasis related indexes of patients with advanced breast cancer

    Institute of Scientific and Technical Information of China (English)

    Chuan-Xi Chen

    2016-01-01

    Objective:To explore and analyze the influences on neoadjuvant chemotherapy for serum tumor markers, invasion and metastasis related indexes of patients with advanced breast cancer.Methods:Patients with advanced breast cancer who had been treated in our hospital from February 2010 to February 2014 were randomly selected as research objects. They were randomly divided into control group (conventional surgical treatment group) and observation group (neoadjuant chemotherapy group). There were 32 cases of each group. Then, the changes of the different periods of serum tumor markers, invasion and metastasis related indexes in pretherapy and post-treatment of patients with advanced breast cancer in the two groups were observed.Results:The postoperative serum tumor markers, invasion and metastasis related indexes in different periods of the observation group were all lower than those of the control group, and the postoperative evaluation indexes of the two groups had significant difference. Conclusions:Neoadjuvant chemotherapy has great influences on serum tumor markers, invasion and metastasis related indexes of patients with advanced breast cancer and possesses high clinical application values.

  12. {sup 18}F-FDG PET/CT predicts survival in patients with inflammatory breast cancer undergoing neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Carkaci, Selin [The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX (United States); The Ohio State University, Department of Radiology, Columbus, OH (United States); Sherman, Christopher T.; Ozkan, Efe; Adrada, Beatriz E.; Yang, Wei T. [The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX (United States); Wei, Wei [The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, TX (United States); Rohren, Eric M. [The University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Houston, TX (United States); Mawlawi, Osama R. [The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX (United States); Ueno, Naoto T. [The University of Texas MD Anderson Cancer Center, Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Department of Breast Medical Oncology, Houston, TX (United States); Buchholz, Thomas A. [The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX (United States)

    2013-12-15

    The objective of this study was to evaluate the role of {sup 18}F-FDG PET/CT in predicting overall survival in inflammatory breast cancer patients undergoing neoadjuvant chemotherapy. Included in this retrospective study were 53 patients with inflammatory breast cancer who had at least two PET/CT studies including a baseline study before the start of neoadjuvant chemotherapy. Univariate and multivariate analyses were performed to assess the effects on survival of the following factors: tumor maximum standardized uptake value (SUVmax) at baseline, preoperatively and at follow-up, decrease in tumor SUVmax, histological tumor type, grade, estrogen, progesterone, HER2/neu receptor status, and extent of disease at presentation including axillary nodal and distant metastases. By univariate analysis, survival was significantly associated with decrease in tumor SUVmax and tumor receptor status. Patients with decrease in tumor SUVmax had better survival (P = 0.02). Patients with a triple-negative tumor (P = 0.0006), a Her2/neu-negative tumor (P = 0.038) or an ER-negative tumor (P = 0.039) had worse survival. Multivariate analysis confirmed decrease in tumor SUVmax and triple-negative receptor status as significant predictors of survival. Every 10 % decrease in tumor SUVmax from baseline translated to a 15 % lower probability of death, and complete resolution of tumor FDG uptake translated to 80 % lower probability of death (P = 0.014). Patients with a triple-negative tumor had 4.11 times higher probability of death (P = 0.004). Decrease in tumor SUVmax is an independent predictor of survival in patients with inflammatory breast cancer undergoing neoadjuvant chemotherapy. Further investigation with prospective studies is warranted to clarify its role in assessing response and altering therapy. (orig.)

  13. Gene trio signatures as molecular markers to predict response to doxorubicin cyclophosphamide neoadjuvant chemotherapy in breast cancerpatients

    Directory of Open Access Journals (Sweden)

    M.C. Barros Filho

    2010-12-01

    Full Text Available In breast cancer patients submitted to neoadjuvant chemotherapy (4 cycles of doxorubicin and cyclophosphamide, AC, expression of groups of three genes (gene trio signatures could distinguish responsive from non-responsive tumors, as demonstrated by cDNA microarray profiling in a previous study by our group. In the current study, we determined if the expression of the same genes would retain the predictive strength, when analyzed by a more accessible technique (real-time RT-PCR. We evaluated 28 samples already analyzed by cDNA microarray, as a technical validation procedure, and 14 tumors, as an independent biological validation set. All patients received neoadjuvant chemotherapy (4 AC. Among five trio combinations previously identified, defined by nine genes individually investigated (BZRP, CLPTM1,MTSS1, NOTCH1, NUP210, PRSS11, RPL37A, SMYD2, and XLHSRF-1, the most accurate were established by RPL37A, XLHSRF-1based trios, with NOTCH1 or NUP210. Both trios correctly separated 86% of tumors (87% sensitivity and 80% specificity for predicting response, according to their response to chemotherapy (82% in a leave-one-out cross-validation method. Using the pre-established features obtained by linear discriminant analysis, 71% samples from the biological validation set were also correctly classified by both trios (72% sensitivity; 66% specificity. Furthermore, we explored other gene combinations to achieve a higher accuracy in the technical validation group (as a training set. A new trio, MTSS1, RPL37 and SMYD2, correctly classified 93% of samples from the technical validation group (95% sensitivity and 80% specificity; 86% accuracy by the cross-validation method and 79% from the biological validation group (72% sensitivity and 100% specificity. Therefore, the combined expression of MTSS1, RPL37 and SMYD2, as evaluated by real-time RT-PCR, is a potential candidate to predict response to neoadjuvant doxorubicin and cyclophosphamide in breast cancer

  14. Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: Relation to response patterns on MRI

    International Nuclear Information System (INIS)

    Background. This study evaluated the accuracy of magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy in patients with locally advanced breast cancer and assessed whether the tumor pattern on MRI after chemotherapy influenced the accuracy of the MRI measurement of the residual tumor size. Patients and methods. Fifty patients who received neoadjuvant chemotherapy with doxorubicin and docetaxel for locally advanced breast cancer were evaluated with MRI before and after chemotherapy. We compared the residual tumor size measured by MRI with the pathologically determined size and investigated the influence of the residual tumor pattern on MRI (shrinkage, nest or rim, and mixed) and pathologic characteristics on the accuracy of the MRI measurement. Results. The correlation coefficient between the residual tumor sizes determined by MRI and by pathology was 0.645. The MRI measurement agreed with the pathologically determined size in 36 patients (72%) and disagreed in 14 patients (28%), overestimating the size in 13 (26%) and underestimating the size in one (2%). Disagreement appeared to be more frequent in the cases showing a nest or rim pattern than in those exhibiting a shrinkage pattern, although this was not statistically significant (p=0.119). Conclusions. MRI is an accurate method for predicting the extent of residual tumor after neoadjuvant chemotherapy; however, it may overestimate the residual disease, especially in cases showing a nest or rim tumor pattern and in those having combined lesions with ductal carcinoma in situ or multiple scattered nodules after neoadjuvant chemotherapy

  15. Accuracy of MRI for estimating residual tumor size after neoadjuvant chemotherapy in locally advanced breast cancer: Relation to response patterns on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Jung; Im, Young-Hyuck [Div. of Hematology/Oncology, Dept. of Medic ine, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Suwon (Korea); Han, Boo-Kyung [Dept. of Radiology and Center for Imaging Science, Samsung Medi cal Center, Sungkyunkwan Univ. School of Medicine, Suwon (KR)] (and others)

    2007-10-15

    Background. This study evaluated the accuracy of magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy in patients with locally advanced breast cancer and assessed whether the tumor pattern on MRI after chemotherapy influenced the accuracy of the MRI measurement of the residual tumor size. Patients and methods. Fifty patients who received neoadjuvant chemotherapy with doxorubicin and docetaxel for locally advanced breast cancer were evaluated with MRI before and after chemotherapy. We compared the residual tumor size measured by MRI with the pathologically determined size and investigated the influence of the residual tumor pattern on MRI (shrinkage, nest or rim, and mixed) and pathologic characteristics on the accuracy of the MRI measurement. Results. The correlation coefficient between the residual tumor sizes determined by MRI and by pathology was 0.645. The MRI measurement agreed with the pathologically determined size in 36 patients (72%) and disagreed in 14 patients (28%), overestimating the size in 13 (26%) and underestimating the size in one (2%). Disagreement appeared to be more frequent in the cases showing a nest or rim pattern than in those exhibiting a shrinkage pattern, although this was not statistically significant (p=0.119). Conclusions. MRI is an accurate method for predicting the extent of residual tumor after neoadjuvant chemotherapy; however, it may overestimate the residual disease, especially in cases showing a nest or rim tumor pattern and in those having combined lesions with ductal carcinoma in situ or multiple scattered nodules after neoadjuvant chemotherapy.

  16. Clinical analysis of preoperative induction chemotherapy with gemcitabine combined with cisplatin for locally advanced non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    Qianping Li; Jianjun Wang; Jun Zhang; Chengyi Lin

    2012-01-01

    Objective: The purpose of this study was to assess the curative effect and adverse reaction of preoperative induction chemotherapy with gemcitabine combined with cisplatin for locally advanced non-small cell lung cancer (NSCLC). Methods: This prospective randomized controlled trial included 115 patients with locally advanced NSCLC were randomly divided into experimental and control groups and were treated from January 2007 to January 2010. The experimental group of 63 cases was treated with two cycles of induction chemotherapy before operation, radical surgery had been performed about three weeks after completion of chemotherapy, followed by received two cycles of chemotherapy. And the control group (52 cases) was treated at first with radical surgery, then treated with four cycles of chemotherapy. Two groups of the cases received routine thoracic radiotherapy with a total dose of 45 Gy. One cycle of gemcitabine combined with cisplatin regimen in-cluded gemcitabine 1000 mg/m2 on day 1 and day 8 and cisplatin 25 mg/m2 on day 1, day 2 and day 3 by intravenous infusion, with 21 days as one cycle. The tumor recurrence was evaluated by chest CT and abdominal B-ultrasound. Efficacy and toxicity results were compared by two groups. Results: All patients were followed up for three months to two years. The surgical stage of the experimental group reduced, two-years disease-free survival and postoperative recovery in the experimental group were better than in the control group, the difference was statistical significant. Toxicity and side effect after chemotherapy were mainly bone marrow suppression and gastrointestinal reactions, other complications included thrombocytopenia, leuko-penia, anemia, liver and kidney dysfunction were no significant difference in two groups. Conclusion: Preoperative induction chemotherapy with gemcitabine combined with cisplatin for locally advanced lung cancer can reduce the surgical staging and extend the postoperative disease-free survival.

  17. Trial on Refinement of Early stage non-small cell lung cancer. Adjuvant chemotherapy with pemetrexed and cisplatin versus vinorelbine and cisplatin: The TREAT protocol

    International Nuclear Information System (INIS)

    Adjuvant chemotherapy has been proven to be beneficial for patients with early stage non-small cell lung cancer. However, toxicity and insufficient dose delivery have been critical issues with the chemotherapy used. Doublet regimens with pemetrexed, a multi-target folate inhibitor, and platin show clear activity in non-small cell lung cancer and are well tolerated with low toxicity rates and excellent delivery. In this prospective, multi-center, open label randomized phase II study, patients with pathologically confirmed non-small cell lung cancer, stage IB, IIA, IIB, T3N1 will be randomized after complete tumor resection either to 4 cycles of the standard adjuvant vinorelbine and cisplatin regimen from the published phase III data, or to 4 cycles of pemetrexed 500 mg/m2 d1 and cisplatin 75 mg/m2 d1, q 3 weeks. Primary objective is to compare the clinical feasibility of these cisplatin doublets defined as non-occurrence of grade 4 neutropenia and/or thrombocytopenia > 7 days or bleeding, grade 3/4 febrile neutropenia and/or infection, grade 3/4 non-hematological toxicity, non-acceptance leading to premature withdrawal and no cancer or therapy related death. Secondary parameters are efficacy (time to relapse, overall survival) and drug delivery. Parameters of safety are hematologic and non-hematologic toxicity of both arms. The TREAT trial was designed to evaluate the clinical feasibility, i.e. rate of patients without dose limiting toxicities or premature treatment withdrawal or death of the combination of cisplatin and pemetrexed as well as the published phase III regimen of cisplatin and vinorelbine. Hypothesis of the study is that reduced toxicities might improve the feasibility of drug delivery, compliance and the convenience of treatment for the patient and perhaps survival. Clinicaltrials.gov NCT00349089

  18. Meta-analysis on the association between pathologic complete response and triple-negative breast cancer after neoadjuvant chemotherapy

    OpenAIRE

    Wu, Kunpeng; Yang, Qiaozhu; Liu, Yi; Wu, Aibing; Yang, Zhixiong

    2014-01-01

    Background Triple-negative breast cancer (TNBC) is a special subtype of breast cancer that is characterized by poor prognosis, strong tumor invasion and a high pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC). The pCR rate is a prognostic factor for TNBC. We aimed to evaluate the relationship between pCR and TNBC after NAC and originally tried to identify factors related to achieving pCR for TNBC using a meta-analysis. Methods We systematically searched the literature for ...

  19. CHEMOTHERAPY FOR ADVANCED NASOPHARYNGEAL CARCINOMA WITH METHOTREXATE, VINCRISTINE, CISPLATIN AND ADRIAMYCIN

    Institute of Scientific and Technical Information of China (English)

    苏勇; 张锦明; 夏云飞; 朱荣; 钱朝南; 莫浩元

    2002-01-01

    Objective: To evaluate the efficacy and toxicity of M-VCA (methortrexate 30 mg/m2, vincristine 2 mg, cisplatin 70 mg/m2, adriamycin 30 mg/m2) combination chemotherapy for advanced nasopharyngeal carcinoma. Methods: Thirty-five patients with advanced nasopharyngeal carcinoma, including 11 patients with untreated local advanced nasopharyngeal carcinoma and 24 patients with local-regional recurrent or metastatic nasopharyngeal carcinoma, received the chemotherapy of M-VCA. The cycle was repeated on day 22 for two cycles. All patients completed the chemotherapy courses. Results: The overall response rate was 75%, with untreated local advanced nasopharyngeal carcinomas 11/11(100%), local-regional recurrent nasopharyngeal carcinomas 12/18(67%), lung metastases 8/9(89%), bone metastases 5/9(56%), and liver metastases 1/2(50%). The main side effects included mild to moderate degree alopecia, nausea/vomiting, and neutropenia. Conclusion: M-VCA is well tolerated and has good efficacy for advanced nasopharyngeal carcinoma and is worth investigating further.

  20. Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy

    DEFF Research Database (Denmark)

    De Santis, Maria; Bellmunt, Joaquim; Mead, Graham;

    2012-01-01

    This is the first randomized phase II/III trial comparing two carboplatin-based chemotherapy regimens in patients with urothelial cancer who are ineligible ("unfit") for cisplatin chemotherapy.......This is the first randomized phase II/III trial comparing two carboplatin-based chemotherapy regimens in patients with urothelial cancer who are ineligible ("unfit") for cisplatin chemotherapy....

  1. [Accuracy of multislice CT in restaging patients with non-small cell lung carcinoma after neoadjuvant chemotherapy using a multiparametric approach].

    Science.gov (United States)

    Mazzei, Maria Antonietta; Guerrini, Susanna; Genovese, Eugenio Annibale; Voltolini, Luca; Mazzei, Francesco G; Volterrani, Luca; Macarini, Luca

    2012-11-01

    The aim of this study was to assess diagnostic accuracy of multislice CT in restaging patients with N2 non-small cell lung carcinoma after neoadjuvant chemotherapy, using a multiparametric approach as compared with traditional size-based radiological criteria. All patients staged as N2 at histologic examination after neoadjuvant chemotherapy were correctly staged with multislice CT (sensitivity, specificity, positive and negative predictive value, and accuracy were 100%, 80%, 85%, 100% and 93,7% respectively, vs 34%, 60%, 34%, 60% and 50% using size-based criteria), suggesting that a multiparametric approach results in improved diagnostic accuracy. PMID:23096733

  2. Combined therapy of radiotherapy and chemotherapy (cisplatin, methotrexate and peplomycin) for esophageal cancer

    International Nuclear Information System (INIS)

    Between January 1984 and June 1989, 39 patients with esophageal cancer were treated with radiotherapy and 1-3 courses of cisplatin (80 mg/m2 iv day 1), methotrexate (40 mg/m2 iv day 2), and peplomycin (10 mg/body day 24 hours continuous subcutaneous infusion days 2-5) (Group 1). Results were compared with 35 patients treated between January 1984 and June 1989 with radiotherapy alone (Group 2). Group 1 patients had 35.9% complete response (CR) compared to Group 2 (28.6%). In stage 2, CR rate of Group 1 and Group 2 were 100% and 46.2% respectively (p<0.05). Median survival time (MST) for Group 1 (11 months) was longer than for Group 2 (7 months). Especially in stage 3, MST of Group 1 and Group 2 were 11 months and 5 months respectively (p<0.05). Radiation esophagitis and pneumonitis of Group 1 was more severe and more frequently than Group 2, but no fatal reaction occurred. These data suggest that radiotherapy with chemotherapy (cisplatin, methotrexate, and peplomycin) for esophageal cancer may improve response rate and survival. (author)

  3. Combined therapy of radiotherapy and chemotherapy (cisplatin, methotrexate and peplomycin) for esophageal cancer

    International Nuclear Information System (INIS)

    Between 1984 and 1990, 46 patients with esophageal cancer (squamous cell carcinoma) were treated with radiotherapy and cisplatin, methotrexate and peplomycin. There were 43 males and 3 females. Ages ranged from 40 to 76 years, with a median of 62 years. There were six stage 2, twenty-three stage 3 and seventeen stage 4 (UICC, 1987). Chemotherapy was done at pre-radiotherapy and at 40 Gy. Radiotherapy was external beam irradiation or external beam irradiation combined with intracavitary irradiation. Initial complete response was achieved in 37.0% of patients. Five year cause-specific survival rate was 15.7% in all patients and 83.3% in patients of stage 2. In patients of stage 2 and stage 3 without esophago-broncho fistula and 60 Gy and more of administrated dose, 5 year cause-specific survival rate was 37.5%. Severe esophagitis and pneumonitis occurred in some patients but no fatal reaction occurred. (author)

  4. Neoadjuvant dose-dense chemotherapy for locally advanced breast cancer: a meta-analysis of published studies.

    Science.gov (United States)

    Petrelli, Fausto; Coinu, Andrea; Lonati, Veronica; Cabiddu, Mary; Ghilardi, Mara; Borgonovo, Karen; Barni, Sandro

    2016-08-01

    Large operable or locally advanced breast cancers (BCs) are usually treated with neoadjuvant chemotherapy (CT) before surgery. However, there is no evidence to support an improvement in efficacy with dose-dense (DD) CT in this setting. We, therefore, carried out a meta-analysis to investigate whether DD-CT was more effective than the reference (every 3 weeks anthracyclines±taxanes) standard-dose CT as neoadjuvant treatment for BC. We searched Pubmed, SCOPUS, EMBASE, the Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials for randomized trials comparing conventional versus DD neoadjuvant CT for BC. Odds ratios (ORs) for pathologic complete responses (ypT0N0M0: pCR) and hazard ratios (HRs) of death and recurrence [overall survival (OS), and disease-free survival (DFS)] were estimated and pooled. A QUADAS-2 report for all studies included in the final analysis was tabulated for the risk of bias and applicability. A total of six randomized trials fulfilled the inclusion criteria. The pooled rates of the pCR were 13.5 and 9.2% in the experimental and control arms. A significant increase in the pCR [OR=1.55, 95% confidence interval (CI) 1.18-2.02, P=0.001] was noted with neoadjuvant DD-CT. However, the patients who received DD-CT did not have significantly better DFS and OS rates (DFS: HR=0.88, 95% CI 0.76-1.01, P=0.06; OS: HR=0.89, 95% CI 0.78-1.02, P=0.08). Even with the limitation of a relatively short follow-up period, this meta-analysis shows that DD neoadjuvant CT, despite not leading to a significant increase in survival, increases by 46.7% the possibility of achieving a pCR in operable and locally advanced BC. This treatment should thus be considered one of the backbone treatments of choice when neoadjuvant therapy is planned. PMID:27058707

  5. Accumulation of ALDH1-positive cells after neoadjuvant chemotherapy predicts treatment resistance and prognosticates poor outcome in ovarian cancer.

    Science.gov (United States)

    Ayub, Tiyasha H; Keyver-Paik, Mignon-Denise; Debald, Manuel; Rostamzadeh, Babak; Thiesler, Thore; Schröder, Lars; Barchet, Winfried; Abramian, Alina; Kaiser, Christina; Kristiansen, Glen; Kuhn, Walther; Kübler, Kirsten

    2015-06-30

    Although ovarian cancer is a highly chemosensitive disease, it is only infrequently cured. One of the major reasons lies in the presence of drug-resistant cancer stem-like cells, sufficient to fuel recurrence. We phenotyped cancer stem-like cells by flow cytometry and immunohistochemistry in 55 matched samples before and after taxane/platinum-based neoadjuvant chemotherapy. All used markers of stemness (ALDH1, CD24, CD117, CD133) isolated low frequencies of malignant cells. ALDH1 was the most valuable marker for tracking stemness in vivo. The enrichment of ALDH1 expression after treatment was associated with a poor response to chemotherapy, with platinum resistance and independently prognosticated unfavorable outcome. Our results suggest that increased ALDH1 expression after treatment identifies patients with aggressive tumor phenotypes. PMID:25999351

  6. Prospective validation of immunological infiltrate for prediction of response to neoadjuvant chemotherapy in HER2-negative breast cancer--a substudy of the neoadjuvant GeparQuinto trial.

    Directory of Open Access Journals (Sweden)

    Yasmin Issa-Nummer

    Full Text Available INTRODUCTION: We have recently described an increased lymphocytic infiltration rate in breast carcinoma tissue is a significant response predictor for anthracycline/taxane-based neoadjuvant chemotherapy (NACT. The aim of this study was to prospectively validate the tumor-associated lymphocyte infiltrate as predictive marker for response to anthracycline/taxane-based NACT. PATIENTS AND METHODS: The immunological infiltrate was prospectively evaluated in a total of 313 core biopsies from HER2 negative patients of the multicenter PREDICT study, a substudy of the neoadjuvant GeparQuinto study. Intratumoral lymphocytes (iTuLy, stromal lymphocytes (strLy as well as lymphocyte-predominant breast cancer (LPBC were evaluated by histopathological assessment. Pathological complete response (pCR rates were analyzed and compared between the defined subgroups using the exact test of Fisher. RESULTS: Patients with lymphocyte-predominant breast cancer (LPBC had a significantly increased pCR rate of 36.6%, compared to non-LPBC patients (14.3%, p<0.001. LPBC and stromal lymphocytes were significantly independent predictors for pCR in multivariate analysis (LPBC: OR 2.7, p = 0.003, strLy: OR 1.2, p = 0.01. The amount of intratumoral lymphocytes was significantly predictive for pCR in univariate (OR 1.2, p = 0.01 but not in multivariate logistic regression analysis (OR 1.2, p = 0.11. CONCLUSION: Confirming previous investigations of our group, we have prospectively validated in an independent cohort that an increased immunological infiltrate in breast tumor tissue is predictive for response to anthracycline/taxane-based NACT. Patients with LPBC and increased stromal lymphocyte infiltration have significantly increased pCR rates. The lymphocytic infiltrate is a promising additional parameter for histopathological evaluation of breast cancer core biopsies.

  7. Relative Contributions of Radiation and Cisplatin-Based Chemotherapy to Sensorineural Hearing Loss in Head-and-Neck Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: To investigate the risk of sensorineural hearing loss (SNHL) in patients with head-and-neck cancer and treated with radiation therapy (RT) or concomitant cisplatin-based chemoradiation, the relationship among SNHL and radiation dose to the cochlea, the use of two common cisplatin dose regimens. Methods and Materials: A total of 62 head-and-neck cancer patients treated with curative intent were included in this prospective study. Of the patients, 21 received RT alone, 27 received 40 mg/m2 weekly cisplatin, 13 received 100 mg/m2 every 3 weeks during RT, and 1 received RT with weekly epidermal growth factor receptor inhibitor antibody. The effect of chemotherapy and RT dose on hearing was determined using a model that accounted for the age and variability between each ear for each patient. Results: We constructed a model to predict dose-dependent hearing loss for RT or cisplatin-based chemotherapy either alone or in combination. For patients only receiving RT, no significant hearing loss was found at doses to the cochlea of less than 40 Gy. Patients receiving 100 mg/m2 or 40 mg/m2 of cisplatin chemotherapy had an estimated +21.5 dB and +9.5 dB hearing loss at 8,000 Hz with low radiation doses (10 Gy), which rose to +38.4 dB and +18.9 dB for high radiation doses (40 Gy). Conclusions: Use of RT alone with doses of less than 40 Gy did not result in clinically significant hearing loss. High-frequency SNHL was profoundly damaged in patients who received concomitant cisplatin when doses of 100 mg/m2 were used. The threshold cochlear dose for hearing loss with cisplatin-based chemotherapy and RT was predicted to be 10 Gy. The inner ear radiation dose constraints and cisplatin dose intensity should be considered in the treatment of advanced head-and-neck cancer

  8. The safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer: a systematic review and meta analysis

    Science.gov (United States)

    He, Du; Duan, Chunyan; Chen, Jun; Lai, Lin; Chen, Jiaquan; Chen, Dian

    2015-01-01

    Objective: To evaluate the safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer. Methods: A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined neoadjuvant chemotherapy treatment (NACT)/radical surgery treatment (RST) with RST alone in patients with cervical cancer were eligible for inclusion. Results: Eight studies were finally included in this meta analysis, involving a total of 1302 patients. Meta analysis shows that NACT might have lower lymph node metastasis than RST [OR=0.57, 95% CI (0.41, 0.79), P=0.0008]. However, there are no differentiation between two groups in operation time [SMD=0.16, 95% CI (-0.08, 0.48), P=0.19], intraoperative estimated blood loss [SMD=0.20, 95% CI (-0.19, 0.58), P=0.48], intraoperative and postoperative complication rates [OR=1.33, 95% CI (0.45, 3.92), P=0.60], overall survival rate [OR=1.07, 95% CI (0.48, 2.41), P=0.86] and recurrence rate [OR=1.06, 95% CI (0.56, 2.03), P=0.85]. Conclusions: The safety and efficacy of two treatments are similarly. However, NACT can reduce the rate of lymph node metastasis, which is an independent risk factor for cervical cancer prognosis and may improve the prognosis of cervical cancer. PMID:26628951

  9. Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center

    Directory of Open Access Journals (Sweden)

    V M Patil

    2014-01-01

    Full Text Available Background: Use of any treatment modality in cancer depends not only on the effectiveness of the modality, but also on other factors such as local expertise, tolerance of the modality, cost and prevalence of the disease. Oropharyngeal and laryngeal cancer are the major subsites in which majority of neoadjuvant chemotherapy (NACT literature in the head and neck cancers is available. However, oral cancers form a major subsite in India. Materials And Methods: This is an analysis of a prospectively maintained data on NACT in the head and neck cancers from 2008 to 2012. All these patients were referred for NACT for various indications from a multidisciplinary clinic. Descriptive analysis of indications for NACT in this data base is presented. Results: A total of 862 patients received NACT within the stipulated time period. The sites where oral cavity 721 patients (83.6%, maxilla 41 patients (4.8%, larynx 33 patients (3.8%, laryngopharynx 8 patients (0.9% and hypopharynx 59 patients (8.2%. Out of oral cancers, the major indication for NACT was to make the cancer resectable in all (100% patients. The indication in carcinoma of maxilla was to make the disease resectable in 29 patients (70.7% of maxillary cancers and in 12 patients (29.3% of maxillary cancers it was given as an attempt to preserve the eyeball. The indication for NACT in laryngeal cancers was organ preservation in 14 patients (42.4% of larnyngeal cancer and to achieve resectability in 19 patients (57.6% of larnyngeal cancer. The group with laryngopharynx is a cohort of eight patients in whom NACT was given to prevent tracheostomy, these patients had presented with early stridor (common terminology criteria for adverse events Version 4.02. The reason for NACT in hypopharyngeal cancers was for organ preservation in 24 patients (40.7% of hypopharyngeal cancer and for achievement of resectability in 35 patients (59.3% of hypopharyngeal cancer. Conclusion: The major indication for NACT is to

  10. Combined radiotherapy and preradiation chemotherapy with Cisplatin and 5-Fluorouracil for advanced esophageal carcinoma, 1

    International Nuclear Information System (INIS)

    Eight patients with untreated squamous cell carcinoma of the esophagus accompanying distant metastases who were treated by one to five cycles of chemotherapy consisting of Cisplatin and 120 hour infusion of 5-Fluorouracil were reported. Two patients showed complete response (CR), four partial response (PR), one minor response, and one no response. High response rate of 75% (6 of 8) was obtained. Radiation therapy was then administered to six of the patients. After definitive treatment, CR was obtained in four, and PR in two of the cases. However, relapses were noted in all four of the CR cases, with four at distant sites, and one locally. Five of the eight patients (62.5%) survived one year and two survived three years (25%). Two patients could not receive radiotherapy because of uncontrollable lung metastases or death from duodenal ulcer. Although the follow-up period is still short, the combined treatment of radiation and preradiation chemotherapy appears to be an effective treatment, and has made a major impact upon survival time in cases of disseminated esophageal carcinoma. (author)

  11. Prospective Pilot Study of Consolidation Chemotherapy With Docetaxel and Cisplatin After Concurrent Chemoradiotherapy for Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: With the improvement concurrent chemoradiotherapy (CCRT) in the management of patients with locoregionally advanced head and neck squamous cell carcinoma (HNSCC), distant failures have become a more relevant problem in terms of survival. The primary objective of this Phase II study is to assess the feasibility of docetaxel and cisplatin consolidation after primary CCRT for patients with HNSCC. Methods and Materials: Patients with locoregionally advanced HNSCC received chemotherapy with three cycles of cisplatin, 100 mg/m2, on Days 1, 22, and 43. Concurrent radiotherapy to the primary tumor and neck was given in a daily dose of 2 Gy to a total dose of 70-70.2 Gy over 7 weeks. After completion of CCRT, patients without evidence of disease progression received an additional four cycles of consolidation chemotherapy with docetaxel, 75 mg/m2, and cisplatin, 75 mg/m2, every 3 weeks. Results: Of 33 patients, 27 (81%) completed CCRT. After CCRT, three complete and 19 partial responses were recorded, giving an overall response rate of 67%. Of 19 patients who went to the consolidation phase, only 4 (21%) received all four cycles of docetaxel and cisplatin. Causes of failure of consolidation chemotherapy were toxicity in 11 patients, including three treatment-related deaths, and progression in 4 patients. Three patients died of sepsis during the consolidation phase. Median survival was 11 months for all patients and 8 months for those treated with consolidation chemotherapy. Conclusion: The poor compliance and high incidence of severe toxicities prompted no further evaluation of this consolidation chemotherapy after CCRT

  12. 顺铂联合化疗的病历分析%Cisplatin Chemotherapy Analysis of Hospital Medical Records

    Institute of Scientific and Technical Information of China (English)

    陈苏琴

    2015-01-01

    目的 观察和分析顺铂与不同药物联合化疗在临床上的应用.方法 随机选取160例使用过顺铂的出院病例,统计这些出院病例的联合化疗方案.结果 顺铂主要和多西他赛、吉西他滨、培美曲塞、紫杉醇联合化疗,一共有141例,占所查病例的88.15%,分别统计四种化疗方案的患者癌症种类,进行分析.结论 顺铂和不同的药物联合化疗可以有针对性的治疗不同的癌症,减轻患者痛苦,提高患者生活质量.%Objective To evaluate the clinical applications of cisplatin combined chemotherapy different drugs.Methods Randomly selected 160 cases of use over cisplatin patient's hospital discharge cases, statistics of the use of these discharged cases joint chemotherapy program.Result Cisplatin primary and docetaxe, gemcitabine, pemetrexed, paclitaxel joint chemotherapy, a total of 141 cases of, accounting for 88.15%, respectively statistics these four chemotherapy regimens for the patient and the types of cancer, for analysis.Conclusion Cisplatin and different drugs for chemotherapy can be targeted to treat different cancers, relieve the suffering of the patients, and improve patient's quality of life.

  13. Phosphorylation of p90RSK is associated with increased response to neoadjuvant chemotherapy in ER-positive breast cancer

    International Nuclear Information System (INIS)

    The clinical implication of Ras/Raf/ERK pathway activity in breast cancer tissue and its association with response to chemotherapy is controversial. We aimed to explore the value of p90RSK phosphorylation, a downstram molecule of the pathway, in predicting chemotherapy response in breast cancer. The expression of phosphorylated p90RSK (phospho-p90RSK) and chemotherapy response was measured in 11 breast cancer cell lines and 21 breast cancer tissues. The predictive value of phospho-p90RSK was validated in core needle biopsy specimens of 112 locally advanced breast cancer patients who received anthracycline and taxane-based neoadjuvant chemotherapy. In 11 breast cancer cell lines, the relative expression of phospho-p90RSK was inversely correlated with cell survival after doxorubicin treatment (p = 0.021). Similar association was observed in fresh tissues from 21 breast cancer patients in terms of clinical response. In paraffin-embedded, formalin-fixed tissues from core needle biopsy tissues from 112 patients, positive phospho-p90RSK expression was associated with greater tumor shrinkage and smaller post-chemotherapy tumor size. The association between phospho-p90RSK expression and chemotherapy response was more evident in estrogen receptor(ER)-positive tumors. The expression of phosphor-p90RSK did not show a significant relationship with the incidence of pCR. P90RSK silencing using siRNA did not affect the cancer cell’s response to doxorubicin, and the expression of phospho-p90RSK was highly correlated with other Ras/Raf/ERK pathway activation. Our results suggest that phospho-p90RSK expression, which reflects the tumor’s Ras/Raf/ERK/p90RSK pathway activation can be a potential predictive marker for chemotherapy response in ER-positive breast cancer which needs further independent validation

  14. Pretreatment vitamin D level and response to neoadjuvant chemotherapy in women with breast cancer on the I-SPY trial (CALGB 150007/150015/ACRIN6657)

    OpenAIRE

    Clark, Amy S; Chen, Jinbo; Kapoor, Shiv; Friedman, Claire; Mies, Carolyn; Esserman, Laura; DeMichele, Angela; ,

    2014-01-01

    Laboratory studies suggest that vitamin D (vitD) enhances chemotherapy-induced cell death. The objective of this study was to determine whether pretreatment vitD levels were associated with response to neoadjuvant chemotherapy (NACT) in women with breast cancer. Study patients (n = 82) were enrolled on the I-SPY TRIAL, had HER2-negative tumors, and available pretreatment serum. VitD levels were measured via DiaSorin radioimmunoassay. The primary outcome was pathologic residual cancer burden (...

  15. Early prediction of response to neoadjuvant chemotherapy in patients with breast cancer using diffusion-weighted imaging and gray-scale ultrasonography

    OpenAIRE

    IWASA, HITOMI; KUBOTA, KEI; Hamada, Norihiko; Nogami, Munenobu; Nishioka, Akihito

    2014-01-01

    Neoadjuvant chemotherapy (NACT) is a widely accepted therapeutic option for patients with breast cancer. Although NACT produces good results for breast cancer patients, it has the potential to delay effective treatment in patients with chemotherapy-resistant breast cancer. The purpose of the present study was to evaluate the utility of the pretreatment apparent diffusion coefficient (ADC), which is calculated from diffusion-weighted imaging (DWI), the change in ADC after first administration ...

  16. Value of post-operative reassessment of estrogen receptor α expression following neoadjuvant chemotherapy with or without gefitinib for estrogen receptor negative breast cancer

    DEFF Research Database (Denmark)

    Bernsdorf, Mogens; Balslev, Eva; Lykkesfeldt, Anne;

    2011-01-01

    The NICE trial was designed to evaluate the possible benefits of adding epidermal growth factor receptor targeted therapy to neoadjuvant chemotherapy in patients with estrogen receptor α (ER) negative and operable breast cancer. Preclinical data have suggested that signalling through the Erb...

  17. Value of post-operative reassessment of estrogen receptor α expression following neoadjuvant chemotherapy with or without gefitinib for estrogen receptor negative breast cancer

    DEFF Research Database (Denmark)

    Bernsdorf, Mogens; Balslev, Eva; Lykkesfeldt, Anne;

    2011-01-01

    The NICE trial was designed to evaluate the possible benefits of adding epidermal growth factor receptor targeted therapy to neoadjuvant chemotherapy in patients with estrogen receptor a (ER) negative and operable breast cancer. Preclinical data have suggested that signalling through the Erb...

  18. Role of Neoadjuvant Chemotherapy in the Management of Stage IIIC-IV Ovarian Cancer Survey Results from the Members of the European Society of Gynecological Oncology

    NARCIS (Netherlands)

    Cornelis, Sarah; Van Calster, Ben; Amant, Frederic; Leunen, Karin; van der Zee, Ate Gerard Jan; Vergote, Ignace

    2012-01-01

    Objective: The aim of this study is to evaluate the current opinion of the members of the European Society of Gynecological Oncology (ESGO) on the use of neoadjuvant chemotherapy (NACT) in stage IIIC and IV ovarian cancer. Methods: A link to a 21-item questionnaire, with questions about the manageme

  19. Quality of life of advanced ovarian cancer patients in the randomized phase III study comparing primary debulking surgery versus neo-adjuvant chemotherapy

    NARCIS (Netherlands)

    Greimel, E.; Kristensen, G.B.; Burg, M.E.L. van der; Coronado, P.; Rustin, G.; Rio, A.S. del; Reed, N.S.; Nordal, R.R.; Coens, C.; Vergote, I.; Massuger, L.F.A.G.; Ottevanger, P.B.

    2013-01-01

    OBJECTIVE: The EORTC 55971 trial compared primary debulking surgery (PDS) versus neo-adjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). The impact of both treatment arms on quality of life (QOL) is reported. METHODS: Patients with stages IIIc or IV ovarian cancer completed th

  20. Locally advanced esophageal adenocarcinoma: Response to neoadjuvant chemotherapy and survival predicted by {sup [18F]}FDG-PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Kauppi, Juha T.; Salo, Jarmo A.; Sihvo, Eero I.; Raesaenen, Jari V. [Helsinki Univ. Central Hospital, Div. of General Thoracic and Esophageal Surgery, Dept. of Cardiothoracic Surgery, Helsinki Univ. Central Hospital, Helsinki (Finland)], Email: jarmo.salo@hus.fi; Oksala, Niku [Dept. of Vascular Surgery, Tampere Univ. Central Hospital, Tampere (Finland); Helin, Heikki [HUSLAB/Dept. of Pathology, Helsinki Univ. Central Hospital, Helsinki (Finland); Karhumaeki, Lauri [HUSLAB/Dept. of Clinical Physiology and Nuclear Medicine, Helsinki Univ. Central Hospital, Helsinki (Finland); Kemppainen, Jukka [PET-Center, Turku Univ., Turku (Finland)

    2012-05-15

    Background. {sup [18F]}fluorodeoxyglucose-Positron Emission Tomography/Computer Tomography ({sup [18F]}FDG-PET/CT) is commonly used in staging of locally advanced esophageal cancer. Its predictive value for response to neoadjuvant therapy and survival after multimodality therapy is controversial. Methods. Sixty-six consecutive patients with locally advanced adenocarcinoma of the esophagus or esophagogastric junction underwent surgery after neoadjuvant chemotherapy. Staging was done prospectively with {sup [18F]}FDG-PET/CT, before and after completion of neoadjuvant therapy. Pre- and post-therapy maximal standardized uptake values for the primary tumor (SUV1 and SUV2) were determined, and their relative change (SUV{Delta}%) calculated. Percentage change in SUV1 was compared with histopathologic response (HPR, complete or subtotal histologic remission), disease-free- (DFS) and overall survival (OS). Results. Resection with negative margins was achieved in 60 patients. HPR rate was 14 of 66 (21.2%). Median follow-up was 16 months (range 4-72). For all patients, OS probability at three years was 59% and DFS 50%. In receiver operating characteristics (ROC) analysis, HPR was optimally predicted by a > 67% change in baseline maximal SUV (sensitivity 79% and specificity 75%). In univariate survival analysis (Cox regression proportional hazards), HPR associated with improved DFS (HR 0.208, p = 0.033) but not OS (HR 0.030, p = 0.101), SUV % > 67% associated with improved OS (HR 0.249, p = 0.027) and DFS (HR 0.383, p 0.040). In a multivariate model (adjusted by age, sex, and ASA score), neither HPR nor SUV{Delta}% > 67% was predictive of improved OS and DFS. However, SUV{Delta}% as a continuous variable was an independent predictor of OS (HR 0.966, p < 0.0001) or DFS (HR 0.973, p < 0.0001). Conclusion. Our results support previous results showing that {sup [18F]}FDG-PET/CT can distinguish a group of patients with worse prognosis after neoadjuvant chemotherapy in

  1. Factors that influence the antiemetic activity of metoclopramide to cisplatin based chemotherapy.

    Science.gov (United States)

    Tsavaris, N; Mylonakis, N; Bacoyiannis, C; Kosmas, C; Kalergis, G; Iakovidis, V; Tzaninis, D; Kosmidis, P

    1998-01-01

    Some clinical parameters play a role in developing effective antiemetic therapy. In the present study, 310 patients entered and 301 were evaluable. They received cisplatin based combination chemotherapy (100 mg/m2), with antiemetic therapy based in metoclopramide, at a standard dose and schedule (2 mg/kg in 5 doses). Patient characteristics such as age, sex, performance status (Karnofsky), site of primary tumor, weight loss >15%, previous chemotherapy, previous radiotherapy, history of vomiting during pregnancy, additional drugs (dexamethasone, alprazolam), in the antiemetic regimen were included in the evaluation. We also studied the manifestation of anxiety and depression and the presence of psychosocial problems related to therapy, evaluated them with specific psychological indexes modified for our study. We evaluated incidence of vomiting, retches, and nausea, with several scales. We distinguished three groups of factors influencing nausea and vomiting. Factors that predicted for increased nausea and vomiting was gender (women), stress and age (younger patients experienced more prolonged duration and higher grades of nausea). The addition of alprazolam (a sedative drug) and dexamethasone, was associated with decreased incidence of nausea and vomiting. The weight loss (increased nausea and decreased vomiting control according to Gralla's scale). Previous chemotherapy decreased the number of patients without nausea and vomiting control according to Gralla's scale. Patients with previous radiotherapy presented an increased grade of nausea. Patients with head and neck cancer presented less nausea with shorter duration, less frequent episodes of vomiting. Patients with ovarian cancer presented increased mean number of retches. In conclusion, despite difficulties in assessing nausea and vomiting among clinical trials, several factors, especially stress, gender, weight loss, additional drugs (corticosteroids and sedatives) may play an important role in modulating the

  2. Combined preoperative neoadjuvant radiotherapy and chemotherapy for anal and rectal cancer

    International Nuclear Information System (INIS)

    Neoadjuvant therapy combining 5-fluorouracil, mitomycin C, and moderate-dose radiotherapy was given preoperatively to 29 patients with adenocarcinoma of the rectum, 3 patients with squamous cell cancer, and 1 patient with basaloid carcinoma of the anus. Significant downstaging, and even eradication, of these lesions was realized in a high percentage of cases. Population-based data for the period of 1979 to 1984 which encompasses the time of our study indicate the survival of those treated by the neoadjuvant therapy was superior to that of patients treated by surgery alone or by surgery followed by radiotherapy. In general, patients with the poorest clinical presentation had been referred for this therapy

  3. Pathologic tumor size and lymph node status predict for different rates of locoregional recurrence after mastectomy for breast cancer patients treated with neoadjuvant versus adjuvant chemotherapy

    International Nuclear Information System (INIS)

    Purpose: To compare the pathologic factors associated with postmastectomy locoregional recurrence (LRR) in breast cancer patients not receiving radiation who were treated with neoadjuvant chemotherapy (NEO) vs. adjuvant chemotherapy (ADJ). Methods and Materials: We retrospectively analyzed the rates of LRR of subsets of women treated in prospective trials who underwent mastectomy and received chemotherapy but not radiation. These trials were designed to answer chemotherapy questions. There were 150 patients in the NEO group and 1031 patients in the ADJ group. In the NEO group, 55% had clinical Stage IIIA or higher vs. 9% in the ADJ group (p5 cm (46% vs. 28%, p=0.028). The risk of LRR by the number of +LNs was similar in the NEO and ADJ groups, except for the subset of patients with ≥4 +LNs (53% vs. 23%, p5 cm, or clinical Stage IIIA or greater disease, regardless of whether they receive neoadjuvant or postoperative chemotherapy. The information assessing LRR rates in patients with clinical Stage II disease who receive neoadjuvant chemotherapy, particularly if 1-3 lymph nodes remain pathologically involved, is insufficient to determine whether these patients should receive radiotherapy

  4. Topoisomerase II alpha and TLE3 as predictive markers of response to anthracycline and taxane-containing regimens for neoadjuvant chemotherapy in breast cancer

    Directory of Open Access Journals (Sweden)

    Susini T

    2014-11-01

    Full Text Available Tommaso Susini,1 Barbara Berti,1 Carlo Carriero,1 Ketty Tavella,2 Jacopo Nori,3 Ermanno Vanzi,3 Cecilia Molino,1 Mariarosaria Di Tommaso,1 Marco Santini,1 Valeria Saladino,4 Simonetta Bianchi4 1Department of Health Science, Gynecology Section, 2Department of Health Science, Chemotherapy Section, University of Florence, Italy; 3Diagnostic Senology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; 4Department of Surgery and Translational Medicine, Pathology Unit, University of Florence, Italy Purpose: Anthracyclines and taxanes are considered the standard for neoadjuvant chemotherapy of breast cancer, although they are often associated with serious side effects and wide variability of individual response. In this study, we analyzed the value of topoisomerase II alpha (TOP2A and transducin-like enhancer of split 3 (TLE3 as predictive markers of response to therapy with anthracyclines and taxanes. Materials and methods: TOP2A and TLE3 protein expressions were evaluated using immunohistochemistry on 28 samples, obtained by core needle biopsy in patients with locally advanced breast carcinoma, subsequently subjected to epirubicin- and paclitaxel-based neoadjuvant chemotherapy. The immunohistochemical staining was correlated with the clinical response measured by the tumor size reduction evaluated by breast magnetic resonance imaging, prior and after chemotherapy, and by pathologic evaluation of the surgical specimen. Results: Neoadjuvant chemotherapy achieved a size reduction in 26/28 tumors (92.9%, with an average percentage decrease of 45.6%. A downstaging was achieved in 71.4% of the cases of locally advanced carcinoma. TOP2A positivity was correlated with a greater reduction in tumor diameter (P=0.06; negative staining for TLE3 was predictive of a better response to neoadjuvant chemotherapy (P=0.07. A higher reduction in tumor diameter (P=0.03 was also found for tumors that were concurrently TLE3-negative and TOP2A

  5. Emmprin and Survivin predict response and survival following cisplatin-containing chemotherapy in patients with advanced bladder cancer

    DEFF Research Database (Denmark)

    Als, Anne Birgitte; Andersen, Lars Dyrskjøt; Maase, Hans von der;

    2007-01-01

    PURPOSE: Cisplatin-containing chemotherapy is the standard of care for patients with locally advanced and metastatic transitional cell carcinoma of the urothelium. The response rate is approximately 50% and tumor-derived molecular prognostic markers are desirable for improved estimation of response...... and survival. EXPERIMENTAL DESIGN: Affymetrix GeneChip expression profiling was carried out using tumor material from 30 patients. A set of genes with an expression highly correlated to survival time after chemotherapy was identified. Two genes were selected for validation by immunohistochemistry...... in an independent material of 124 patients receiving cisplatin-containing therapy. RESULTS: Fifty-five differentially expressed genes correlated significantly to survival time. Two of the protein products (emmprin and survivin) were validated using immunohistochemistry. Multivariate analysis identified emmprin...

  6. Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer. Results of the first prospective randomized phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Golcher, Henriette; Merkel, Susanne; Hohenberger, Werner [University Hospital Erlangen, Department of Surgery, Erlangen (Germany); Brunner, Thomas B. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); University Hospital Freiburg, Department of Radiation Oncology, Freiburg (Germany); Witzigmann, Helmut [University Hospital Leipzig, Department of Surgery, Leipzig (Germany); Hospital Dresden-Friedrichstadt, General Surgery, Dresden (Germany); Marti, Lukas [Hospital of Kanton St. Gallen, General Surgery, St. Gallen (Switzerland); Bechstein, Wolf-Otto [University Hospital Frankfurt, Department of Surgery, Frankfurt/Main (Germany); Bruns, Christiane [University Hospital Munich, Department of Surgery - Hospital Campus Grosshadern, Munich (Germany); University Hospital Magdeburg, Department of Surgery, Magdeburg (Germany); Jungnickel, Henry [Hospital Dresden-Friedrichstadt, General Surgery, Dresden (Germany); Schreiber, Stefan [University Hospital Leipzig, Department of Surgery, Leipzig (Germany); Grabenbauer, Gerhard G. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Hospital Coburg, Department of Radiation Oncology, Coburg (Germany); Meyer, Thomas [University Hospital Erlangen, Department of Surgery, Erlangen (Germany); Hospital Ansbach, General Surgery, Ansbach (Germany); Fietkau, Rainer [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany)

    2014-09-25

    In nonrandomized trials, neoadjuvant treatment was reported to prolong survival in patients with pancreatic cancer. As neoadjuvant chemoradiation is established for the treatment of rectal cancer we examined the value of neoadjuvant chemoradiotherapy in pancreatic cancer in a randomized phase II trial. Radiological staging defining resectability was basic information prior to randomization in contrast to adjuvant therapy trials resting on pathological staging. Patients with resectable adenocarcinoma of the pancreatic head were randomized to primary surgery (Arm A) or neoadjuvant chemoradiotherapy followed by surgery (Arm B), which was followed by adjuvant chemotherapy in both arms. A total of 254 patients were required to detect a 4.33-month improvement in median overall survival (mOS). The trial was stopped after 73 patients; 66 patients were eligible for analysis. Twenty nine of 33 allocated patients received chemoradiotherapy. Radiotherapy was completed in all patients. Chemotherapy was changed in 3 patients due to toxicity. Tumor resection was performed in 23 vs. 19 patients (A vs. B). The R0 resection rate was 48 % (A) and 52 % (B, P = 0.81) and (y)pN0 was 30 % (A) vs. 39 % (B, P = 0.44), respectively. Postoperative complications were comparable in both groups. mOS was 14.4 vs. 17.4 months (A vs. B; intention-to-treat analysis; P = 0.96). After tumor resection, mOS was 18.9 vs. 25.0 months (A vs. B; P = 0.79). This worldwide first randomized trial for neoadjuvant chemoradiotherapy in pancreatic cancer showed that neoadjuvant chemoradiation is safe with respect to toxicity, perioperative morbidity, and mortality. Nevertheless, the trial was terminated early due to slow recruiting and the results were not significant. ISRCTN78805636; NCT00335543. (orig.) [German] Mehrere nichtrandomisierte Studien zeigten, dass eine neoadjuvante Therapie das Ueberleben bei Patienten mit Pankreaskarzinom verlaengert. Beim lokal fortgeschrittenen Rektumkarzinom gehoert die

  7. Pharmacokinetics of concomitant cisplatin and paclitaxel administered by hyperthermic intraperitoneal chemotherapy to patients with peritoneal carcinomatosis from epithelial ovarian cancer

    OpenAIRE

    Ansaloni, L.; Coccolini, F.; Morosi, L; Ballerini, A; Ceresoli, M; Grosso, G.; P. Bertoli; Busci, L M; Lotti, M.; Cambria, F; Pisano, M; Rossetti, D; Frigerio, L; D'Incalci, M; Zucchetti, M

    2014-01-01

    Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is advised as a treatment option for epithelial ovarian cancer (EOC) with peritoneal carcinomatosis. This study was designed to define the pharmacokinetics of cisplatin (CDDP) and paclitaxel (PTX) administered together during HIPEC. Methods: Thirteen women with EOC underwent cytoreductive surgery (CRS) and HIPEC, with CDDP and PTX. Blood, peritoneal perfusate and tissue samples were harvested to determine drug exposure by high-perf...

  8. Intravenous Ondansetron plus Intravenous Dexamethasone with Different Ondansetron Dosing Schedules during Multiple Cycles of Cisplatin-based Chemotherapy

    OpenAIRE

    Chuang-Chi Liaw; Ping-Tsung Chen

    2008-01-01

    Background: This study examined whether different ondansetron dosing schedules plusdexamethasone influenced antiemetic efficacy during multiple cycles of cisplatin-based chemotherapy (CT). Antiemetic activities between previous CTand subsequent cycles were compared.Methods: The cross-over study involved 424 patients. Arm A, three doses of 8 mgondansetron given intravenously (IV) at 4-hourly intervals plus dexamethasone20 mg IV at the start of CT, followed by dexamethasone 5 mg IV every12 hour...

  9. Prognostic impact of clinicopathologic parameters in stage II/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer

    Directory of Open Access Journals (Sweden)

    Kim Dong-Wan

    2007-11-01

    Full Text Available Abstract Background Prognostic factors in locally advanced breast cancer treated with neoadjuvant chemotherapy differ from those of early breast cancer. The purpose of this study was to identify the clinical significance of potential predictive and prognostic factors in breast cancer patients treated by neoadjuvant chemotherapy. Methods A total of 145 stage II and III breast cancer patients received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. We examined the clinical and biological factors (ER, PR, p53, c-erbB2, bcl-2, and Ki-67 by immunohistochemistry. We analyzed clinical outcome and their correlation with clinicopathologic parameters. Results Among the clinicopathologic parameters investigated, none of the marker was correlated with response rate (RR except triple negative phenotype. Patients with triple negative phenotype showed higher RR (83.0% in triple negative vs. 62.2% in non-triple negative, p = 0.012 and pathologic complete RR (17.0% in triple negative vs. 3.1% in non-triple negative, p = 0.005. However, relapse free survival (RFS and overall survival (OS were significantly shorter in triple negative breast cancer patients (p p = 0.021, respectively. Low histologic grade, positive hormone receptors, positive bcl-2 and low level of Ki-67 were associated with prolonged RFS. In addition, positive ER and positive bcl-2 were associated with prolonged OS. In our homogeneous patient population, initial clinical stage reflects RFS and OS more precisely than pathologic stage. In multivariate analysis, initial clinical stage was the only significant independent prognostic factor to impact on OS (hazard ratio 3.597, p = 0.044. Conclusion Several molecular markers provided useful predictive and prognostic information in stage II and III breast cancer patients treated with neoadjuvant docetaxel/doxorubicin chemotherapy. Triple negative phenotype was associated with shorter survival, even though it was associated

  10. Usefulness of combined metabolic volumetric indices of 18FFDG PET/CT for the early prediction of neoadjuvant chemotherapy outcomes in breast cancer

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate the usefulness of metabolic volumetric indices of 18F fluorodeoxy D glucose (18FFDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of neoadjuvant chemotherapy outcomes in breast cancer. Twenty four patients with locally advanced breast cancer were enrolled in the study. They underwent baseline 18F FDG PET/CT scan and received four or six cycles of neoadjuvant chemotherapy, interim 18F FDG PET/CT was done after second cycle of chemotherapy. Maximum standardized uptake value (SUVmax), metabolic tumor volume(MTV), and total lesion glycolysis (TLG) of the primary lesions were calculated. Reduction rates of these parameters were obtained between baseline and interim 18F FDG PET/CT. Chemotherapy outcomes were assessed using tumor size reduction rate and histological grading system (Miller and Payne system). Reduction rates of SUVmax, MTV, and TLG correlated with chemotherapy outcomes. MTV and TLG reduction rates showed significant correlation with tumor size reduction rate (R=0.68, P=0.0004; R=0.62, P=0.002, respectively). However, SUVmax reduction rate showed no significant correlation. MTV and TLG reduction rates were significantly higher in responders than nonresponders, as determined by Miller and Payne system (P<0.0007, P<0.0002). However, SUVmax reduction rate showed no significant difference. On ROC analysis, the area under the MTV and TLG curves was 0.886, and that of SUVmax was 0.743. Sensitivity, specificity, positive predictive value, and negative predictive value to predict histopathologic response were the same for MTV and TLG, and the values were 100%, 85,7%, 83.3%, and 100%, respectively (at the reduction rate of 93.2%, for MTV, and 95.8% for TLG). Changes of metabolic volumetric indices successfully reflected the neoadjuvant chemotherapy outcomes. MTV and TLG could be robust indices in discriminating pathologic responder as SUVmax, after neoadjuvant chemotherapy

  11. A mechanically coupled reaction-diffusion model for predicting the response of breast tumors to neoadjuvant chemotherapy

    Science.gov (United States)

    Weis, Jared A.; Miga, Michael I.; Arlinghaus, Lori R.; Li, Xia; Bapsi Chakravarthy, A.; Abramson, Vandana; Farley, Jaime; Yankeelov, Thomas E.

    2013-09-01

    There is currently a paucity of reliable techniques for predicting the response of breast tumors to neoadjuvant chemotherapy. The standard approach is to monitor gross changes in tumor size as measured by physical exam and/or conventional imaging, but these methods generally do not show whether a tumor is responding until the patient has received many treatment cycles. One promising approach to address this clinical need is to integrate quantitative in vivo imaging data into biomathematical models of tumor growth in order to predict eventual response based on early measurements during therapy. In this work, we illustrate a novel biomechanical mathematical modeling approach in which contrast enhanced and diffusion weighted magnetic resonance imaging data acquired before and after the first cycle of neoadjuvant therapy are used to calibrate a patient-specific response model which subsequently is used to predict patient outcome at the conclusion of therapy. We present a modification of the reaction-diffusion tumor growth model whereby mechanical coupling to the surrounding tissue stiffness is incorporated via restricted cell diffusion. We use simulations and experimental data to illustrate how incorporating tissue mechanical properties leads to qualitatively and quantitatively different tumor growth patterns than when such properties are ignored. We apply the approach to patient data in a preliminary dataset of eight patients exhibiting a varying degree of responsiveness to neoadjuvant therapy, and we show that the mechanically coupled reaction-diffusion tumor growth model, when projected forward, more accurately predicts residual tumor burden at the conclusion of therapy than the non-mechanically coupled model. The mechanically coupled model predictions exhibit a significant correlation with data observations (PCC = 0.84, p statistically significant >4 fold reduction in model/data error (p = 0.02) as compared to the non-mechanically coupled model.

  12. Role of p-glycoprotein expression in predicting response to neoadjuvant chemotherapy in breast cancer-a prospective clinical study

    Directory of Open Access Journals (Sweden)

    Bhatia Ashima

    2005-09-01

    Full Text Available Abstract Background Neoadjuvant chemotherapy (NACT is an integral part of multi-modality approach in the management of locally advanced breast cancer. It is vital to predict response to chemotherapy in order to tailor the regime for a particular patient. The prediction would help in avoiding the toxicity induced by an ineffective chemotherapeutic regime in a non-responder and would also help in the planning of an alternate regime. Development of resistance to chemotherapeutic agents is a major problem and one of the mechanisms considered responsible is the expression of 170-k Da membrane glycoprotein (usually referred to as p-170 or p-glycoprotein, which is encoded by multidrug resistance (MDR1 gene. This glycoprotein acts as an energy dependent pump, which actively extrudes certain families of chemotherapeutic agents from the cells. The expression of p-glycoprotein at initial presentation has been found to be associated with refractoriness to chemotherapy and a poor outcome. Against this background a prospective study was conducted using C219 mouse monoclonal antibody specific for p-glycoprotein to ascertain whether pretreatment detection of p-glycoprotein expression could be utilized as a reliable predictor of response to neoadjuvant chemotherapy in patients with breast cancer. Patients and methods Fifty cases of locally advanced breast cancer were subjected to trucut® biopsy and the tissue samples were evaluated immunohistochemically for p-glycoprotein expression and ER, PR status. The response to neoadjuvant chemotherapy was assessed clinically and by using ultrasound after three cycles of FAC regime (cyclophosphamide 600 mg/m2, Adriamycin 50 mg/m2, 5-fluorourail 600 mg/m2 at an interval of three weeks. The clinical response was correlated with both the pre and post chemotherapy p-glycoprotein expression. Descriptive studies were performed with SPSS version 10. The significance of correlation between tumor response and p

  13. Decreased ERCC1 Expression After Platinum-Based Neoadjuvant Chemotherapy in non-Small Cell Lung Cancer.

    Science.gov (United States)

    Podmaniczky, Eszter; Fábián, Katalin; Pápay, Judit; Puskás, Rita; Gyulai, Márton; Furák, József; Tiszlavicz, László; Losonczy, György; Tímár, József; Moldvay, Judit

    2015-04-01

    We have already demonstrated in a small cohort of 17 non-small cell lung cancer patients that ERCC1 (excision repair cross-complementation group 1) protein expression decreased after platinum-based treatment, however, certain clinicopathological parameters, such as histologic subtypes, ERCC1 expression scores, chemotherapeutic combinations, response rate, gender and smoking history were not analyzed. The aim of our present study was to extend the studied cohort and analyze those parameters. ERCC1 protein expression was examined in 46 patients treated with neoadjuvant chemotherapy. 46 bronchoscopic biopsy samples (27 squamous cell carcinomas /SCC/ and 19 adenocarcinomas /ADC/) together with their corresponding surgical biopsies were studied. ERCC1 immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissues. Staining scores were calculated by multiplying the percentage of positive tumor cells (0-100) by the staining intensity (0-3). 24/27 bronchoscopic SCC tissues expressed ERCC1. Thirteen of these cases became negative after neoadjuvant therapy and the expression differences between pre- and postchemotherapy samples were highly significant (p affects the ERCC1 expression probably referring to an induction of tumor cell selection. PMID:25194563

  14. Trimodality bladder-sparing approach without neoadjuvant chemotherapy for node-negative localized muscle-invasive urinary bladder cancer resulted in comparable cystectomy-free survival

    International Nuclear Information System (INIS)

    To retrospectively review the efficacy and organ preservation experience for muscle-invasive bladder cancer by trimodality therapy at our institution. Between July 2004 and February 2012, seventy patients (M/F = 55/15; median age = 69 years) of lymph node negative localized muscle-invasive bladder cancer were treated primarily with trimodality approach including transurethral resection of bladder tumor (TURBT) prior to combined chemotherapy and radiotherapy (CCRT). Radiotherapy consisted of initial large field size irradiation with 3D conformal technique (3D-CRT), followed by cone-down tumor bed boost with intensity modulated radiotherapy (IMRT) technique. The median total doses delivered to bladder tumor bed and whole bladder were 59.4Gy and 40.0Gy, respectively. No patient received neoadjuvant chemotherapy (NAC). Weekly cisplatin was administered during radiotherapy. Toxicity was scored according to the RTOG criteria. Tumor response was evaluated both cystoscopically and radiographically 3 months after treatment. The numbers of patients with T2, T3 and T4 lesions were 41, 16 and 13, respectively. Overall survival (OS) and progression-free survival (PFS) at 2 and 5 year were 65.7%, 51.9% and 50.8%, 39.9%, respectively, after a median follow-up time of 24 months. Local-regional control and distant metastasis free survival at 2 year were 69.8% and 73.5%, respectively. Complete response (CR) rate assessed three month after CCRT was 78.1%. Ten patients (20%) had local recurrence after initial CR (n = 50), 3 of them were superficial recurrence. One patient underwent radical cystectomy after recurrence. The overall 5-year bladder intact survival was 49.0% (95% CI, 35.5% to 62.5%). Acute toxicities were limited to grade 1-2. One patient developed late grade 3 GU toxicity. Our result suggested that trimodality bladder-sparing approach without NAC or dose-intensification could be well-tolerated with a high CR rate and bladder preserving rate for muscle-invasive bladder

  15. TPF (Paclitaxel, Cisplatin, 5-fluorouracil) 療法を施行した進行性陰茎癌の1例

    OpenAIRE

    高本, 大路; 春日, 純; 湯村, 寧; 小泉, 充之; 花井, 孝宏; 石田, 寛明; 服部, 裕介; 寺西, 淳一; 三好, 康秀; 近藤, 慶一; 野口, 和美

    2014-01-01

    54-year-old male was introduced to our hospital in January 2012 for surgical treatment and chemotherapy. The pathological examination revealed well differentiated squamous cell carcinoma of the penis. Computed tomography and magnetic resonance imaging indicated right inguinal and pelvic lymphadenopathy. We diagnosed the tumor to be unresectable radically and administered paclitaxel, cisplatin and 5-fluorouracil (TPF) as neoadjuvant chemotherapy. After 3 courses of chemotherapy, the size of ly...

  16. HER-2 expression after neoadjuvant chemotherapy of the breast cancers%乳腺癌新辅助化疗前后HER-2表达的变化

    Institute of Scientific and Technical Information of China (English)

    Yaojun Feng; Xinhong Wu; Cuiping Pan; Juan Xu; Wei Zhong; Jun Shao; Biao Ma

    2011-01-01

    Objective: The aim of this study was to study changes of HER-2 expression after neoadjuvant chemotherapy in the breast cancer cases. Methods: One hundred and thirty-seven female patients with primary breast cancers, who received neoadjuvant chemotherapy, underwent core needle puncture and Mammotome biopsy before chemotherapy, and the biopsy results were used as the basis of histological diagnosis, fluorescence in situ hybridization (FISH) was performed to test HER 2 status of tumor tissues before and after chemotherapy. All patients underwent FEC, TE, or AC neoadjuvant chemotherapy of 2-6 cycles before surgery. Results: Twenty-two patients were positive according to FISH test among 137 preoperative patients, 8 patients achieved pathological complete remission after chemotherapy (three HER-2 positive patients and five negative patients), 91 patients achieved partial remission, 24 patients were stable, and 14 cases were invalid. Twenty-two patients were positive according to FISH test (8 patients with pathological complete remission did not undergo test), and positive patients still expressed positively after chemotherapy before neoadjuvant chemotherapy. Three negative patients were converted to be positive, and changes before and after chemotherapy had no statistical difference (P > 0.05). Conclusion: Neoadjuvant chemotherapy makes no influence on patients with HER-2 positive expression, while patients with negative expression can be converted to be positive, but without significant difference.

  17. P07.03RECURRENT MEDULLOBLASTOMA AND CNS PNET IN ADULTS - RESULTS OF VIP CHEMOTHERAPY

    OpenAIRE

    Gravendeel, L.A.; van den Bent, M. J; Taal, W.; Rijt, C.C.D. van der; Bromberg, J. E. C.

    2014-01-01

    INTRODUCTION: Medulloblastoma and central nervous system (CNS) primitive neuroectodermal tumor (PNET) are rare embryonal brain tumors in adults. Surgery and radiotherapy are an important part of the initial treatment, however, the role of (neo)adjuvant chemotherapy or chemotherapy at relapse is still unclear. In our center, etoposide/ifosfamide/cisplatin (VIP) chemotherapy is the standard of care for patients with a first relapse of medulloblastoma or CNS PNET. We reviewed the outcome in a co...

  18. Modulation of circulating angiogenic factors and tumor biology by aerobic training in breast cancer patients receiving neoadjuvant chemotherapy.

    Science.gov (United States)

    Jones, Lee W; Fels, Diane R; West, Miranda; Allen, Jason D; Broadwater, Gloria; Barry, William T; Wilke, Lee G; Masko, Elisabeth; Douglas, Pamela S; Dash, Rajesh C; Povsic, Thomas J; Peppercorn, Jeffrey; Marcom, P Kelly; Blackwell, Kimberly L; Kimmick, Gretchen; Turkington, Timothy G; Dewhirst, Mark W

    2013-09-01

    Aerobic exercise training (AET) is an effective adjunct therapy to attenuate the adverse side-effects of adjuvant chemotherapy in women with early breast cancer. Whether AET interacts with the antitumor efficacy of chemotherapy has received scant attention. We carried out a pilot study to explore the effects of AET in combination with neoadjuvant doxorubicin-cyclophosphamide (AC+AET), relative to AC alone, on: (i) host physiology [exercise capacity (VO2 peak), brachial artery flow-mediated dilation (BA-FMD)], (ii) host-related circulating factors [circulating endothelial progenitor cells (CEP) cytokines and angiogenic factors (CAF)], and (iii) tumor phenotype [tumor blood flow ((15)O-water PET), tissue markers (hypoxia and proliferation), and gene expression] in 20 women with operable breast cancer. AET consisted of three supervised cycle ergometry sessions/week at 60% to 100% of VO2 peak, 30 to 45 min/session, for 12 weeks. There was significant time × group interactions for VO2 peak and BA-FMD, favoring the AC+AET group (P blood flow in the AC+AET group. There were no differences in any tumor tissue markers (P > 0.05). Whole-genome microarray tumor analysis revealed significant differential modulation of 57 pathways (P < 0.01), including many that converge on NF-κB. Data from this exploratory study provide initial evidence that AET can modulate several host- and tumor-related pathways during standard chemotherapy. The biologic and clinical implications remain to be determined. PMID:23842792

  19. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yip, Connie [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); National Cancer Centre, Department of Radiation Oncology, Singapore (Singapore); Imaging 2, Level 1, Lambeth Wing, St Thomas' Hospital, London (United Kingdom); Goh, Vicky [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Davies, Andrew; Gossage, James; Mason, Robert [Guy' s and St Thomas' NHS Foundation Trust, Department of Upper Gastrointestinal and General Surgery, London (United Kingdom); Mitchell-Hay, Rosalind; Griffin, Nyree [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Hynes, Orla [Department of Dietetics, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Maisey, Nick; Ross, Paul; Gaya, Andrew [Department of Oncology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Landau, David B. [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom); Department of Oncology, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Cook, Gary J. [King' s College London, Division of Imaging Sciences and Biomedical Engineering, London (United Kingdom)

    2014-05-15

    Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer. A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS). Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 % ± 6.4 (SD) in comparison to FM index (-1.2 ± 4.2), FFM index (-4.6 ± 6.8), FMR (-1.2 ± 24.3) and VA/SA (-62.3 ± 12.7). Changes in FM index (p = 0.022), FMR (p = 0.028), VA/SA (p = 0.024) and weight (p = 0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival. Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity. (orig.)

  20. Prospective cohort study of febrile neutropenia in breast cancer patients with neoadjuvant and adjuvant chemotherapy: CSPOR-BC FN study.

    Science.gov (United States)

    Ishikawa, Takashi; Sakamaki, Kentaro; Narui, Kazutaka; Kaise, Hiroshi; Tsugawa, Koichiro; Ichikawa, Yasushi; Mukai, Hirofumi

    2016-07-01

    With the increasing use of adjuvant chemotherapy for treating early breast cancer, febrile neutropenia management has become crucial. Guidelines for febrile neutropenia management are mostly based on a Caucasian population survey although ethnic differences are reported in terms of adverse events. We survey the current status of febrile neutropenia and risk factors in Japanese female breast cancer patients receiving neoadjuvant and adjuvant chemotherapy regimens potential for febrile neutropenia. Subsequently, we plan to conduct a multicenter prospective cohort study involving 1000 patients with operable breast cancer. With the current state of oral antibiotics being routinely prescribed without hematology tests, we survey febrile neutropenia based on two different definitions, namely, true febrile neutropenia: ≥37.5°C and Grade 4 neutropenia, and surrogate febrile neutropenia: ≥37.5°C and oral antibiotic and antipyretic intake. The comparison of true febrile neutropenia and surrogate febrile neutropenia incidences is anticipated to provide information on the safety and feasibility of chemotherapy management without performing blood tests. PMID:27162322

  1. Pretreatment serum lactate dehydrogenase is an independent prognostic factor for patients receiving neoadjuvant chemotherapy for locally advanced cervical cancer.

    Science.gov (United States)

    Li, Jing; Wu, Miao-Fang; Lu, Huai-Wu; Chen, Qing; Lin, Zhong-Qiu; Wang, Li-Juan

    2016-08-01

    For locally advanced cervical cancer (LACC), hypoxia is a characteristic property. This study aimed to investigate whether baseline lactic dehydrogenase (LDH) level, which is a marker of hypoxia, had clinical value in determining neoadjuvant chemotherapy (NACT) response and prognosis for LACC patients. The study cohort included 418 patients with a median follow-up of 37.5 months. Cox proportional hazards models were used to assess the prognostic value of baseline LDH levels. Multivariate logistic regression analysis was performed to identify independent predictors of complete response after NACT. Backward stepwise selection with the Akaike information criterion was used to identify factors that could be entered into the multivariate regression model. Compared with patients with LDH levels NACT (adjusted odds ratio [OR], 0.29; 95% CI, 0.15-0.58; P NACT. PMID:27350066

  2. Association of primary tumour FDG uptake with clinical, histopathological and molecular characteristics in breast cancer patients scheduled for neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Koolen, B.B.; Aukema, T.S. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam (Netherlands); Vrancken Peeters, M.J.T.F.D.; Rutgers, E.J.T. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam (Netherlands); Wesseling, J.; Lips, E.H. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Pathology and Experimental Therapy, Amsterdam (Netherlands); Vogel, W.V.; Valdes Olmos, R.A. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Werkhoven, E. van [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Biometrics, Amsterdam (Netherlands); Gilhuijs, K.G.A. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiology, Amsterdam (Netherlands); University Medical Centre Utrecht, Department of Radiology, Utrecht (Netherlands); Rodenhuis, S. [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam (Netherlands)

    2012-12-15

    The aim of this study was to evaluate the association of primary tumour {sup 18}F-fluorodeoxyglucose (FDG) uptake with clinical, histopathological and molecular characteristics of breast cancer patients scheduled for neoadjuvant chemotherapy. Second, we wished to establish for which patients pretreatment positron emission tomography (PET)/CT could safely be omitted because of low FDG uptake. PET/CT was performed in 214 primary stage II or III breast cancer patients in the prone position with hanging breasts. Tumour FDG uptake was qualitatively evaluated to determine the possibility of response monitoring with PET/CT and was quantitatively assessed using maximum standardized uptake values (SUV{sub max}). FDG uptake was compared with age, TNM stage, histology, hormone and human epidermal growth factor receptor 2 status, grade, Ki-67 and molecular subtype in univariable and multivariable analyses. In 203 tumours (95 %) FDG uptake was considered sufficient for response monitoring. No subgroup of patients with consistently low tumour FDG uptake could be identified. In a univariable analysis, SUV{sub max} was significantly higher in patients with distant metastases at staging examination, non-lobular carcinomas, tumours with negative hormone receptors, triple negative tumours, grade 3 tumours, and in tumours with a high proliferation index (Ki-67 expression). After multiple linear regression analysis, triple negative and grade 3 tumours were significantly associated with a higher SUV{sub max}. Primary tumour FDG uptake in breast cancer patients scheduled for neoadjuvant chemotherapy is significantly higher in tumours with prognostically unfavourable characteristics. Based on tumour characteristics associated with low tumour FDG uptake, this study was unable to identify a subgroup of patients unlikely to benefit from pretreatment PET/CT. (orig.)

  3. Neoadjuvant intra-arterial chemotherapy combined with radiotherapy and surgery in patients with advanced maxillary sinus cancer

    International Nuclear Information System (INIS)

    The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, 500 mg/m2) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

  4. Neoadjuvant intra-arterial chemotherapy combined with radiotherapy and surgery in patients with advanced maxillary sinus cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Tae; Kim, Yong Kan; Lee, Ju Hye; Kim, Dong Hyun; Park, Dahl; Cho, Kyu Sup; Kim, Dong Won [Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of); Nam, Ji Ho; Roh, Hwan Jung [Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2013-09-15

    The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, 500 mg/m2) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

  5. Decreased FOXP3+ and GARP+ Tregs to neoadjuvant chemotherapy associated with favorable prognosis in advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Li K

    2016-06-01

    Full Text Available Kai Li,1 Fuchao Chen,2 Huijuan Xie3 1Department of Pathology, 2Department of Clinical Pharmacy, 3Department of Hyperbaric Oxygen, Dongfeng Hospital, Hubei University of Medicine, Shiyan, People’s Republic of China Abstract: Neoadjuvant chemotherapy (NACT has been an increasingly used therapeutic strategy to improve the outcome of advanced gastric cancer (GC over the past few decades. Lymphocytic infiltration has been reported to be associated with response to NACT, but the immune cell subpopulation and its prognosis contributing to response in GC have not been clarified yet. In the current study, the tumor infiltration of FOXP3+ and GARP+ regulatory T-cells (Tregs, marked by FOXP3 and GARP response to NACT in advanced GC and their correlation with prognosis were evaluated. The infiltration of FOXP3+ and GARP+ Tregs in 102 patients with advanced GC who were treated with or without NACT was measured using immunohistochemical method. The infiltration of FOXP3+ and GARP+ Tregs was significantly decreased in the NACT group than in the non-NACT group (P=0.023 and P=0.012, respectively and significantly associated with tumor, node, metastasis stage (P=0.019 and P=0.011, respectively. There was no significant difference in patient’s overall survival between the NACT and non-NACT groups (P=0.166; however, patients in the NACT group with decreased infiltration of FOXP3+ and GARP+ Tregs had longer overall survival (P=0.002 and P<0.001, respectively. Univariate and multivariate analyses indicated that the infiltration of GARP+ Tregs and lymph node metastasis were independent prognostic factors (P=0.038 and P=0.013, respectively. The results demonstrated that NACT could decrease the infiltration of FOXP3+ and GARP+ Tregs, and that the infiltration of GARP+ Tregs may serve as a new prognostic factor of human GC response to NACT. Keywords: neoadjuvant chemotherapy, gastric cancer, Tregs, FOXP3, GARP

  6. Young Cervical Cancer Patients May Be More Responsive than Older Patients to Neoadjuvant Chemotherapy Followed by Radical Surgery.

    Directory of Open Access Journals (Sweden)

    Jin Zhou

    Full Text Available To evaluate the effects of age and the clinical response to neoadjuvant chemotherapy (NACT in patients with cervical cancer who received neoadjuvant chemotherapy followed by radical surgery.A total of 1,014 patients with advanced cervical cancer who received NACT followed by radical surgery were retrospectively selected. Patients were divided into young (aged ≤35 years, n = 177 and older (aged >35 years, n = 837 groups. We compared the short-term responses and survival rates between the groups. The five-year disease-free survival (DFS and overall survival (OS rates were stratified by age, NACT response, and FIGO stage.The overall response rate was 86.8% in the young group and 80.9% in the older group. The young patients had an earlier FIGO stage (P<0.001, a higher rate of adenocarcinoma (P = 0.022, and more lymph node metastasis (P = 0.033 than the older patients. The presence of adenocarcinoma as the histological type (P = 0.024 and positive lymph node metastasis (P<0.001 were identified as independent risk factors for survival. When stratified by age and clinical response, young patients with no response to NACT had a worse clinicopathological condition compared with the other subgroups. Compared with non-responders, responders to NACT had a higher five-year DFS rate (80.1% versus 71.8%; P = 0.019 and OS rate (82.6% versus 71.8%; P = 0.003 among the young patients but not among the older patients.Responders to NACT aged 35 years or younger benefitted the most from NACT, while the young non-responders benefitted the least. Age might represent an important factor to consider when performing NACT in patients with cervical cancer.

  7. A safe and effective dose of cisplatin in hepatic arterial infusion chemotherapy for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Cisplatin (CDDP) is an anticancer agent that is commonly used in hepatic arterial infusion (HAI) chemotherapy for hepatocellular carcinoma (HCC). This study aimed to clarify the safe and effective dose of CDDP in HAI for HCC. The hypervascular area was measured in 42 HCCs before and after HAI with CDDP. Serum platinum concentration was quantified in the peripheral and/or middle hepatic veins by atomic absorption spectrometry. The relation between the HCC response and CDDP dose was statistically analyzed. The multiple HCC nodules in an individual case generally demonstrated the same response to CDDP. The free-platinum concentration stayed relatively constant in the hepatic vein during HAI followed by a rapid decline, while total-platinum gradually increased then slowly disappeared over several days. After CDDP-HAI, 15 HCCs shrunk and 27 HCCs grew. The reduction rate in the shrunken nodules was tended to be correlated with CDDP dose after standardization with the target liver volume. On the other hand, the growth rate of the enlarged HCCs was significantly correlated with CDDP dose after normalization with creatinine clearance. These data support a recommendation of CDDP-HAI infusion where the amount of CDDP (mg) administered is less than patient creatinine clearance (mL/min/1.73 m2) upon an assumption of HCC doubling time of 90 days, and the targeted liver is smaller than 200 times the CDDP dose (mg). A further analysis is required to define appropriate injection speeds

  8. Neoadjuvant chemotherapy in advanced sinonasal teratocarcinosarcoma with intracranial extension: Report of two cases with literature review

    OpenAIRE

    Amit Joshi; Vanita Noronha; Mansi Sharma; Sachin Dhumal; Shashikant Juvekar; Vijay Maruti Patil; Prathamesh Pai; Kumar Prabhash

    2015-01-01

    Sinonasal teratocarcinosarcoma (SNTCS) is a highly aggressive rare tumor of the nasal cavity. Surgery followed by concurrent chemoradiation is the mainstay of treatment in SNTCS. However, intracranial extension may complicate surgical resection, with difficulty in achieving R0 resection. Here we present two cases of SNTCS with intracranial extension; both patients were seen in skull base clinic of our hospital and deemed unsuitable for surgery. These patients then were offered neoadjuvant che...

  9. Phase ii/iii study of intraperitoneal chemotherapy after neoadjuvant chemotherapy for ovarian cancer: ncic ctg ov.21

    OpenAIRE

    Mackay, H.J.; Provencheur, D.; Heywood, M; Tu, D; Eisenhauer, E A; Oza, A. M.; Meyer, R

    2011-01-01

    Three large randomized clinical trials have shown a survival benefit in women with stage iii epithelial ovarian cancer (eoc) who receive intraperitoneal (IP) chemotherapy after optimal primary debulking surgery. The most recent Gynecologic Oncology Group study, gog 172, showed an improvement in median overall survival of approximately 17 months. That result led to a U.S. National Cancer Institute (nci) clinical announcement recommending that IP chemotherapy be considered for this group of wom...

  10. Voluntary Exercise Prevents Cisplatin-Induced Muscle Wasting during Chemotherapy in Mice

    OpenAIRE

    Pernille Hojman; Jonas Fjelbye; Bo Zerahn; Jesper F Christensen; Christine Dethlefsen; Lonkvist, Camilla K.; Claus Brandt; Hanne Gissel; Bente Klarlund Pedersen; Julie Gehl

    2014-01-01

    Loss of muscle mass related to anti-cancer therapy is a major concern in cancer patients, being associated with important clinical endpoints including survival, treatment toxicity and patient-related outcomes. We investigated effects of voluntary exercise during cisplatin treatment on body weight, food intake as well as muscle mass, strength and signalling. Mice were treated weekly with 4 mg/kg cisplatin or saline for 6 weeks, and randomized to voluntary wheel running or not. Cisplatin treatm...

  11. Gemcitabine and Cisplatin Combination Chemotherapy as a First-Line Treatment in Patients with Metastatic Breast Cancer

    International Nuclear Information System (INIS)

    The prospective study were to evaluate the efficacy and toxicity of Gemcitabine plus cisplatin as a first line chemotherapy in female patients with metastatic breast cancer who previously received anthracyclin-based regimen as adjuvant chemotherapy. Patients and Methods: Twenty five patients with metastatic and at least one bi-dimensionally measurable lesion were included in this study. Adequate bone marrow reserve, adequate hepatic and renal functions and performance status $ 2 were required. Patients have previously received anthracyclin based-chemotherapy as adjuvant. Treatment consisted of Gemcitabine 1250 mg/m2 on days I and 8 and cisplatin 75 mg/m2 on day I, cycles were repeated at 3-week intervals. 25 patients were evaluable for toxicity and 22 patients for response. Overall response was 54.5%. Complete response was reported in 13.6% of patients and partial response was reported in 40.9% of patients. Six patients (27.2%) had stable disease and disease progression was reported in (18.2%) of patients. Response was reported in all metastatic sites. Toxicities included grade 3,4 vomiting in 32% and grade 3, 4 neutropenia in 12%, grade 3, 4 thrompocytopenia in 32%. Only one case of neutropenic fever was reported. Renal and neurotoxicity was encountered in 12% and alopecia grade I. 2 in 8% of patients. o treatment related death was reported. The median overall survival was ]4.8 months (range: 2 to 18.5). Gemcitabine and cisplatin combination chemotherapy is active and well tolerated regimen for patients with metastatic breast cancer. This regimen represents a therapeutic option for patients receiving front line therapy for their metastatic breast cancer. Phase III randomized trial is needed for comparison with other 2nd line regimens to define the exact role of this combination

  12. The Impact of Neo-adjuvant and Adjuvant Chemotherapy in Treatment Outcome of Patients with High Risk Soft Tissue Sarcomas of the Extremities

    Directory of Open Access Journals (Sweden)

    Rasha Hamdy Hamed

    2012-04-01

    Full Text Available Background: This prospective study assessed the efficacy of neoadjuvant and adjuvant chemotherapy on patients with high risk soft tissue sarcomasof the extremities.Methods: Enrolled patients received the following neoadjuvant chemotherapy: doxorubicin (75 mg/m2 on day1, ifosfamide (2.5 g/m2/d and mesna (20% of the ifosfamide dose from days1 to 3, repeated every three weeks for a total of three cycles, followed by surgery and radiotherapy. Patients received an additional three cycles ofadjuvant chemotherapy that was the same as the neoadjuvant protocol following completion of radiotherapy.Results: There were 52 patients enrolled in the study, of which 50 were included in data analysis. Neoadjuvant chemotherapy was completed by 90% of enrolled patients and 88% completed all planned chemotherapy. A total of 96% of patients underwent surgery and 92% of these had R0 resections. Postoperative radiotherapy was administered to 96% of patients. The estimated three-year local-regional failure was 10%. Estimated three-year rate for distant disease-free survival was 66% and overall survival was 88%. One patient died with treatment secondary to leukopenic sepsis and respiratory failure. Grades 3-4 toxicities were experienced by 86% of patients of which 84% were grades 3- 4 hematologic toxicities and 38% were grades 3-4 nonhematologic toxicities.Conclusion: The current protocol is feasible and associated with favorable distant disease-free survival, overall survival, and limb preservation. This protocol is tolerable and has a manageable toxicity level.

  13. 新辅助化疗对肌层浸润性膀胱癌死亡预后风险的荟萃分析%Effects of neoadjuvant chemotherapy on the prognostic mortality risk of invasive transitional bladder cancer: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    范博; 张亮; 李先承; 宋永胜; 郭恩忠; 潘涛; 沈亮; 辛士永; 宋希双

    2013-01-01

    Objective To systematically assess the effects of neoadjuvant chemotherapy on the prognostic risk of iuvasive transitional bladder cancer.Methods All known randomized controlled trials (RCTs) on neoadjuvant chemotherapy in the treatment of invasive transitional bladder cancer,published from the date of database building to September 2012,were retrieved from such databanks as Pubmed,CBMdisc,Embase and Cochrane.The data on 5-year survival rate of included studies were extracted for further heterogeneity exploration,subgroup analysis and statistical pooling with the RevMan 5.10 software.Results Fourteen subjects involving 2072 cases and 2086 controls were published from 1991 to 2012.The overall odds ratio of survival suggested a 21% relative reduction in mortality risk for neoadjuvant chemotherapy compared to that on control (OR =0.79,95% CI:0.70-0.90).In subgroup analysis according to different neoadjuvant chemotherapies,MCV (methotrexate,cisplatin and vinblastine) and MVAC (methotrexate,vinblastine,adriamycin and cisplatin) chemotherapies showed significant benefit to overall survival with 28% and 25% reduction in risk of death respectively (OR =0.72,95% CI:0.60-0.86,OR =0.75,95% CI:0.59-0.96).However,no significant difference existed in effects between C (cisplatin) chemotherapy,CM (cisplatin and methotrexate) chemotherapy and CD (cisplatin and docetaxel) chemotherapy and controls.In subgroup analysis according to local treatment of cystectomy or radiotherapy after neoadjuvant chemotherapy,the patients with cystectomy showed significant benefits in overall survival with 25% reduction in risk of death (OR =0.75,95% CI:0.65-0.87).However,the patients with radiotherapy or radiotherapy plus cystectomy showed no significant benefits in overall survival.Conclusions MCV and MVAC neoadjuvant chemotherapies improve survival among patients with bladder cancer.And neoadjuvant chemotherapy has better long-term survival after cystectomy.%目的 探讨新辅助

  14. Neoadjuvant and adjuvant chemotherapy combined with anatomical resection of feline injection-site sarcoma: results in 21 cats.

    Science.gov (United States)

    Bray, J; Polton, G

    2016-06-01

    This study assesses the outcome of two combined treatment strategies for the treatment of feline injection-site sarcoma (FISS). Twenty-one cats with primary or recurrent FISS received 3 cycles of neoadjuvant chemotherapy with epirubicin (25 mg m(-2) ), then an anatomical resection of the entire muscle compartment containing the tumour was performed based on the findings of co-axial imaging. Cats then received a further 3 cycles of adjuvant chemotherapy. Follow-up was performed by telephone contact with a median follow-up time of 1072 days. Three cats (14%) developed local tumour recurrence at days 264, 664 and 1573 after surgery. A median survival time could not be calculated as over 80% of the study population remained alive or were censored due to death from other causes. When compared to historical controls, the results of this study demonstrate superior rates of tumour-free survival and disease-free interval. PMID:24502401

  15. Neo-adjuvant chemotherapy plus surgery versus surgery alone for cervical cancer: Meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Peng, Yun-Hua; Wang, Xin-Xiu; Zhu, Jing-Song; Gao, Li

    2016-02-01

    The aim of this study was to evaluate the efficacy and safety of neo-adjuvant chemotherapy (NACT) versus radical surgery (RS) for patients with cervical cancer. A meta-analysis of randomized controlled trials (RCT) of NACT + RS versus RS alone for patients with cervical cancer was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The following electronic databases were searched from their inception to April 2015: PUBMED, EMBASE and Cochrane Library. Statistical analysis was done using REVIEW MANAGER 5.3. Five RCT involving 739 patients were studied. There were significant differences between the NACT + RS and the RS-alone groups for positive lymph nodes (OR, 0.45; 95%CI: 0.29-0.70) and parametrial infiltration (OR, 0.48; 95% CI: 0.25-0.92), while treatment efficacy did not differ significantly for 5-year overall survival rate (OR, 1.17; 95% CI: 0.85-1.61), 5-year disease-free survival rate (OR, 1.09; 95% CI: 0.77-1.56) or recurrence rate (OR, 1.17; 95% CI: 0.85-1.61). The results also indicated that chemotherapy-related toxicity was well tolerated. For patients with cervical cancer, NACT could significantly reduce the number of positive lymph nodes and the level of parametrial infiltration compared with RS alone, and be well tolerated. PMID:26807961

  16. Consolidation chemotherapy during neoadjuvant chemoradiation (CRT) for distal rectal cancer leads to sustained decrease in tumor metabolism when compared to standard CRT regimen

    International Nuclear Information System (INIS)

    Neoadjuvant CRT may lead to significant tumor regression in patients with rectal cancer. Different CRT regimens with consolidation chemotherapy may lead to increased rates of complete tumor regression. The purpose of this study was to understand tumor metabolic activity following two different neoadjuvant CRT regimens using sequential PET/CT imaging in two different intervals following RT. Patients with cT2-4 N0-2 M0 rectal cancer treated by standard CRT (54Gy and 2 cycles of 5FU-based chemotherapy) or extended CRT (54Gy and 6 cycles of 5FU-based chemotherapy) underwent sequential PET/CT imaging at baseline, 6 weeks and 12 weeks from radiation completion. 99 patients undergoing standard CRT were compared to 12 patients undergoing CRT with consolidation chemotherapy. Patients treated with consolidation CRT had increased rates of complete clinical or pathological response (66 % vs. 23 %; p < 0.001). SUVmax variation between baseline and 6 weeks (88 % vs. 63 %; p < 0.001) and between baseline and 12 weeks (90 % vs. 57 %; p < 0.001) were significantly more pronounced among patients undergoing extended CRT with consolidation chemotherapy. An increase in SUVmax between 6 and 12 weeks was observed in 51 % of patients undergoing standard and 18 % of patients undergoing consolidation CRT (p = 0.04). Most of the reduction in tumor metabolism after neoadjuvant CRT occurs within the first 6 weeks from RT completion. In patients undergoing CRT with consolidation chemotherapy, tumors are less likely to regain metabolic activity between 6 and 12 weeks. Therefore, assessment of tumor response may be safely postponed to 12 weeks in patients undergoing extended CRT with consolidation chemotherapy.

  17. Neoadjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: Defining high-risk patients who may benefit before concurrent chemotherapy combined with intensity-modulated radiotherapy

    Science.gov (United States)

    Du, Xiao-Jing; Tang, Ling-Long; Chen, Lei; Mao, Yan-Ping; Guo, Rui; Liu, Xu; Sun, Ying; Zeng, Mu-Sheng; Kang, Tie-Bang; Shao, Jian-Yong; Lin, Ai-Hua; Ma, Jun

    2015-01-01

    The purpose of this study was to create a prognostic model for distant metastasis in patients with locally advanced NPC who accept concurrent chemotherapy combined with intensity-modulated radiotherapy (CCRT) to identify high-risk patients who may benefit from neoadjuvant chemotherapy (NACT). A total of 881 patients with newly-diagnosed, non-disseminated, biopsy-proven locoregionally advanced NPC were retrospectively reviewed; 411 (46.7%) accepted CCRT and 470 (53.3%) accepted NACT followed by CCRT. Multivariate analysis demonstrated N2–3 disease, plasma Epstein–Barr virus (EBV) DNA > 4000 copies/mL, serum albumin ≤46 g/L and platelet count >300 k/cc were independent prognostic factors for distant metastasis in the CCRT group. Using these four factors, a prognostic model was developed, as follows: 1) low-risk group: 0–1 risk factors; and 2) high-risk group: 2–4 risk factors. In the high-risk group, patients who accepted NACT + CCRT had significantly higher distant metastasis-free survival and progression-free survival rates than the CCRT group (P = 0.001; P = 0.011). This simple prognostic model for distant metastasis in locoregionally advanced NPC may facilitate with the selection of high-risk patients who may benefit from NACT prior to CCRT. PMID:26564805

  18. Is drug-induced toxicity a good predictor of response to neo-adjuvant chemotherapy in patients with breast cancer? -A prospective clinical study

    International Nuclear Information System (INIS)

    Neo-adjuvant chemotherapy is an integral part of multi-modality approach in the management of locally advanced breast cancer and it is vital to predict the response in order to tailor the regime for a patient. The common final pathway in the tumor cell death is believed to be apoptosis or programmed cell death and chemotherapeutic drugs like other DNA-damaging agents act on rapidly multiplying cells including both the tumor and the normal cells by following the same common final pathway. This could account for both the toxic effects and the response. Absence or decreased apoptosis has been found to be associated with chemo resistance. The change in expression of apoptotic markers (Bcl-2 and Bax proteins) brought about by various chemotherapeutic regimens is being used to identify drug resistance in the tumor cells. A prospective clinical study was conducted to assess whether chemotherapy induced toxic effects could serve as reliable predictors of apoptosis or response to neo-adjuvant chemotherapy in patients with locally advanced breast cancer. 50 cases of locally advanced breast cancer after complete routine and metastatic work up were subjected to trucut biopsy and the tissue evaluated immunohistochemically for apoptotic markers (bcl-2/bax ratio). Three cycles of Neoadjuvant Chemotherapy using FAC regime (5-fluorouracil, adriamycin, cyclophosphamide) were given at three weekly intervals and patients assessed for clinical response as well as toxicity after each cycle. Modified radical mastectomy was performed in all patients three weeks after the last cycle and the specimen were re-evaluated for any change in the bcl-2/bax ratio. The clinical response, immunohistochemical response and the drug-induced toxicity were correlated and compared. Descriptive studies were performed with SPSS version 10 and the significance of response was assessed using paired t-test. Significance of correlation between various variables was assessed using chi-square test and coefficient

  19. Is drug-induced toxicity a good predictor of response to neo-adjuvant chemotherapy in patients with breast cancer? -A prospective clinical study

    Directory of Open Access Journals (Sweden)

    Singh JP

    2004-08-01

    Full Text Available Abstract Background Neo-adjuvant chemotherapy is an integral part of multi-modality approach in the management of locally advanced breast cancer and it is vital to predict the response in order to tailor the regime for a patient. The common final pathway in the tumor cell death is believed to be apoptosis or programmed cell death and chemotherapeutic drugs like other DNA-damaging agents act on rapidly multiplying cells including both the tumor and the normal cells by following the same common final pathway. This could account for both the toxic effects and the response. Absence or decreased apoptosis has been found to be associated with chemo resistance. The change in expression of apoptotic markers (Bcl-2 and Bax proteins brought about by various chemotherapeutic regimens is being used to identify drug resistance in the tumor cells. A prospective clinical study was conducted to assess whether chemotherapy induced toxic effects could serve as reliable predictors of apoptosis or response to neo-adjuvant chemotherapy in patients with locally advanced breast cancer. Methods 50 cases of locally advanced breast cancer after complete routine and metastatic work up were subjected to trucut biopsy and the tissue evaluated immunohistochemically for apoptotic markers (bcl-2/bax ratio. Three cycles of Neoadjuvant Chemotherapy using FAC regime (5-fluorouracil, adriamycin, cyclophosphamide were given at three weekly intervals and patients assessed for clinical response as well as toxicity after each cycle. Modified radical mastectomy was performed in all patients three weeks after the last cycle and the specimen were re-evaluated for any change in the bcl-2/bax ratio. The clinical response, immunohistochemical response and the drug-induced toxicity were correlated and compared. Descriptive studies were performed with SPSS version 10 and the significance of response was assessed using paired t-test. Significance of correlation between various variables was

  20. Parameters that influence the outcome of nausea and emesis in cisplatin based chemotherapy.

    Science.gov (United States)

    Tsavaris, N; Kosmas, C; Mylonakis, N; Bacoyiannis, C; Kalergis, G; Vadiaka, M; Boulamatsis, D; Iakovidis, V; Kosmidis, P

    2000-01-01

    Some factors have demonstrated an influence on emesis and antiemetic response. In order to study these factors, 306 patients (pts) entered this study receiving cisplatin based combination chemotherapy (CT) (100 mg/m3, with ondansetron (8 mg, 3 times daily for 4 days) as the only antiemetic treatment. Known factors that influence the result of antiemetic therapy such as age, sex, performance status (Karnofsky), site of primary tumor, weight loss, anxiety, depression, psychological problems related to CT (psychological PRC) etc, were included in the evaluation. We evaluated the number of vomits, retches and nausea. The existence of psychological PRC was found to be a prominent factor for the development of nausea and emesis, being at the same time strongly associated with scaling variables (Gralla, retching and nausea grading) used to measure the severity of nausea and emesis (p = 0.001). Stress was also a significant predictor; patients with stress had an almost two times higher probability to develop nausea or retching compared to patients without stress indications (p = 0.001), while the occurrence of retching was marginal. Younger patients (less than 40 years old) were found to be almost three times more susceptible to retching compared to older patients (more than 40 years old) (P 0.006). With all possible evaluations, we concluded that significant factors are psychological PRC, stress and age. In conclusion, three factors, age, stress and psychological PRC, should be taken seriously into consideration in the design of future trials evaluating antiemetic treatment, as well as in the every-day clinical practice, in order to provide patients with a better quality of life during emetogenic CT. PMID:11205218

  1. Cisplatin and vinorelbine first-line chemotherapy in non-resectable malignant pleural mesothelioma

    DEFF Research Database (Denmark)

    Frank, H.; Palshof, T.; Sørensen, Jens Benn

    2008-01-01

    The aim was to evaluate the activity of cisplatin and vinorelbine in previously untreated, inoperable patients having histologically verified malignant pleural mesothelioma (MPM), normal organ function, and performance status 0-2. Treatment was vinorelbine 25 mg m(-2) i.v. weekly and cisplatin 10...

  2. Risk Factors of anemia in head and neck cancer patients undergoing chemotherapy with high-dose cisplatin

    Directory of Open Access Journals (Sweden)

    Johan Kurnianda

    2008-12-01

    Full Text Available Cisplatin is well-known for its effectiveness against cancer, as well as its toxicity to human tissues. Of several documented side effects, anemia was reported to have significant association with decreased quality of life. This study was conducted to investigate development of cisplatin-induced anemia, and to identify independent factors contributing to anemia. Clinical data from head and neck cancer patients treated with high-dose cisplatin between December 2002 and December 2005 were obtained in this study. Incidence and risk factors of anemia were assessed in a model including age, sex, baseline hemoglobin level, baseline creatinine clearance, and occurrence of distant metastases. Multivariate logistic regression was used to define independent predictors of anemia. Among 86 eligible patients, 26 (30.2% developed anemia, defined as Hb level lower than 11 g/dL. Age > 55 years old (RR = 2.2, 95% CI, 1.2-4.0, female sex (RR = 2.0, 95% CI, 1.2-3.8, baseline Hb ≤ 13 g/dL (RR = 4.2, 95% CI, 1.9-9.4 and baseline CrCl < 50 mL/min (RR = 2.9, 95% CI, 1.7-5.1 were significantly correlated with incidence of anemia (P < 0.05. In multivariate analysis, baseline Hb and baseline CrCl were identified as independent risk factors for anemia. However, considerable confounding was observed in baseline CrCl after stratified by age (aRR = 2.2, 95% CI, 1.1-4.7. Thus, baseline Hb level was the strongest predictor of anemia. The findings suggested that baseline Hb and CrCl were useful to recognize cisplatin-treated patients at risk for anemia who might benefits from preventive measures. (Med J Indones 2008; 17: 248-54Keywords: anemia, cisplatin, chemotherapy, hemoglobin, creatinine clearance

  3. [Benefits of cisplatin-based polychemotherapy in non-small cell bronchogenic carcinoma. Kyushu Lung Cancer Chemotherapy Study Group].

    Science.gov (United States)

    Ohta, M; Hara, N; Ichikawa, Y; Kanda, T; Shima, K; Tamura, K; Hokama, M

    1988-06-01

    We studied the efficacy of cisplatin-based polychemotherapy for non-small-cell lung cancer. One hundred nineteen patients with adenocarcinoma or large cell carcinoma were randomized to receive cyclophosphamide, adriamycin, cisplatin and mitomycin C (CAPM) or mitomycin C, cytosine arabinoside and tegafur (MCT), and 48 patients with squamous cell carcinoma were randomized to receive cisplatin, adriamycin and peplomycin (PAP) or mitomycin C, cyclophosphamide, tespamine, toyomycin and tegafur (MCTTT). Radiation was given to the chest in patients with stage I-III disease. The response rates were CAPM, 34.5%; MCT, 13.1% (p less than 0.01) and PAP, 63.3%; MCTTT, 42.3%. A significant difference in response rate between the CAPM and MCT regimens was observed only in stage IV patients and not in stage I-III patients. The median survival was 9.5 months in the CAPM arm vs. 6.5 months in the MCT arm (p less than 0.007), and 8.5 months in the PAP arm vs. 6.5 months in the MCTTT arm. Improved median survival for the CAPM regimen was noted only in stage IV patients and not in stage I-III patients when compared to patients given the MCT regimen, respectively. Nausea and vomiting were significantly increased in patients with cisplatin-based polychemotherapy. Myelosuppression was more severe with the CAPM regimen than with the other chemotherapy regimens. We concluded that cisplatin-based polychemotherapy, CAPM and PAP therapy were of more benefit to patients with disseminated non-small-cell lung cancer than MCT and MCTTT therapy. PMID:2454615

  4. FDG PET for staging of advanced non-small cell lung cancer prior to neoadjuvant radio-chemotherapy

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) for the staging of non-small cell lung cancer (NSCLC) before combined neoadjuvant, i.e. preoperative, radio-chemotherapy (RCT). From November 1998 until September 2001, 101 patients with NSCLC were investigated prospectively. The inclusion criterion was a histologically proven NSCLC of stage IIIA or B according to conventional staging including biopsy. The results of PET were compared with those obtained by mediastinoscopy, computed tomography (CT), bone scan and abdominal ultrasonography. Validation of discrepant findings was achieved by biopsy or repeated CT. PET proved to be highly accurate for the detection of lymph node metastases (sensitivity 96%, specificity 73%, positive predictive value 88%, negative predictive value 89%, accuracy 88%) as well as distant metastases (in 25/101 patients, all previously unknown). PET findings changed further treatment in 29/101 patients (29%). Twenty-five were excluded from RCT due to the presence of previously unknown distant metastases. One patient was free of metastases and therefore was operated on without pre-treatment. Two patients did not receive any further treatment because a malignant tumour could be excluded after PET. In the final patient PET demonstrated a tumour pattern not typical for NSCLC which could be attributed to a seminoma after repeated biopsy. FDG PET is the most accurate non-invasive diagnostic procedure for the staging of advanced NSCLC. Therefore use of FDG PET is highly recommended in order to select patients for neoadjuvant or other stage-dependent treatment modalities. (orig.)

  5. Fine-needle aspiration cytology can play a role in neoadjuvant chemotherapy in operable breast cancer.

    Science.gov (United States)

    Garbar, Christian; Curé, Hervé

    2013-01-01

    Despite the fact that CNB has been progressively replaced by FNAC in the investigation of nonpalpable lesions or microcalcifications without a clinical or radiological mass lesion, FNAC has yet a role in palpable lesions provided it is associated with the triple diagnosis and experienced cytologist. In these conditions, FNAC is a safe, effective, economical, and accurate technique for breast cancer evaluation. Numerous literature reviews and meta-analyses illustrated the advantages and disadvantages of both methods CNB and FNAC. The difference does not seem significant when noninformative and unsatisfactory FNAC was excluded. Recently, cytological methods using liquid-based cytology (LBC) technology improve immunocytological and molecular tests with the same efficiency as classical immunohistochemistry. The indications of FNAC were, for palpable lesions, relative contraindication of CNB (elderly or frailty), staging of multiple nodules in conjunction or not with CNB, staging of lymph node status, newly appearing lesion in patient under neoadjuvant treatment, decreasing of anxiety with a rapid diagnosis, evaluation of biomarkers and new biomarkers, and chronological evaluation of biomarker following the neoadjuvant therapy response. PMID:23936675

  6. [Neoadjuvant chemotherapy for symptomatic non operable grade II fibrillary astrocytoma in adults].

    Science.gov (United States)

    Lebrun, C; Fontaine, D; Vandenbos, F; Chanalet, S; Bourg, V; Frénay, M; Alchaar, H; Bleuse, A; Bondiau, P Y; Brunetto, J L; Chatel, M; Courdi, A; Darcourt, J; Fauchon, F; Guibert, F; Grellier, P; Lanteri-Minet, M; Lonjon, M; Michiels, J F; Paquis, P; Paquis, V; Ramaioli, A; Rasendrarijao, D

    2004-05-01

    We collected 6 case-reports of symptomatric non removable low grade fibrillary astrocytoma of adults treated with a procarbazine-CCNU-vincristine chemotherapy regimen. All patients had drug-resistant epilepsy but brain imaging was stable. Total gross resection was rejected because of Volume or tumor location. After 4 to 7 cycles of chemotherapy, 2 patients had partial response and one minor response on brain MRI. All of them were seizure-free. Progression free survival was not reached at 5 Years. Up-front chemotherapy for low-grade astrocytomas may be useful and has to be prospectively evaluated. PMID:15269670

  7. Assessment value of blood flow velocity and resistance index detection by transvaginal color Doppler ultrasound on effect of neoadjuvant chemotherapy for ovarian cancer

    Institute of Scientific and Technical Information of China (English)

    You-Bin Fan

    2016-01-01

    Objective:To analyze the assessment value of blood flow velocity and resistance index detection by transvaginal color Doppler ultrasound on effect of neoadjuvant chemotherapy for ovarian cancer.Methods:A total of 78 cases of ovarian cancer patients receiving treatment in our hospital from September 2012 to May 2014 were included for study, all patients received neoadjuvant chemotherapy, and before and after treatment, transvaginal color Doppler ultrasound (TVCDU) was used to record resistance index (RI) and pulsatility index (PI), the expression levels of serum tumor markers, illness-related indicators and apoptosis-related factors in circulating blood were detected, and the correlation between TVCDU monitoring indexes and ovarian cancer-related indicators was further analyzed.Results: PI value (1.13±0.12) and RI value (0.65±0.05) of ovarian cancer patients after treatment were significantly higher than PI value (0.72±0.06) and RI value (0.32±0.03) of ovarian cancer patients before treatment; serum HE4, CA153, CA125 and毬-HCG levels of ovarian cancer patients after treatment were lower than those before treatment; serum MSLN, CCL-18, FS, CL and Hpa levels of ovarian cancer patients after treatment were lower than those before treatment; after ovarian cancer patients received neoadjuvant chemotherapy, ADM, HIF-1毩, PCNA and bcl-2 gene expression levels were lower than those before treatment; RI and PI values of ovarian cancer patients were inversely proportional to the expression levels of HE4, CA153, CA125,毬-HCG, MSLN, CCL-18, FS, CL, Hpa, ADM, HIF-1毩, PCNA and bcl-2. Conclusion:Blood flow velocity and resistance index detection by transvaginal color Doppler ultrasound can be used as a highly efficient means to evaluate the effect of neoadjuvant chemotherapy for ovarian cancer, and it has positive significance in judging disease severity, guiding treatment and other aspects.

  8. Prediction of neoadjuvant radiation chemotherapy response and survival using pretreatment [18F]FDG PET/CT scans in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    The aim of this study was to investigate metabolic and textural parameters from pretreatment [18F]FDG PET/CT scans for the prediction of neoadjuvant radiation chemotherapy response and 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). We performed a retrospective review of 74 patients diagnosed with LARC who were initially examined with [18F]FDG PET/CT, and who underwent neoadjuvant radiation chemotherapy followed by complete resection. The standardized uptake value (mean, peak, and maximum), metabolic volume (MV), and total lesion glycolysis of rectal cancer lesions were calculated using the isocontour method with various thresholds. Using three-dimensional textural analysis, about 50 textural features were calculated for PET images. Response to neoadjuvant radiation chemotherapy, as assessed by histological tumour regression grading (TRG) after surgery and 3-year DFS, was evaluated using univariate/multivariate binary logistic regression and univariate/multivariate Cox regression analyses. MVs calculated using the thresholds mean standardized uptake value of the liver + two standard deviations (SDs), and mean standard uptake of the liver + three SDs were significantly associated with TRG. Textural parameters from histogram-based and co-occurrence analysis were significantly associated with TRG. However, multivariate analysis revealed that none of these parameters had any significance. On the other hand, MV calculated using various thresholds was significantly associated with 3-year DFS, and MV calculated using a higher threshold tended to be more strongly associated with 3-year DFS. In addition, textural parameters including kurtosis of the absolute gradient (GrKurtosis) were significantly associated with 3-year DFS. Multivariate analysis revealed that GrKurtosis could be a prognostic factor for 3-year DFS. Metabolic and textural parameters from initial [18F]FDG PET/CT scans could be indexes to assess tumour heterogeneity

  9. Prediction of neoadjuvant radiation chemotherapy response and survival using pretreatment [{sup 18}F]FDG PET/CT scans in locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bang, Ji-In; Ha, Seunggyun; Kim, Sang Eun [Seoul National University Bundang Hospital, Department of Nuclear Medicine, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Kang, Sung-Bum; Oh, Heung-Kwon [Seoul National University Bundang Hospital, Department of Surgery, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Lee, Keun-Wook [Seoul National University Bundang Hospital, Department of Internal Medicine, Seongnam (Korea, Republic of); Lee, Hye-Seung [Seoul National University Bundang Hospital, Department of Pathology, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Kim, Jae-Sung [Seoul National University Bundang Hospital, Department of Radiation Oncology, Seongnam (Korea, Republic of); Lee, Ho-Young [Seoul National University Bundang Hospital, Department of Nuclear Medicine, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of)

    2016-03-15

    The aim of this study was to investigate metabolic and textural parameters from pretreatment [{sup 18}F]FDG PET/CT scans for the prediction of neoadjuvant radiation chemotherapy response and 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). We performed a retrospective review of 74 patients diagnosed with LARC who were initially examined with [{sup 18}F]FDG PET/CT, and who underwent neoadjuvant radiation chemotherapy followed by complete resection. The standardized uptake value (mean, peak, and maximum), metabolic volume (MV), and total lesion glycolysis of rectal cancer lesions were calculated using the isocontour method with various thresholds. Using three-dimensional textural analysis, about 50 textural features were calculated for PET images. Response to neoadjuvant radiation chemotherapy, as assessed by histological tumour regression grading (TRG) after surgery and 3-year DFS, was evaluated using univariate/multivariate binary logistic regression and univariate/multivariate Cox regression analyses. MVs calculated using the thresholds mean standardized uptake value of the liver + two standard deviations (SDs), and mean standard uptake of the liver + three SDs were significantly associated with TRG. Textural parameters from histogram-based and co-occurrence analysis were significantly associated with TRG. However, multivariate analysis revealed that none of these parameters had any significance. On the other hand, MV calculated using various thresholds was significantly associated with 3-year DFS, and MV calculated using a higher threshold tended to be more strongly associated with 3-year DFS. In addition, textural parameters including kurtosis of the absolute gradient (GrKurtosis) were significantly associated with 3-year DFS. Multivariate analysis revealed that GrKurtosis could be a prognostic factor for 3-year DFS. Metabolic and textural parameters from initial [{sup 18}F]FDG PET/CT scans could be indexes to assess

  10. Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?

    OpenAIRE

    Vandenput, I.; Van Calster, B; Capoen, A; Leunen, K; Berteloot, P.; Neven, P.; Moerman, Ph.; Vergote, I; Amant, F

    2009-01-01

    Background: To investigate the value of neoadjuvant chemotherapy (NACT), followed by interval debulking surgery (IDS), in endometrial cancer with transperitoneal spread (stage IV). Methods: Patients with endometrial cancer with transperitoneal spread, as determined by laparoscopy (±pleural effusion), were treated with NACT. Efficacy was determined according to the Response Evaluation Criteria in Solid Tumors, residual tumour at IDS and histopathological assessment of tumour regression. Result...

  11. Efficacy of the Additional Neoadjuvant Chemotherapy to Concurrent Chemoradiotherapy for Patients with Locoregionally Advanced Nasopharyngeal Carcinoma: a Bayesian Network Meta-analysis of Randomized Controlled Trials

    OpenAIRE

    Chen, Yu-Pei; Guo, Rui; Liu, Na; Liu, Xu; Mao, Yan-Ping; Tang, Ling-Long; Zhou, Guan-qun; Lin, Ai-Hua; Sun, Ying; Ma, Jun

    2015-01-01

    Background: Due to the lack of studies, it remains unclear whether the additional neoadjuvant chemotherapy (NACT) to concurrent chemoradiotherapy (CCRT) is superior to CCRT alone for locoregionally advanced nasopharyngeal carcinoma (NPC). The main objective of this Bayesian network meta-analysis was to determine the efficacy of NACT+CCRT as compared with CCRT alone. Methods: We comprehensively searched databases and extracted data from randomized controlled trials involving NPC patients who r...

  12. Assessing the Early Response of Advanced Cervical Cancer to Neoadjuvant Chemotherapy Using Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging: A Pilot Study

    OpenAIRE

    Yan-Chun Wang; Dao-Yu Hu; Xue-Mei Hu; Ya-Qi Shen; Xiao-Yan Meng; Hao Tang; Zhen Li

    2016-01-01

    Background: Diffusion-weighted imaging (DWI) with the intravoxel incoherent motion (IVIM) model has shown promising results for providing both diffusion and perfusion information in cervical cancer; however, its use to predict and monitor the efficacy of neoadjuvant chemotherapy (NACT) in cervical cancer is relatively rare. The study aimed to evaluate the use of DWI with IVIM and monoexponential models to predict and monitor the efficacy of NACT in cervical cancer. Methods: Forty-two pati...

  13. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: A study in mastectomy specimens using simulation lumpectomy

    OpenAIRE

    Viswambharan Jaiganesh; Kadambari D; Iyengar Krishnan; Srinivasan K

    2005-01-01

    BACKGROUND : The response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy (NACT) offers these patients previously treated by mastectomy, the chance for breast conservation. AIM : This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor 5 cm. SETTINGS, DESIGN : Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS : Thirty patients with LABC whose tumors reduced...

  14. Tolerance of weekly metronomic paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin

    OpenAIRE

    Dessai, S. B.; Chakraborty, S; Babu, T. V. S.; Nayanar, S.; A Bhattacharjee; Jones, J.; S Balasubramanian; Patil, Vijay M.

    2016-01-01

    Objective: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to examine the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. Methods: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly pacl...

  15. Decreased intratumoral Foxp3 Tregs and increased dendritic cell density by neoadjuvant chemotherapy associated with favorable prognosis in advanced gastric cancer

    OpenAIRE

    Hu, Min; Li, Kai; Maskey, Ninu; Xu, Zhigao; Peng, Chunwei; Wang, Bicheng; Li, Yan; Yang, Guifang

    2014-01-01

    Although neoadjuvant chemotherapy (NACT) has been increasingly used to improve the outcome of advanced gastric cancer (GC) for decades, its precise efficacy has been difficult to evaluate yet. Abundant studies have investigated the predictive factors that represent the effect of NACT on advanced GC. In the present study, the intratumoral infiltration of regulatory T cells (Tregs) and dendritic cells (DCs) response to NACT in advanced GC and their correlation with prognosis were evaluated. Inf...

  16. Role of Tc99m-Sestamibi scintimammography in assessing response to neoadjuvant chemotherapy in patients with locally advanced breast cancer

    OpenAIRE

    Mittal, Bhagwant Rai; Singh, Rajesh K; Kumari, Saumya; Manohar, Kuruva; Bhattacharya, Anish; Singh, Gurpreet

    2012-01-01

    Introduction: Neoadjuvant chemotherapy (NACT) is an essential part of multi-disciplinary management of locally advanced breast cancer (LABC). In this study, we aimed at evaluating the role of Tc99m-Sestamibi scinti-mammography in assessing response to NACT in patients with LABC. Materials and Methods: A total of 42 patients of histologically proven LABC were enrolled in this prospective study. Imaging was performed according to pre-defined protocol at 10 min and 4 h after injection of tracer ...

  17. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Londero, Viviana; Bazzocchi, Massimo; Del Frate, Chiara; Francescutti, Giuliana; Zuiani, Chiara [Institute of Radiology, University of Udine, via Colugna 50, 33100, Udine (Italy); Puglisi, Fabio [Department of Oncology, University of Udine, via Colugna 50, 33100, Udine (Italy); Di Loreto, Carla [Institute of Pathology, University of Udine, via Colugna 50, 33100, Udine (Italy)

    2004-08-01

    The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography. (orig.)

  18. Comparisons of predictive values of breast cancer pathology response after neoadjuvant chemotherapy between physical examination, ultrasound and mammography

    International Nuclear Information System (INIS)

    Objective: To evaluate the method for predicting breast cancer pathology response through comparisons between application value of physical examination, ultrasound and mammography in measuring the size of tumor before and after chemotherapy and the results of pathological Miller and Payne (MP) grade. Methods: 65 patients who received neoadjuvant chemotherapy (NAC) in our department were selected. All patients received one to six cycles of TAC (Docetaxel, Doxorubicin and Cyclophosphamide) regimen or other regimen after being diagnosed as breast cancer by mammotomy biopsy. The following operation was undergone within 3 weeks after the last chemotherapy. The tumor sizes of all patients were examined by physical examination, ultrasound and mammography before NAC and before the operation. The pathological responses were evaluated by MP grading system criteria by comparing the changes of cancer tissues in biopsy tissues before NAC and after te operation. ROC curve and Spearman correlation analysis were used for the analysis between the changes of tumor sizes examined by physical examination, ultrasound and mammography and the results of MP grade. Results: There was a significant correlation between MP grade and the results of physical examination, ultrasound and mammography (r=0.487, P=0.000; r=0.251, P=0.004). The area of pathology complete response (pCR) of MP grade 5 under the ROC curve (Az value) was 0.703 for physical examination, 0.531 for ultrasound, 0.712 for mammography, and 0.727 for combining three techniques. Conclusion: Physical examination and mammography are more useful than ultrasound in predicting the pathologic results of NAC. Combining three techniques has predictive value in pathology response of breast cancer after NAC. (authors)

  19. Patterns of relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy followed by surgery and radiotherapy

    Directory of Open Access Journals (Sweden)

    Yadav B

    2007-01-01

    Full Text Available Aims : To define the clinical and pathological predictors of locoregional recurrence (LRR in locally advanced breast cancer (LABC patients treated with neoadjuvant chemotherapy (NACT. Materials and Methods : We retrospectively reviewed the outcome of 141 patients with stage II to stage III carcinoma breast treated at Department of Radiotherapy, PGIMER, Chandigarh from 1998-2002. Mean age of the patients was 46 years, 49% of patients were premenopausal and 51% were postmenopausal. The tumor stage was T2 in 18%; T3 in 61% and T4 in 26% of the patients. NACT regimen given was FAC (5-fluorouracil, adriamycin and cyclophosphamide in 85% and CMF (cyclophosphamide, methotrexate and 5-Fu in 15% patients. Results : After NACT, surgery was possible in 95% patients. Conservative surgery was possible in 23% patients and mastectomy was done in 72% of patients. Pathological complete response (pCR was seen in 18% patients and pathological partial response (pPR in 69% of patients. Stable and progressive disease was seen in 6% and 7% of patients respectively. Adjuvant radiation therapy was given to 86% patients. Six percent patients developed progressive disease and 4% of patients did not turn up for radiation. Five year LRR was 6% and relapse free survival (RFS was 94%. Thirty-two (23% patients developed distant metastasis resulting in distant metastasis free survival of 77%. The factors that correlated positively with LRR on univariate analysis included tumor stage, stage and pathological nodal stage. However, on multivariate analysis, tumor stage and pathological nodal stage were significant. Factors that correlated for distant relapse were tumor stage, response to chemotherapy, type of surgery, extracapsular extension (ECE and tamoxifen therapy. On multivariate analysis only ECE was the significant factor that correlated with distant relapse free survival. Conclusion : Thus, tumor stage and pathological nodal stage remains the most important predictor of LRR

  20. Study on the value of color Doppler ultrasound in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer

    Institute of Scientific and Technical Information of China (English)

    Chao-Xi Li; De-Hui Wen; Wei-Liang Liu; Hai-Yong Lu

    2016-01-01

    Objective:To explore the value of color Doppler flow imaging (CDFI) in evaluating the efficacy of neoadjuvant chemotherapy (NCT) for breast cancer.Methods: A total of 60 patients with breast cancer who were admitted in our hospital from January, 2015 to December, 2015 were included in the study. TC scheme was used for chemotherapy before operation, i.e. cyclophosphamide 600 mg/m2, docetaxel 75 mg/m2, IV. Three-week treatment was regarded as one course, for 2-4 weeks. After chemotherapy for 1-2 week, the operation was performed. CDFI was used to observe the lesion location, number, size, shape, boundary, internal echo, surrounding echo, rear echo, axillary lymph node, and the relation with the surrounding tissues. The lesion resistance index (RI) was measured.Results:CDFI results showed that 3 were CF, 35 were PR, 20 were SD, and 2 were PD, with a diagnostic sensitivity of 80.6% and coincidence rate of 68.3%. After NCT, the length, width, thickness, area, and volume of the lesions were significantly reduced when compared with before NCT. The comparison of the evaluation of the boundary resolution and echo of the lesions by CDFI before and after NCT was statistically significant. The pathological results showed that 31 were effective, and 29 were invalid, among which RI in the effective group was significantly reduced when compared with before NCT, while RI in the invalid group was not significantly different from that before NCT.Conclusions:The efficacy evaluation of NCT by CDFI is highly consistent with the pathology. CDFI in evaluating the size, boundary, echo, and blood flow indicators of the lesions is of great scientificity and clinical application value.

  1. Are additional trace elements necessary in total parenteral nutrition for patients with esophageal cancer receiving cisplatin-based chemotherapy?

    Science.gov (United States)

    Akutsu, Yasunori; Kono, Tsuguaki; Uesato, Masaya; Hoshino, Isamu; Murakami, Kentaro; Fujishiro, Takeshi; Imanishi, Shunsuke; Endo, Satoshi; Toyozumi, Takeshi; Matsubara, Hisahiro

    2012-12-01

    It is known that cisplatin induces the excretion of zinc from the urine and thereby reduces its serum concentration. However, the fluctuation of these trace elements during or after cisplatin-based chemotherapy has not been evaluated. To answer this question, we performed a clinical study in esophageal cancer patients undergoing cisplatin-based chemotherapy. Eighteen patients with esophageal cancer who were not able to swallow food or water orally due to complete stenosis of the esophagus were evaluated. The patients were divided into a control group [total parenteral nutrition (TPN) alone for 28 days, ten cases] and an intervention group (TPN with additional trace elements for 28 days, eight cases). The serum concentrations of zinc, iron, copper, manganese, triiodothyronin (T3), and thyroxin (T4), as alternative indicators of iodine, were measured on days 0, 14, and 28 of treatment, and statistically analyzed on day 28. In the control group, the serum concentration of copper was significantly decreased from 135.4 (day 0) to 122.1 μg/ml (day 14), and finally to 110.6 μg/ml (day 28, p = 0.015). The concentration of manganese was also significantly decreased from 1.34 (day 0) to 1.17 μg/ml (day 14) and finally to 1.20 (day 28, p = 0.049). The levels of zinc, iron, T3, and T4 were not significantly changed. In the intervention group, the supplementation with trace elements successfully prevented these decreases in their concentrations. TPN with supplementary trace elements is preferable and recommended for patients who are undergoing chemotherapy in order to maintain the patients' nutrient homeostasis. PMID:23054866

  2. Chemotherapy with cisplatin and vinorelbine for elderly patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC)

    International Nuclear Information System (INIS)

    Although modest improvements in the survival of patients with non-small cell lung cancer (NSCLC) can be achieved with cisplatin-based chemotherapy (CT), its value is disputed in the geriatric setting. In this study, we evaluate the feasibility of vinorelbine/cisplatin CT for elderly NSCLC patients. In this pilot phase I/II trial, all patients received CT with vinorelbine 25 mg/m2, on day 1 and 8, and cisplatin on day 1, in 28 days-cycles. After stratification for age (up to 75 years), younger patients were sequentially allocated to moderate cisplatin doses (80 mg/m2 or 90 mg/m2), and older patients were allocated to lower cisplatin doses (60 mg/m2 or 70 mg/m2). We recruited patients aged over 70 years with newly diagnosed NSCLC, clinical stage III or IV, Karnofsky performance status ≥ 70%, normal serum creatinine, peripheral neuropathy ≤ grade 1, and no prior cancer therapy. Analysis was by intention to treat. Main toxicities (grade 3–4) was as follows: neutropenia, 20%; anemia, 11%; and thrombocytopenia, 2%; alopecia, 55%; fatigue, 11%; and peripheral neurotoxicity, 2%. No grade 3–4 emesis or renal toxicity occurred. Global median time to progression (TTP) and overall survival (OS) were 27.0 (95% CI: 10.1 to 43.7) weeks and 30.1 (95% CI: 24.4 to 35.8) weeks; 1- and 2-year survival rates were 36.3% and 13.2%, respectively. Overall response rate was 50.0% (95% CI: 35.4% to 64.5%), with 1 complete response; no difference on response rate was noticed according to cisplatin dose. Median overall survival was 30.1 weeks, with 1- and 2-year survival rates of 36.3% and 13.2%, respectively. Age does not preclude assessment on the role of cisplatin-vinorelbine CT for elderly NSCLC patients with good performance status and adequate bodily functions

  3. A Pilot Study to Investigate the Role of Thymidylate Synthase as a Marker of Prognosis for Neoadjuvant Chemotherapy in Gastric and Gastro-Oesophageal Junction Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    A. Mirza

    2013-01-01

    Full Text Available Aims and Background. Patients in the United Kingdom with operable gastric and gastro-oesophageal junction (GOJ tumours receive neoadjuvant chemotherapy. Our aim was to study the expression of thymidylate synthase (TS enzyme in pre-treatment diagnostic biopsy specimens and investigate its clinical usefulness. Methods. A single-centre study was carried out in 45 patients with gastric and GOJ adenocarcinoma treated with neo-adjuvant chemotherapy according to the MAGIC protocol. TS expression was determined using immunohistochemistry. >10% tumour nuclei expression of TS was used as cut-off for positivity. Results. Forty-one (91% of the 45 tumours expressed TS. There was no association between TS expression and lymph node status (P = 0.80, histological response (P = 0.30, and recurrence (P = 0.55. On univariate analysis, only N-stage (P = 0.02 and vascular invasion (P = 0.04 were associated with a poor prognosis. Patients with negative tumour TS expression had better outcome than those with positive expression. The overall 5-year survival rate was 100% in the TS negative versus 56% in TS positive group, but the difference was not statistically significant (P = 0.17. Conclusion. TS expression should be studied in a larger series of gastro-oesophageal cancers as a potential prognostic marker of prognosis to neo-adjuvant chemotherapy.

  4. Clinical efficacy and safety of paclitaxel plus carboplatin as neoadjuvant chemotherapy prior to radical hysterectomy and pelvic lymphadenectomy for Stage IB2-IIB cervical cancer

    Science.gov (United States)

    Yang, Lu; Guo, Jianfeng; Shen, Yi; Cai, Jing; Xiong, Zhoufang; Dong, Weihong; Min, Jie; Wang, Zehua

    2015-01-01

    Objective: To assess the efficacy and toxicity of the combination of paclitaxel plus carboplatin as neoadjuvant chemotherapy (NACT) for locally advanced cervical cancer (LACC) prior to radical hysterectomy and pelvic lymphadenectomy. Methods: We reviewed patients with cervical cancer of the International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin followed by radical hysterectomy (NACT group) or only received primary radical surgery (PRS group) in our hospital between Jan 2007 and Jan 2012. Toxicity, NACT response, surgery pathological factors and survival data were collected and analyzed. Results: In the NACT group, the overall response rate was 71.3% (82/115). Eighteen (15.7%) patients achieved complete remission. Well differentiated tumors showed a more favorable response to NACT (P=0.011). Myelosuppression was the most common adverse effect (51.7%) and serious adverse effects were rare (3.4%). The median follow-up period was 44 months (range, 6-75). The NACT responders had significantly longer OS and PFS when compared to the non-NACT responders and patients in the PRS group. Conclusion: Patients with LACC can benefit from neoadjuvant chemotherapy with paclitaxel plus carboplatin when they have response to the chemotherapeutic agents. PMID:26550314

  5. Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy

    OpenAIRE

    Sato, Seiya; Itamochi, Hiroaki

    2014-01-01

    Approximately 70% of women with epithelial ovarian cancer (EOC) are diagnosed with advanced stage disease, which is associated with high morbidity and mortality. The standard approach to treating patients with advanced EOC remains primary debulking surgery (PDS) followed by chemotherapy. EOC is one of the most sensitive of all solid tumors to cytotoxic drugs, with over 80% of women showing a response to standard chemotherapy combined with taxane and platinum. Furthermore, residual disease is ...

  6. A case of Esophageal small cell carcinoma with multiple liver metastases responding to chemotherapy with Irinotecan plus Cisplatin

    Energy Technology Data Exchange (ETDEWEB)

    Endo, K.; Kohnoe, S. [Fukuoka Dental College Hospital, Fukuoka (Japan). Dept. of General Surgery; Toh, Y.; Haraguchi, M.; Okamura, T. [National Kyushu Cancer Center, Fukuoka (Japan). Dept. of Gastroenteological Surgery; Nishiyama, K. [National Kyushu Cancer Center, Fukuoka (Japan). Dept. of Pathology; Baba, H.; Maehara, Y. [Graduate School of Medical Science, Fukuoka (Japan). Dept. of General Surgery

    2005-12-15

    We report a case of small cell esophageal carcinoma (SCEC) with multiple liver metastases treated with some success by chemotherapy with irinotecan (CPT-11) plus cisplatin (CDDP). Radiologic and endoscopic examination of a 75-year-old man with multiple liver tumors disclosed a 4.0-cm type 2 tumor in the middle third of the esophagus. An endoscopically obtained biopsy specimen was diagnosed as undifferentiated small cell carcinoma. Multiple liver metastases were confirmed but lymph node metastases and distant metastases other than those in the liver were not detected. After six courses of chemotherapy with CPT-11 plus CDDP, the primary lesion showed complete response and liver metastases showed partial response. However, because all lesions almost immediately relapsed or progressed, arterial infusion chemotherapy for liver metastases and radiation for the primary lesion were given as second-line treatment. The primary lesion showed complete response with radiation. Arterial infusion chemotherapy prevented the progression of liver metastases once, but the patient died of liver failure at last. No distant lesions including metastatic lymph nodes were confirmed over the course of his illness, and the patient survived for a year after first diagnosis. Although the prognosis of SCEC is quite unfavorable due to highly aggressive behavior, a better prognosis is possible with effective chemotherapy and second-line treatment is important in improving prognosis.

  7. A case of Esophageal small cell carcinoma with multiple liver metastases responding to chemotherapy with Irinotecan plus Cisplatin

    International Nuclear Information System (INIS)

    We report a case of small cell esophageal carcinoma (SCEC) with multiple liver metastases treated with some success by chemotherapy with irinotecan (CPT-11) plus cisplatin (CDDP). Radiologic and endoscopic examination of a 75-year-old man with multiple liver tumors disclosed a 4.0-cm type 2 tumor in the middle third of the esophagus. An endoscopically obtained biopsy specimen was diagnosed as undifferentiated small cell carcinoma. Multiple liver metastases were confirmed but lymph node metastases and distant metastases other than those in the liver were not detected. After six courses of chemotherapy with CPT-11 plus CDDP, the primary lesion showed complete response and liver metastases showed partial response. However, because all lesions almost immediately relapsed or progressed, arterial infusion chemotherapy for liver metastases and radiation for the primary lesion were given as second-line treatment. The primary lesion showed complete response with radiation. Arterial infusion chemotherapy prevented the progression of liver metastases once, but the patient died of liver failure at last. No distant lesions including metastatic lymph nodes were confirmed over the course of his illness, and the patient survived for a year after first diagnosis. Although the prognosis of SCEC is quite unfavorable due to highly aggressive behavior, a better prognosis is possible with effective chemotherapy and second-line treatment is important in improving prognosis

  8. Feasibility of preoperative combined radiation therapy and chemotherapy with 5-fluorouracil and cisplatin in potentially resectable pancreatic adenocarcinoma: The French SFRO-FFCD 97-04 Phase II trial

    International Nuclear Information System (INIS)

    Purpose More than 80% of patients who undergo a potentially curative resection for pancreatic cancer develop local or distant recurrence. Neoadjuvant chemoradiotherapy might offer potential benefits regarding local and systemic control and survival. This multi-institutional Phase II trial explored the feasibility of preoperative chemoradiation in this situation. Methods and Materials Treatment consisted of concurrent radiotherapy (50 Gy within 5 weeks), and chemotherapy with 5-fluorouracil (300 mg/m2/day, 5 days/week, 5 consecutive weeks) and cisplatin (20 mg/m2/day, Days 1-5 and 29-33), followed by surgical resection of the pancreatic tumor in patients without progression. Results A total of 41 patients were enrolled. Of these, 38 (93%) received ≥47 Gy; 30 patients (73%) received ≥75% of the prescribed doses of chemotherapy. Surgical resection was performed in 26 patients (63%). Because of local or metastatic progression, 5 patients (12%) did not undergo surgery and 10 underwent surgery without resection of the pancreatic tumor. Operative mortality was 2.8%. Among 40 evaluable patients, 27 were successfully treated (67.5%; 95% CI, 50.9-81.4%). Conclusions Pancreatic cancer is chemo-radiosensitive. The proposed pre-operative scheme is feasible, does not prevent successful surgery, and must be tested on a Phase III setting. Yet, the large proportion of tumor progression during and after chemoradiation justifies the use of more efficient drugs such as Gemcitabine, and optimized radiotherapy including new techniques such as intensity-modulated radiation therapy

  9. Voluntary exercise prevents cisplatin-induced muscle wasting during chemotherapy in mice

    DEFF Research Database (Denmark)

    Hojman, Pernille; Fjelbye, Jonas; Zerahn, Bo;

    2014-01-01

    % (P<0.001), maintained lean body mass (P<0.001) and muscle strength (P<0.001), reversed anorexia and impairments in Akt and protein degradation signalling. Cisplatin-induced muscular inflammation was not prevented by voluntary wheel running, nor was glucose tolerance improved. Exercise training may......Loss of muscle mass related to anti-cancer therapy is a major concern in cancer patients, being associated with important clinical endpoints including survival, treatment toxicity and patient-related outcomes. We investigated effects of voluntary exercise during cisplatin treatment on body weight......, food intake as well as muscle mass, strength and signalling. Mice were treated weekly with 4 mg/kg cisplatin or saline for 6 weeks, and randomized to voluntary wheel running or not. Cisplatin treatment induced loss of body weight (29.8%, P<0.001), lean body mass (20.6%, P = 0.001), as well as anorexia...

  10. A phase II study evaluating neo-/adjuvant EIA chemotherapy, surgical resection and radiotherapy in high-risk soft tissue sarcoma

    International Nuclear Information System (INIS)

    The role of chemotherapy in high-risk soft tissue sarcoma is controversial. Though many patients undergo initial curative resection, distant metastasis is a frequent event, resulting in 5-year overall survival rates of only 50-60%. Neo-adjuvant and adjuvant chemotherapy (CTX) has been applied to achieve pre-operative cytoreduction, assess chemosensitivity, and to eliminate occult metastasis. Here we report on the results of our non-randomized phase II study on neo-adjuvant treatment for high-risk STS. Patients with potentially curative high-risk STS (size ≥ 5 cm, deep/extracompartimental localization, tumor grades II-III [FNCLCC]) were included. The protocol comprised 4 cycles of neo-adjuvant chemotherapy (EIA, etoposide 125 mg/m2 iv days 1 and 4, ifosfamide 1500 mg/m2 iv days 1 - 4, doxorubicin 50 mg/m2 day 1, pegfilgrastim 6 mg sc day 5), definitive surgery with intra-operative radiotherapy, adjuvant radiotherapy and 4 adjuvant cycles of EIA. Between 06/2005 and 03/2010 a total of 50 subjects (male = 33, female = 17, median age 50.1 years) were enrolled. Median follow-up was 30.5 months. The majority of primary tumors were located in the extremities or trunk (92%), 6% originated in the abdomen/retroperitoneum. Response by RECIST criteria to neo-adjuvant CTX was 6% CR (n = 3), 24% PR (n = 12), 62% SD (n = 31) and 8% PD (n = 4). Local recurrence occurred in 3 subjects (6%). Distant metastasis was observed in 12 patients (24%). Overall survival (OS) and disease-free survival (DFS) at 2 years was 83% and 68%, respectively. Multivariate analysis failed to prove influence of resection status or grade of histological necrosis on OS or DFS. Severe toxicities included neutropenic fever (4/50), cardiac toxicity (2/50), and CNS toxicity (4/50) leading to CTX dose reductions in 4 subjects. No cases of secondary leukemias were observed so far. The current protocol is feasible for achieving local control rates, as well as OS and DFS comparable to previously published data on

  11. A phase II study evaluating neo-/adjuvant EIA chemotherapy, surgical resection and radiotherapy in high-risk soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Schmitt Thomas

    2011-12-01

    Full Text Available Abstract Background The role of chemotherapy in high-risk soft tissue sarcoma is controversial. Though many patients undergo initial curative resection, distant metastasis is a frequent event, resulting in 5-year overall survival rates of only 50-60%. Neo-adjuvant and adjuvant chemotherapy (CTX has been applied to achieve pre-operative cytoreduction, assess chemosensitivity, and to eliminate occult metastasis. Here we report on the results of our non-randomized phase II study on neo-adjuvant treatment for high-risk STS. Method Patients with potentially curative high-risk STS (size ≥ 5 cm, deep/extracompartimental localization, tumor grades II-III [FNCLCC] were included. The protocol comprised 4 cycles of neo-adjuvant chemotherapy (EIA, etoposide 125 mg/m2 iv days 1 and 4, ifosfamide 1500 mg/m2 iv days 1 - 4, doxorubicin 50 mg/m2 day 1, pegfilgrastim 6 mg sc day 5, definitive surgery with intra-operative radiotherapy, adjuvant radiotherapy and 4 adjuvant cycles of EIA. Result Between 06/2005 and 03/2010 a total of 50 subjects (male = 33, female = 17, median age 50.1 years were enrolled. Median follow-up was 30.5 months. The majority of primary tumors were located in the extremities or trunk (92%, 6% originated in the abdomen/retroperitoneum. Response by RECIST criteria to neo-adjuvant CTX was 6% CR (n = 3, 24% PR (n = 12, 62% SD (n = 31 and 8% PD (n = 4. Local recurrence occurred in 3 subjects (6%. Distant metastasis was observed in 12 patients (24%. Overall survival (OS and disease-free survival (DFS at 2 years was 83% and 68%, respectively. Multivariate analysis failed to prove influence of resection status or grade of histological necrosis on OS or DFS. Severe toxicities included neutropenic fever (4/50, cardiac toxicity (2/50, and CNS toxicity (4/50 leading to CTX dose reductions in 4 subjects. No cases of secondary leukemias were observed so far. Conclusion The current protocol is feasible for achieving local control rates, as well as OS

  12. Chemotherapy related toxicity in locally advanced non-small cell lung cancer

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    Bahl Amit

    2006-01-01

    Full Text Available Background: For inoperable non-small cell lung cancer combined chemotherapy and radiotherapy plays an important role as a therapeutic modality. The aim of the present study was to analyze neoadjuvant chemotherapy related acute toxicity in locally advanced lung cancer (stage IIIA and IIIB in Indian patients using Cisplatin and Etoposide combination chemotherapy. Material and methods: Forty patients of locally advanced Non small cell lung cancer received three cycles neoadjuvant chemotherapy using Injection Cisplatin and Etoposide. The patients were taken for Radical radiotherapy to a dose of 60 Gray over 30 fractions in conventional fractionation after completing chemotherapy. Chemotherapy associated toxicity was assessed using common toxicity criteria (CTC v2.0 Results: Forty patients were available for final evaluation. Median age of presentation of patients was fifty-six years. Thirteen patients had Non small cell lung cancer stage IIIA while twenty-seven patients had Stage IIIB disease. Anemia was the most common hematological toxicity observed (seen in 81% of patients. Nausea and vomiting were the most common non -hematological toxicity seen. Sensory neuropathy was seen in 38%of patients. 88% patients developed alopecia. Seven patients developed febrile neutropenias. Conclusion: Neo-adjuvant chemotherapy using Cisplatin and Etoposide continues to be a basic regimen in the Indian set up despite availability of higher molecules, since it is cost effective, well tolerated and therapeutically effective. Blood transfusions, growth factors and supportive care can be used effectively to over come toxicity associated with this regimen.

  13. Combination of taxanes, cisplatin and fluorouracil as induction chemotherapy for locally advanced head and neck cancer: a meta-analysis.

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    Hao Qin

    Full Text Available BACKGROUND: Some investigations have suggested that induction chemotherapy with a combination of taxanes, cisplatin and fluorouracil (TPF is effective in locally advanced head and neck cancer. However, other trials have indicated that TPF does not improve outcomes. The objective of this study was to compare the efficacy and safety of TPF with a cisplatin and fluorouracil (PF regimen through a meta-analysis. METHODS: Four randomized clinical trials were identified, which included 1,552 patients with locally advanced head and neck cancer who underwent induction chemotherapy with either a TPF or PF protocol. The outcomes included the 3-year survival rate, overall response rate and different types of adverse events. Risk ratios (RRs and their 95% confidence intervals (CIs were pooled using RevMan 5.1 software. RESULTS: The 3-year survival rate (51.0% vs. 42.4%; p = 0.002, 3-year progression-free survival rate (35.9% vs. 27.2%; p = 0.007 and overall response to chemotherapy (72.9% vs. 62.1%; p<0.00001 of the patients in the TPF group was statistically superior to those in the PF group. In terms of toxicities, the incidence of febrile neutropenia (7.0% vs. 3.2%; p = 0.001 and alopecia (10.8% vs. 1.1%; p<0.00001 was higher in the TPF group. CONCLUSION: The TPF induction chemotherapy regimen leads to a significant survival advantage with acceptable toxicity rates for patients with locally advanced head and neck cancer compared with the PF regimen.

  14. Clinical Effects of Shenqi Fuzheng Injection in the Neoadjuvant Chemotherapy for Local Advanced Breast Cancer and the Effects on T-lymphocyte Subsets

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective: To evaluate clinical effects of Shenqi Fuzheng Injection (参芪抉正注射液) in the neoadjuvant chemotherapy for local advanced breast cancer and the effects on T-lymphocyte subsets. Methods: During the period from 2000 to 2005, 126 patients with local advanced breast cancer were treated with the neoadjuvant chemotherapy. They were randomly divided into the following two groups: a control group of 61 cases treated by chemotherapy alone and a study group of 65 cases treated by chemotherapy plus Shenqi Fuzheng Injection. All the cases of both groups were given the CEF (CTX 500 mg/m2, d1, 8; EPI 40 mg/m2, d1, 8; and 5-Fu 500 mg/m2, d1,8) regimen. The clinical effects, the effects on T-lymphocyte subgroup and NK cells, and the toxic side effects were observed. Results: All the patients completed two cycles of the chemotherapy, and the efficacy and the toxic side effects were evaluated. For the primary tumor in the breast, the total effective rate was 69.2% (45/65) in the study group and 49.2% (30/61) in the control group with a statistically significant difference in the intergroup comparison (χ2=5.251, P=0.022, < 0.05). There was no progression of the disease in both the groups, and there were no grade IV toxic side effects in the two groups. The major toxic responses were myelosuppression and gastrointestinal reaction, which were milder in the study group than the control group, and with a shorter recovery course in the former than the latter. Besides, an obvious rise of the T-lymphocyte subgroup and NK cells was found in the study group after the neoadjuvant chemotherapy, with a very significant difference from the controls (P<0.01). Conclusions: Shenqi Fuzheng Injection can improve and regulate immune function of the patients with local advanced breast cancer given the neoadjuvant chemotherapy, and therefore it can enhance the curative effect and reduce the side effect as well.

  15. Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy

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    The objective of the present study was to monitor response to preoperative chemotherapy with breast MRI in patients with large breast cancer. Fifty-eight women in whom core biopsy had confirmed the presence of breast carcinoma underwent breast MRI prior to beginning chemotherapy and before surgical excision. In 24 cases patients underwent one or two additional examinations during chemotherapy to monitor their progress. Breast MRI included both T2-weighted spin-echo sequences and T1-weighted gradient-echo sequences before and 1, 2, 3, and 8 min after bolus injection of gadolinium-DTPA. Tumor size and the dynamic contrast medium uptake patterns of the respective carcinomas were evaluated and compared with the final histology findings. Based on their MR tomographic findings (change in tumor size and intensity of contrast media uptake), patients were assigned to groups with non-response (NR), partial response (PR), and complete response (CR). Based on MR tomographic findings, there were 12 patients in the NR group, 34 in the PR group, and 12 in the CR group. In NR group contrast medium uptake tended to increase or show no more than minimal decrease. Diagnostic accuracy for assigning patients to the NR group was 83.3% and to the PR group 82.4%. In patients whose tumors showed only slight response to chemotherapy, breast MRI proved very reliable in determining the size of the lesions. In patients whose tumors displayed significant response and in the CR group, the size of the residual tumor was underestimated in 8 of 12 cases. In 66.7% of patients in the CR group histology revealed residual tumor masses in areas up to 5 cm in diameter. During chemotherapy, intensity of contrast medium uptake decreased in 88.2% of patients with PR and in all patients with CR. Reliable determination of response was possible within 6 weeks following the initiation of chemotherapy. Breast MRI is suitable as a monitoring method. The determination of residual tumor size is unreliable in

  16. Voluntary exercise prevents cisplatin-induced muscle wasting during chemotherapy in mice.

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    Pernille Hojman

    Full Text Available Loss of muscle mass related to anti-cancer therapy is a major concern in cancer patients, being associated with important clinical endpoints including survival, treatment toxicity and patient-related outcomes. We investigated effects of voluntary exercise during cisplatin treatment on body weight, food intake as well as muscle mass, strength and signalling. Mice were treated weekly with 4 mg/kg cisplatin or saline for 6 weeks, and randomized to voluntary wheel running or not. Cisplatin treatment induced loss of body weight (29.8%, P < 0.001, lean body mass (20.6%, P = 0.001, as well as anorexia, impaired muscle strength (22.5% decrease, P < 0.001 and decreased glucose tolerance. In addition, cisplatin impaired Akt-signalling, induced genes related to protein degradation and inflammation, and reduced muscle glycogen content. Voluntary wheel running during treatment attenuated body weight loss by 50% (P < 0.001, maintained lean body mass (P < 0.001 and muscle strength (P < 0.001, reversed anorexia and impairments in Akt and protein degradation signalling. Cisplatin-induced muscular inflammation was not prevented by voluntary wheel running, nor was glucose tolerance improved. Exercise training may preserve muscle mass in cancer patients receiving cisplatin treatment, potentially improving physical capacity, quality of life and overall survival.

  17. Effectiveness of evaluating tumor vascularization using 3D power Doppler ultrasound with high-definition flow technology in the prediction of the response to neoadjuvant chemotherapy for T2 breast cancer: a preliminary report

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    The aim of this study was to evaluate the effectiveness of advanced ultrasound (US) imaging of vascular flow and morphological features in the prediction of a pathologic complete response (pCR) and a partial response (PR) to neoadjuvant chemotherapy for T2 breast cancer.Twenty-nine consecutive patients with T2 breast cancer treated with six courses of anthracycline-based neoadjuvant chemotherapy were enrolled. Three-dimensional (3D) power Doppler US with high-definition flow (HDF) technology was used to investigate the blood flow in and morphological features of the tumors. Six vascularity quantization features, three morphological features, and two vascular direction features were selected and extracted from the US images. A support vector machine was used to evaluate the changes in vascularity after neoadjuvant chemotherapy, and pCR and PR were predicted on the basis of these changes.The most accurate prediction of pCR was achieved after the first chemotherapy cycle, with an accuracy of 93.1% and a specificity of 85.5%, while that of a PR was achieved after the second cycle, with an accuracy of 79.31% and a specificity of 72.22%.Vascularity data can be useful to predict the effects of neoadjuvant chemotherapy. Determination of changes in vascularity after neoadjuvant chemotherapy using 3D power Doppler US with HDF can generate accurate predictions of the patient response, facilitating early decision-making. (paper)

  18. Effectiveness of evaluating tumor vascularization using 3D power Doppler ultrasound with high-definition flow technology in the prediction of the response to neoadjuvant chemotherapy for T2 breast cancer: a preliminary report

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    Shia, Wei-Chung; Chen, Dar-Ren; Huang, Yu-Len; Wu, Hwa-Koon; Kuo, Shou-Jen

    2015-10-01

    The aim of this study was to evaluate the effectiveness of advanced ultrasound (US) imaging of vascular flow and morphological features in the prediction of a pathologic complete response (pCR) and a partial response (PR) to neoadjuvant chemotherapy for T2 breast cancer. Twenty-nine consecutive patients with T2 breast cancer treated with six courses of anthracycline-based neoadjuvant chemotherapy were enrolled. Three-dimensional (3D) power Doppler US with high-definition flow (HDF) technology was used to investigate the blood flow in and morphological features of the tumors. Six vascularity quantization features, three morphological features, and two vascular direction features were selected and extracted from the US images. A support vector machine was used to evaluate the changes in vascularity after neoadjuvant chemotherapy, and pCR and PR were predicted on the basis of these changes. The most accurate prediction of pCR was achieved after the first chemotherapy cycle, with an accuracy of 93.1% and a specificity of 85.5%, while that of a PR was achieved after the second cycle, with an accuracy of 79.31% and a specificity of 72.22%. Vascularity data can be useful to predict the effects of neoadjuvant chemotherapy. Determination of changes in vascularity after neoadjuvant chemotherapy using 3D power Doppler US with HDF can generate accurate predictions of the patient response, facilitating early decision-making.

  19. Chemoradiotherapy with or without consolidation chemotherapy using cisplatin and 5-fluorouracil in anal squamous cell carcinoma: long-term results in 31 patients

    International Nuclear Information System (INIS)

    The objectives of this study were to evaluate long-term results of concurrent chemoradiotherapy (CRT) with 5-fluorouracil and cisplatin and the potential benefit of consolidation chemotherapy in patients with anal squamous cell carcinoma (ASCC). Between January 1995 and February 2006, 31 patients with ASCC were treated with CRT. Radiotherapy was administered at 45 Gy over 5 weeks, followed by a boost of 9 Gy to complete or partial responders. Chemotherapy consisted of 5-fluorouracil (750 or 1,000 mg/m2) daily on days 1 to 5 and days 29 to 33; and, cisplatin (75 or 100 mg/m2) on day 2 and day 30. Twelve patients had T3–4 disease, whereas 18 patients presented with lymphadenopathy. Twenty-one (67.7%) received consolidation chemotherapy with the same doses of 5-fluorouracil and cisplatin, repeated every 4 weeks for maximum 4 cycles. Nineteen patients (90.5%) completed all four courses of consolidation chemotherapy. After CRT, 28 patients showed complete responses, while 3 showed partial responses. After a median follow-up period of 72 months, the 5-year overall, disease-free, and colostomy-free survival rates were 84.7%, 82.9% and 96.6%, demonstrating that CRT with 5-fluorouracil and cisplatin yields a good outcome in terms of survival and sphincter preservation. No differences in 5-year OS and DFS rates between patients treated with CRT alone and CRT with consolidation chemotherapy was observed. our study shows that CRT with 5-FU and cisplatin, with or without consolidation chemotherapy, was well tolerated and proved highly encouraging in terms of long-term survival and the preservation of anal function in ASCC. Further trials with a larger patient population are warranted in order to evaluate the potential role of consolidation chemotherapy

  20. Hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant chemotherapy as prophylaxis of peritoneal carcinosis from advanced gastric cancer—effects on overall and disease free survival

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    Celotti, Andrea; Ceresoli, Marco; Montori, Giulia; Marini, Michele; Catena, Fausto; Ansaloni, Luca

    2016-01-01

    Background The possibility to enlarge criteria for intra-peritoneal chemotherapy (IPC) to all patients at high-risk to develop peritoneal carcinosis (i.e., with serosal invasion) is still discussed. Methods Retrospective case-control study. Three-groups: advanced-gastric-cancer (AGC) (pT4) without proven carcinosis: prophylactic group (PG), those with PC: treatment group (TG), AGC (pT3–pT4) operated without hyperthermic intraperitoneal chemotherapy (HIPEC), surgery alone group (SG T3, SG T4). Results Forty four patients. 26 (59.1%) were male. Sixteen (36%) patients underwent 16 HIPEC: 6 (38%) had AGC (pT4) without PC (PG), 10 (62%) had carcinosis (TG), 28 were operated without HIPEC (SG T3, SG T4). The mean disease free survival (DFS): TG: 7.7 months, SG T4: 21.6 months, SG T3: 27.7 months, PG: 34.5 months. DFS was significantly different for TG (P=0.03, P=0.021, P=0.013 respectively). The mean OS TG: 10 months, SG T4: 27.1 months, SG T3: 28.2 months, PG: 34.6 months. OS was significantly different for TG (P=0.04, P=0.04, P=0.045 respectively). Severe complication rate: TG: 60%, PG: 16.7%, SG T3: 7.7% and SG T4: 25% (P=0.035). Length-of-stay differs significantly (P=0.003); overall length-of-stay: 19.41 days [standard deviation (SD) ±15.03]; TG: 33.01 (SD ±23.08), PG: 20.17 (SD ±6.21), SG T3: 11.33 (SD ±3.22), SG T4: 15.36 (SD ±5.48). Conclusions Prophylactic intraperitoneal chemotherapy associated to neoadjuvant chemotherapy increases the DFS and OS in patients with AGC without carcinosis. More data are needed in order to confirm these results.

  1. [A Case of Resected Gastric Cancer Occurring Simultaneously with Intrahepatic Cholangiocarcinoma after S-1 plus Cisplatin Chemotherapy].

    Science.gov (United States)

    Nishimura, Masashige; Kawada, Junji; Matsuura, Norihiro; Kitagawa, Akihiro; Nomura, Masatoshi; Okumura, Yuichiro; Nakatsuka, Rie; Miyazaki, Susumu; Danno, Katsuki; Motoori, Masaaki; Kubota, Masaru; Matsuda, Chu; Fujitani, Kazumasa; Iwase, Kazuhiro

    2015-11-01

    It is sometimes difficult to differentiate between metastatic and primary liver tumors, when the liver tumor occurs simultaneously with a gastric cancer. We encountered a case of resected gastric cancer, which occurred concomitantly with intrahepatic cholangiocarcinoma after S-1 plus cisplatin chemotherapy, in a patient who was previously diagnosed with metastatic liver tumor before treatment. An 80-year-old man was admitted to our hospital because of epigastralgia. Endoscopic study of the upper gastrointestinal tract showed a type 3 tumor at the upper body of the stomach. A plain CT scan showed an irregular, low-density area, which was enhanced by contrast medium in the lateral segment of the liver. We performed an ultrasound- guided needle biopsy, because it was impossible to make a definitive diagnosis by dynamic CT, contrast-enhanced ultrasonography, and MRI. Immunohistochemical analysis for cytokeratin 7/20 resulted in 7 (+)/20 (-) for both the gastric cancer and the liver tumor. Therefore, we diagnosed the patient with gastric cancer, which occurred concomitantly with the metastatic liver tumor, and administered chemotherapy with S-1 plus cisplatin. After 3 courses of the regimen, a reduction in the size of mass was observed in the stomach and the liver. We subsequently performed left hepatectomy and total gastrectomy with lymph node dissection. Microscopic examination revealed the gastric cancer, which occurred simultaneously with the intrahepatic cholangiocarcinoma. The postoperative course was uneventful, and the patient remains well without recurrences. PMID:26805150

  2. Assessment of CAD-generated tumor volumes measured using MRI in breast cancers before and after neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Objective: To evaluate inter-observer agreement and the predictive value of tumor size measurements using MRI for breast cancer under neoadjuvant chemotherapy (NAC) by comparing the measurements of the longest diameters (LD), total enhanced volumes (TEV) and washout volumes (WOV). Methods: Thirty-seven female breast cancer patients were prospectively enrolled from August 2008 to October 2010. Two of these patients had locally advanced disease. MRI examinations were acquired within 2 weeks before and after NAC. Interim scans were also conducted in 30 patients. Tumor resection was undertaken within 2 weeks after the cessation of NAC. MRI images were independently measured for LD, TEV and WOV by two experienced radiologists. Inter-observer agreement was evaluated using concordance correlation coefficients (CCCs). Tumor sizes after NAC were evaluated relative to their initial sizes for early prediction of a pathological complete response (pCR). Results: The CCCs were 0.93 (CI: 0.90–0.95) for LD, 0.98 (CI: 0.97–0.98) for TEV and 0.99 (CI: 0.991–0.996) for WOV. All measurements had high inter-observer agreement, but the CCCs were significantly increased in the aforementioned order (P < 0.0001). WOV measured after the completion of chemotherapy had significant discriminating ability (P = 0.0056) when evaluated using receiver operating characteristic analysis, and was found to be superior to LD (P = 0.045). The average WOV size was significantly smaller in pCR cases than in non-pCR cases (P = 0.016). Conclusion: Computer-aided detection-generated tumor volumes had significantly higher inter-observer concordance than conventional LD measurements. WOV measurements had the highest concordance, and WOV could better predict pCR after NAC at smaller tumor sizes

  3. Patterns of Care in the Administration of Neo-adjuvant Chemotherapy for Breast Cancer. A Population-Based Study.

    Science.gov (United States)

    Vugts, Guusje; Maaskant-Braat, Adriana J G; Nieuwenhuijzen, Grard A P; Roumen, Rudi M H; Luiten, Ernest J T; Voogd, Adri C

    2016-05-01

    Neo-adjuvant chemotherapy (NAC) is used to facilitate radical surgery for initially irresectable or locally advanced breast cancer. The indication for NAC has been extended to clinically node negative (cN0) patients in whom adjuvant systemic therapy is foreseen. A population-based study was conducted to evaluate the increasing use of NAC, breast conserving surgery (BCS) after NAC and timing of the sentinel node biopsy (SNB). All female breast cancer patients, treated in 10 hospitals in the Eindhoven Cancer Registry area in the Netherlands between January 2003 and June 2012 were included (N = 18,427). In total, 1,402 patients (7.6%) received NAC. The administration increased from 2.5% in 2003 to 13.0% in 2011 (p Downsizing of the tumor and BCS are achieved increasingly. In 2011, in three hospitals NAC was administered in 20% (p < 0.001). Of the 1,402 patients with NAC, 495 patients underwent SNB, 91.5% of whom prior to NAC. In the Netherlands up to one in eight patients receive NAC. The administration of NAC and the percentage of BCS increased over the past decade, especially in cT2 tumors. Considerable hospital variation in the administration of NAC exists. PMID:26945566

  4. Prediction of response to neoadjuvant chemotherapy in osteosarcoma using dual-phase {sup 18}F-FDG PET/CT

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    Byun, Byung Hyun [The Catholic University of Korea, Division of Nuclear Medicine, Department of Radiology, College of Medicine, Seoul (Korea, Republic of); Korea Institute of Radiological and Medical Sciences (KIRAMS), Departments of Nuclear Medicine, Seoul (Korea, Republic of); Kim, Sung Hoon; Chung, Soo Kyo [The Catholic University of Korea, Division of Nuclear Medicine, Department of Radiology, College of Medicine, Seoul (Korea, Republic of); Lim, Sang Moo; Lim, Ilhan [Korea Institute of Radiological and Medical Sciences (KIRAMS), Departments of Nuclear Medicine, Seoul (Korea, Republic of); Kong, Chang-Bae; Song, Won Seok; Cho, Wan Hyeong; Jeon, Dae-Geun; Lee, Soo-Yong [Korea Institute of Radiological and Medical Sciences (KIRAMS), Orthopedic Surgery, Seoul (Korea, Republic of); Koh, Jae-Soo [Korea Institute of Radiological and Medical Sciences (KIRAMS), Pathology, Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2015-07-15

    We evaluated the ability of dual-phase {sup 18}F-FDG PET/CT to predict the histological response after neoadjuvant chemotherapy (NAC) in osteosarcoma. Thirty-one patients with osteosarcoma treated with NAC and surgery were prospectively enrolled. After injection of {sup 18}F-FDG, both early (∝60 min) and delayed (∝150 min) PET were acquired before and after the completion of NAC. SUVmax, early/delayed SUVmax change (RImax), and early/delayed SUVmean change (RImean) of tumour were measured before (SUV1, RImax1, and RImean1) and after NAC (SUV2, RImax2, and RImean2). Then, we calculated the percentage changes between SUV1 and SUV2 (%SUV). Twelve patients (39 %) exhibited good histological response after NAC. SUVmax, RImax, and RImean significantly decreased after NAC. Before NAC, only RImean1 predicted good histological response with the optimal criterion of < 10 %, sensitivity of 92 %, specificity of 57 %, and accuracy of 71 %. After NAC, %SUV, SUV2, and RImax2 predicted histological response. By using combined criterion of %SUV and RImax2 or SUV2 and RImean1 or SUV2 and RImax2, accuracies were 81 %, 77 %, and 77 %, respectively. The histological response after NAC could be predicted by using RImean1 before the initiation of NAC in osteosarcoma. The combined use of SUV and RI values may provide a better prediction. (orig.)

  5. Prognostic value of DCE-MRI in breast cancer patients undergoing neoadjuvant chemotherapy: a comparison with traditional survival indicators

    International Nuclear Information System (INIS)

    To determine associations between dynamic contrast-enhanced MR imaging (DCE-MRI) parameters and survival intervals in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC), surgery, and adjuvant therapies. Further, to compare the prognostic value of DCE-MRI parameters against traditional survival indicators. DCE-MRI and MR tumour volume measures were obtained prior to treatment and post 2nd NAC cycle. To demonstrate which parameters were associated with survival, Cox's proportional hazards models (CPHM) were employed. To avoid over-parameterisation, only those MR parameters with at least a borderline significant result were entered into the final CPHM. When considering disease-free survival positive axillary nodal status (hazard ratio [HR] 6.79), younger age (HR 3.37), negative oestrogen receptor status (HR 3.24), pre-treatment Maximum Enhancement Index (MaxEI) (HR 6.51), and percentage change in MaxEI (HR 1.02) represented the retained CPHM covariates. Similarly, positive axillary nodal status (HR 11.47), negative progesterone receptor status (HR 4.37) and percentage change in AUC90 (HR 1.01) represented the retained predictive variables for overall survival. Multivariate survival analysis has demonstrated that DCE-MRI parameters obtained prior to NAC and/or post 2nd cycle can provide independent prognostic information that can complement traditional prognostic indicators available prior to treatment. (orig.)

  6. Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

    Institute of Scientific and Technical Information of China (English)

    Hong Zheng; Yu-Nong Gao

    2012-01-01

    Objectives:To compare the survival and perioperative morbidity between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NAC/IDS) in treating patients with advanced epithelial ovarian cancer (EOC).Methods:We retrospectively reviewed 67 patients with stage ⅢC or Ⅳ EOC treated at Peking University Cancer Hospital from January 2006 to June 2009.Wherein,37 and 30 patients underwent PDS and NAC/IDS,respectively.Results:No difference in overall survival (OS) or progression-free survival (PFS) was observed between NAC/IDS group and PDS group (OS:41.2 vs.39.1 months,P=0.23; PFS:27.1 vs.24.3 months,P=0.37).The optimal debulking rate was 60% in the NAC/IDS group,which was significantly higher than that in the PDS group (32.4%) (P=0.024).The NAC/IDS group had significantly less intraoperative estimated blood loss and transfusion,lower nasogastric intubation rate,and earlier ambulation and recovery of intestinal function than the PDS group (P<0.05).Conclusions:NAC/IDS is less invasive than PDS,and offers the advantages regarding optimal cytoreduction rate,intraoperative blood loss,and postoperative recovery,without significantly impairing the survival compared with PDS in treating patients with stage ⅢC or Ⅳ EOC.Therefore,NAC/IDS may be a valuable treatment alternative for EOC patients.

  7. Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy

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    Yu, Mi Hye [Konkuk University Medical Center, Department of Radiology, Seoul (Korea, Republic of); Lee, Jeong Min; Han, Joon Koo; Choi, Byung-Ihn [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Hur, Bo Yun [Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Kim, Tae-You [Seoul National University Hospital, Department of Internal Medicine, Seoul (Korea, Republic of); Jeong, Seung-Yong; Yi, Nam-Joon; Suh, Kyung-Suk [Seoul National University Hospital, Department of Surgery, Seoul (Korea, Republic of)

    2015-08-15

    To investigate the diagnostic performance of gadoxetic acid-enhanced MRI including diffusion-weighted imaging (DWI) for the detection of colorectal liver metastases (CRLMs) after neoadjuvant chemotherapy (NAC). Our study population comprised 77 patients with 140 CRLMs who underwent gadoxetic acid-enhanced MRI within 1 month prior to surgery: group A (without NAC, n = 38) and group B (with NAC, n = 39). Two radiologists independently assessed all MR images and graded their diagnostic confidence for CRLM on a 5-point scale. Diagnostic accuracy, sensitivity and positive predictive values (PPV) were calculated and compared between the two groups. Diagnostic accuracy of gadoxetic acid-enhanced MRI in group B was slightly lower than in group A, but a statistically significant difference was not observed (observer 1: A{sub z}, 0.926 in group A, 0.905 in group B; observer 2: A{sub z}, 0.944 in group A, 0.885 in group B; p > 0.05). Sensitivity and PPV of group B were comparable to those of group A (observer 1: sensitivity = 93.5 % vs. 93.6 %, PPV = 95.1 % vs. 86.9 %; observer 2: sensitivity = 96.8 % vs. 91.0 %; PPV = 90.0 % vs. 89.7 %; all p > 0.05). Gadoxetic acid-enhanced MRI including DWI provided good diagnostic performance with high sensitivity (>90 %) for the detection of CRLMs, regardless of the influence of NAC. (orig.)

  8. Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study

    International Nuclear Information System (INIS)

    To investigate whether CT-derived vascular parameters in primary breast cancer predict complete pathological response (pCR) to neoadjuvant chemotherapy (NAC). Twenty prospective patients with primary breast cancer due for NAC underwent volumetric helical perfusion CT to derive whole tumour regional blood flow (BF), blood volume (BV) and flow extraction product (FE) by deconvolution analysis. A pCR was achieved if no residual invasive cancer was detectable on pathological examination. Relationships between baseline BF, BV, FE, tumour size and volume, and pCR were examined using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the parameter best able to predict response. Intra- and inter-observer variability was assessed using Bland-Altman statistics. Seventeen out of 20 patients completed NAC with four achieving a pCR. Baseline BF and FE were higher in patients who achieved a pCR compared with those who did not (P = 0.032); tumour size and volume were not significantly different (P > 0.05). ROC analysis revealed that BF and FE were able to identify responders effectively (AUC = 0.87; P = 0.03). There was good intra- and inter-observer agreement. Primary breast cancers which exhibited higher levels of perfusion before treatment were more likely to achieve a pCR to NAC. (orig.)

  9. Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Li, Sonia P.; Makris, Andreas [Academic Oncology Unit, Mount Vernon Cancer Centre, Middlesex (United Kingdom); Gogbashian, Andrew; Simcock, Ian C.; Stirling, J.J. [Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Middlesex (United Kingdom); Goh, Vicky [Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Middlesex (United Kingdom); Lambeth Wing, St Thomas' Hospital, Division of Imaging Sciences, Kings College London, London (United Kingdom)

    2012-09-15

    To investigate whether CT-derived vascular parameters in primary breast cancer predict complete pathological response (pCR) to neoadjuvant chemotherapy (NAC). Twenty prospective patients with primary breast cancer due for NAC underwent volumetric helical perfusion CT to derive whole tumour regional blood flow (BF), blood volume (BV) and flow extraction product (FE) by deconvolution analysis. A pCR was achieved if no residual invasive cancer was detectable on pathological examination. Relationships between baseline BF, BV, FE, tumour size and volume, and pCR were examined using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the parameter best able to predict response. Intra- and inter-observer variability was assessed using Bland-Altman statistics. Seventeen out of 20 patients completed NAC with four achieving a pCR. Baseline BF and FE were higher in patients who achieved a pCR compared with those who did not (P = 0.032); tumour size and volume were not significantly different (P > 0.05). ROC analysis revealed that BF and FE were able to identify responders effectively (AUC = 0.87; P = 0.03). There was good intra- and inter-observer agreement. Primary breast cancers which exhibited higher levels of perfusion before treatment were more likely to achieve a pCR to NAC. (orig.)

  10. Prognostic value of DCE-MRI in breast cancer patients undergoing neoadjuvant chemotherapy: a comparison with traditional survival indicators

    Energy Technology Data Exchange (ETDEWEB)

    Pickles, Martin D.; Lowry, Martin; Turnbull, Lindsay W. [Hull York Medical School at University of Hull, Hull Royal Infirmary, Centre for Magnetic Resonance Investigations, Hull (United Kingdom); Manton, David J. [Hull and East Yorkshire Hospitals NHS Trust, Radiation Physics Department, Hull (United Kingdom)

    2015-04-01

    To determine associations between dynamic contrast-enhanced MR imaging (DCE-MRI) parameters and survival intervals in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC), surgery, and adjuvant therapies. Further, to compare the prognostic value of DCE-MRI parameters against traditional survival indicators. DCE-MRI and MR tumour volume measures were obtained prior to treatment and post 2nd NAC cycle. To demonstrate which parameters were associated with survival, Cox's proportional hazards models (CPHM) were employed. To avoid over-parameterisation, only those MR parameters with at least a borderline significant result were entered into the final CPHM. When considering disease-free survival positive axillary nodal status (hazard ratio [HR] 6.79), younger age (HR 3.37), negative oestrogen receptor status (HR 3.24), pre-treatment Maximum Enhancement Index (MaxEI) (HR 6.51), and percentage change in MaxEI (HR 1.02) represented the retained CPHM covariates. Similarly, positive axillary nodal status (HR 11.47), negative progesterone receptor status (HR 4.37) and percentage change in AUC{sub 90} (HR 1.01) represented the retained predictive variables for overall survival. Multivariate survival analysis has demonstrated that DCE-MRI parameters obtained prior to NAC and/or post 2nd cycle can provide independent prognostic information that can complement traditional prognostic indicators available prior to treatment. (orig.)

  11. Decreased FOXP3+ and GARP+ Tregs to neoadjuvant chemotherapy associated with favorable prognosis in advanced gastric cancer.

    Science.gov (United States)

    Li, Kai; Chen, Fuchao; Xie, Huijuan

    2016-01-01

    Neoadjuvant chemotherapy (NACT) has been an increasingly used therapeutic strategy to improve the outcome of advanced gastric cancer (GC) over the past few decades. Lymphocytic infiltration has been reported to be associated with response to NACT, but the immune cell subpopulation and its prognosis contributing to response in GC have not been clarified yet. In the current study, the tumor infiltration of FOXP3+ and GARP+ regulatory T-cells (Tregs, marked by FOXP3 and GARP) response to NACT in advanced GC and their correlation with prognosis were evaluated. The infiltration of FOXP3+ and GARP+ Tregs in 102 patients with advanced GC who were treated with or without NACT was measured using immunohistochemical method. The infiltration of FOXP3+ and GARP+ Tregs was significantly decreased in the NACT group than in the non-NACT group (P=0.023 and P=0.012, respectively) and significantly associated with tumor, node, metastasis stage (P=0.019 and P=0.011, respectively). There was no significant difference in patient's overall survival between the NACT and non-NACT groups (P=0.166); however, patients in the NACT group with decreased infiltration of FOXP3+ and GARP+ Tregs had longer overall survival (P=0.002 and PNACT could decrease the infiltration of FOXP3+ and GARP+ Tregs, and that the infiltration of GARP+ Tregs may serve as a new prognostic factor of human GC response to NACT. PMID:27366089

  12. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone

    Science.gov (United States)

    Joshi, Poonam; Joshi, Amit; Prabhash, Kumar; Noronha, Vanita; Chaturvedi, Pankaj

    2015-01-01

    Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT) in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and Methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were included in the study. These patients were studied in two groups. Group 1 included 153 patients who underwent surgery alone, and Group 2 included 52 patients who received 2-3 cycles of NACT followed by surgery. Results: The mean age of the population was 51 years in the Group 1 and 45 years in Group 2. The hospital stay and readmissions in postoperative period were similar in the two groups. In this study, the complication rate was 37.9% in the surgery patients and 30.8% in the NACT patients (P = 0.424). Conclusion: The postoperative complication rates in patients who received NACT followed by surgery were not significantly different from those who underwent surgery. PMID:26811595

  13. Comparison of postoperative complications in advanced head and neck cancer patients receiving neoadjuvant chemotherapy followed by surgery versus surgery alone

    Directory of Open Access Journals (Sweden)

    Poonam Joshi

    2015-01-01

    Full Text Available Background: Head and neck cancer is the third most common cancer in India with 60% presenting in advanced stages. There is the emerging role of neoadjuvant chemotherapy (NACT in the management of these advanced cancers. There is a general perception that complication rates are higher with the use of NACT. Materials and Methods: This is a retrospectively collected data of head and neck cancer patients operated at our hospital from March 2013 to September 2014. A total of 205 patients were included in the study. These patients were studied in two groups. Group 1 included 153 patients who underwent surgery alone, and Group 2 included 52 patients who received 2-3 cycles of NACT followed by surgery. Results: The mean age of the population was 51 years in the Group 1 and 45 years in Group 2. The hospital stay and readmissions in postoperative period were similar in the two groups. In this study, the complication rate was 37.9% in the surgery patients and 30.8% in the NACT patients (P = 0.424. Conclusion: The postoperative complication rates in patients who received NACT followed by surgery were not significantly different from those who underwent surgery.

  14. Prediction of response to neoadjuvant chemotherapy in osteosarcoma using dual-phase 18F-FDG PET/CT

    International Nuclear Information System (INIS)

    We evaluated the ability of dual-phase 18F-FDG PET/CT to predict the histological response after neoadjuvant chemotherapy (NAC) in osteosarcoma. Thirty-one patients with osteosarcoma treated with NAC and surgery were prospectively enrolled. After injection of 18F-FDG, both early (∝60 min) and delayed (∝150 min) PET were acquired before and after the completion of NAC. SUVmax, early/delayed SUVmax change (RImax), and early/delayed SUVmean change (RImean) of tumour were measured before (SUV1, RImax1, and RImean1) and after NAC (SUV2, RImax2, and RImean2). Then, we calculated the percentage changes between SUV1 and SUV2 (%SUV). Twelve patients (39 %) exhibited good histological response after NAC. SUVmax, RImax, and RImean significantly decreased after NAC. Before NAC, only RImean1 predicted good histological response with the optimal criterion of < 10 %, sensitivity of 92 %, specificity of 57 %, and accuracy of 71 %. After NAC, %SUV, SUV2, and RImax2 predicted histological response. By using combined criterion of %SUV and RImax2 or SUV2 and RImean1 or SUV2 and RImax2, accuracies were 81 %, 77 %, and 77 %, respectively. The histological response after NAC could be predicted by using RImean1 before the initiation of NAC in osteosarcoma. The combined use of SUV and RI values may provide a better prediction. (orig.)

  15. Metronomic chemotherapy with 5-fluorouracil and cisplatin for inoperable malignant bowel obstruction because of peritoneal dissemination from gastric cancer

    Science.gov (United States)

    Yang, S.; Li, S.; Yu, H.; Li, S.; Liu, W.; Liu, X.; Ma, H.

    2016-01-01

    Background Gastric cancer is the 2nd leading cause of cancer death worldwide. Malignant bowel obstruction (mbo) is a common complication in advanced gastric cancer because of peritoneal dissemination. A multicentre prospective study reported that patients with peritoneal dissemination of gastric origin survive for a median of 3.1 months. The aim of the present study was therefore to evaluate the efficacy and safety of metronomic combination chemotherapy with 5-fluorouracil and cisplatin in inoperable mbo from peritoneal dissemination in gastric cancer. Methods Gastric cancer patients diagnosed with inoperable mbo because of peritoneal dissemination were treated with infusional 5-fluorouracil 300 mg/m2 daily on days 1–5 and 8–12, and cisplatin 5 mg/m2 daily on days 1–4 and 8–11 every 3 weeks. The primary endpoint was symptom control (remission of obstruction); the secondary endpoint was symptom control time and survival; the tertiary endpoint was adverse effects. Results Between January 2013 and December 2014, 26 patients received the study treatment. Before treatment, 18 patients (69.2%) were nil per os, and 8 (30.8%) could consume liquids. After a mean of 3.3 cycles of the study treatment, just 4 patients (15.4%) was still nil per os. Of the remaining 22 patients, 3 (11.5%) could consume liquids, 7 (26.9%) could consume soft solids, and 12 (46.2%) ate a full diet. The improved ability to eat was statistically significant (p cancer. Metronomic combination chemotherapy with 5-fluorouracil and cisplatin provides a rationale for exploring this medical problem in the future.

  16. Clinical and pathological response rates of docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer and comparison with anthracycline-based chemotherapies: Eight-year experience from single centre

    OpenAIRE

    Gupta, D.; Raina, V.; Rath, G. K.; N K Shukla; Mohanti, B. K.; D N Sharma

    2011-01-01

    Introduction: The administration of neoadjuvant chemotherapy (NACT) prior to local therapy is advantageous for women with locally advanced breast cancer (LABC), since it can render inoperable tumors resectable and can increase rates of breast conservative surgeries. Materials and Methods: We retrospectively analyzed LABC patients who received NACT from January 2000 to December 2007. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NA...

  17. Expression of multidrug resistance proteins P-glycoprotein, multidrug resistance protein 1, breast cancer resistance protein and lung resistance related protein in locally advanced bladder cancer treated with neoadjuvant chemotherapy: biological and clinical implications.

    NARCIS (Netherlands)

    Diestra, JE; Condom, E; Muro, XG Del; Scheffer, G.L.; Perez, J; Zurita, AJ; Munoz-Segui, J; Vigues, F; Scheper, R.J.; Capella, G; Germa-Lluch, JR; Izquierdo, M.A.

    2003-01-01

    PURPOSE: Resistance to chemotherapy is a major obstacle to overcome in the conservative treatment of patients with locally advanced bladder cancer (LABC). We investigated the predictive value of the response to neoadjuvant chemotherapy (NACT) and prognosis of the expression of multidrug resistance (

  18. Computer-Aided Evaluation of Breast MRI for the Residual Tumor Extent and Response Monitoring in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

    International Nuclear Information System (INIS)

    To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics. For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 ± 1.7 cm) was significantly smaller than the mean histological diameter (2.6 ± 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 ± 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confidence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confidence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3

  19. Prognostic value of the 99mTc-Isonitrile washout rate in neoadjuvant chemotherapy in patients with locally advanced breast cancer

    International Nuclear Information System (INIS)

    Full text: Neoadjuvant chemotherapy is the pre-surgical treatment of choice in patients with locally advanced breast tumor for better disease control and breast conservation. Resistance to chemotherapy may be seen in about 18%-51% of the cancers. The term multi drug resistance (MDR) is commonly used to indicate the expression of the transmembrane glycoprotein (P-glycoprotein). This protein removes some very important chemotherapeutic drugs from inside the cell and is responsible for the clinical manifestation of the MDR. The knowledge of MDR before the initiation of chemotherapy can help choosing the best treatment. 99mTc-Isonitrile is a radiotracer largely used in nuclear medicine. It enters cells, is identified by the P-glycoprotein as a substrate and is, therefore, expelled from the neoplastic cell. Various studies have demonstrated direct correlation between the 99mTc-Isonitrile efflux, P-glycoprotein expression and MDR. On the other hand, 99mTc-Isonitrile retention in the tumor suggests chemosensitivity. The objective of this study was to monitor the response to neoadjuvant chemotherapy in breast cancer by the use of 99mTc-Sestamibi scintimammography and its washout rate in a pilot study. Five patients with locally advanced breast cancer were subjected to neoadjuvant chemotherapy. Inclusion criteria were locally advanced tumor, biopsy results, no distant metastasis, and completion of the whole chemotherapy protocol. Exclusion criteria were any previous cancer treatment or other primary tumor. All the patients underwent 99mTc-Sestamibi scintimammography before and after completion of the chemotherapy protocol. For scintimammography, 740MBq of radiotracer was injected in the arm contra lateral to the side of lesion. Planar images were acquired at 10 and 240 minutes, in anterior supine position as well as in both lateral projections in prone position. Regions of interest of same size were drawn over the tumor and in the contra lateral breast to correct for

  20. Protocol and result of neoadjuvant chemotherapy for locally advanced esophageal carcinoma

    International Nuclear Information System (INIS)

    The protocol and result were described of chemotherapy and radiotherapy for locally advanced esophageal carcinoma, especially for A3 stage one with metastasis at neighboring tissues such as aorta, trachea and bronchia. Chemotherapy was done with 5-FU and CDDP and radiotherapy, with 30 Gy/15 fx/3 wk. Double contrast roentgenography, dynamic CT and MRI were performed to follow the process. The efficacy rate was 55.0% with 4 CR and 7 PR in 20 cases. Three CR patients survived at present. Major adverse effects were leukopenia and thrombocytopenia, of which grade 4 were found in 14 and 12% cases, respectively. Low-dose FP therapy might be useful for lowering the adverse effects and for elevating the efficacy rates. (K.H.)

  1. Selection of colon cancer patients for neoadjuvant chemotherapy by preoperative CT scan

    DEFF Research Database (Denmark)

    Nørgaard, Anne; Dam, Claus; Jakobsen, Anders;

    2014-01-01

    tomography (CT) in local staging of colon cancer correlated with histopathological parameters, including criteria for adjuvant chemotherapy. Material and methods. A total of 74 included patients had preoperative CT scans and surgical resection of their colon tumors. Tumor stage (T-stage), extramural tumor...... invasion (ETI), nodal stage (N-stage), extramural venous invasion (EVI) and the distance from tumor to nearest retroperitoneal fascia (DRF) were retrospectively assessed on the CT scan and compared blindly with the results of the pathological examination, including evaluation of the criteria for adjuvant...... chemotherapy. Advanced tumors were defined as T3 with ETI ≥5 mm or T4. Results. Sixty-nine percent of the tumors were correctly T-staged by CT, 7% were overstaged and 24% were understaged. As to correct recognition of ETI on the CT scan, the observer was 73% accurate compared with histology (70% sensitivity...

  2. Correlation of clinico-pathologic and radiologic parameters of response to neoadjuvant chemotherapy in breast cancer

    OpenAIRE

    Mukherjee, P.; Sharma, S.; Z A Sheikh; Vijaykumar, D. K.

    2014-01-01

    Context: As of today, there is no validated standard method to assess clinical response of breast cancer to neo- adjuvant chemotherapy (NACT). Some centers use clinical dimensions while others use radiological measurements to evaluate response according to RECIST criteria. Aims: The aim was to correlate and compare the clinical, radiological, and pathological parameters for assessing the tumor response in patients of breast cancer receiving NACT. Settings and Design: Single institution, prosp...

  3. REG Iα is a biomarker for predicting response to chemotherapy with S-1 plus cisplatin in patients with unresectable stage IV gastric cancer

    OpenAIRE

    Sekikawa, A.; Fukui, H.; Zhang, X.; Maruo, T; Tsumura, T; Okabe, Y.; Wakasa, T.; Osaki, Y.; Chiba, T.; Tomita, T; Oshima, T.; Watari, J; Miwa, H

    2013-01-01

    Background: The regenerating gene Iα (REG Iα) is involved in gastric carcinogenesis as an antiapoptotic factor. Therefore, we investigated whether REG Iα confers resistance to chemotherapeutic drugs in gastric cancer (GC) cells and whether REG Iα expression is useful for predicting the response to chemotherapy and outcome in patients with GC. Methods: A total of 70 patients with unresectable stage IV GC received first-line chemotherapy with S-1 and cisplatin (S-1/CDDP). The expression of REG ...

  4. Results of the Tremplin trial proposing an induction chemotherapy followed by concomitant radiotherapy with cisplatin ou cetuximab in order to protect the larynx

    International Nuclear Information System (INIS)

    The authors report a randomized phase II trial which aimed at comparing over three months the laryngeal protection after a TPF-based induction chemotherapy followed by radiotherapy in combination with cisplatin or cetuximab. Over two years, 153 patients have been concerned. The TPF-based induction chemotherapy followed by radiotherapy with cetuximab seems to be the less toxic. A longer monitoring is needed to get better information in terms of laryngeal protection rate, life quality, and laryngeal functionality. Short communication

  5. Is Tc-99m sestamibi scintimammography useful in the prediction of neoadjuvant chemotherapy responses in breast cancer? A systematic review and meta-analysis.

    Science.gov (United States)

    Guo, Cui; Zhang, Chengpeng; Liu, Jianjun; Tong, Linjun; Huang, Gang

    2016-07-01

    To evaluate the accuracy of Tc-99m sestamibi (MIBI) scintimammography in the prediction of neoadjuvant chemotherapy response in breast cancer. 'PubMed' (MEDLINE included) and Embase database were searched for relevant publications in English. Methodological quality of the included studies was assessed with Quality Assessment of Diagnosis Accuracy Studies (QUADAS), and 'Meta-Disc' and 'Stata' software were used to determine pooled sensitivity, specificity, and diagnostic odds ratio (DOR), and construct a summary receiver-operating characteristic curve. Fourteen studies (a total of 503 individuals) fulfilled the inclusion criteria. The pooled sensitivity was 0.86 [95% confidence interval (CI): 0.78-0.92] and the pooled specificity was 0.69 (95% CI: 0.64-0.74). Pooled likelihood ratio (LRp), negative likelihood ratio (LR-), and DOR were 2.64 (95% CI: 1.81-3.85), 0.26 (95% CI: 0.15-0.46), and 12.06 (95% CI: 6.94-20.96), respectively. The area under the summary receiver-operating characteristic curve was 0.86. For the prediction of pathological complete response (10 studies included), the pooled sensitivity and specificity and DOR were 0.86 (95% CI: 0.77-0.93), 0.67 (95% CI: 0.62-0.72), and 11.43 (95% CI: 5.95-21.97). Our results indicated that Tc-99m MIBI scintimammography had acceptable sensitivity in the prediction of neoadjuvant chemotherapy response in breast cancer; however, its relatively low specificity showed that a combination of other imaging modalities would still be needed. Subgroup analysis indicated that performing early mid-treatment Tc-99m MIBI scintimammography (using the reduction rate of one or two cycles or within the first half-courses of chemotherapy compared with the baseline) was better than carrying out later (after three or more courses) or post-treatment scintimammography in the prediction of neoadjuvant chemotherapy response. PMID:26974314

  6. Concomitant radio chemotherapy with cisplatin-etoposide in inoperable non small cells bronchial neoplasms stage III: toward an improvement of local control and of survive

    International Nuclear Information System (INIS)

    The addition of etoposide to cisplatin in the framework of a concomitant radio chemotherapy is susceptible to improve the local control of the non at small cells bronchial carcinomas with an improvement of survive until two years. Results with fifty patients stage III are described

  7. The Role of Epigenetics in Resistance to Cisplatin Chemotherapy in Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    O' Byrne, Kenneth J.; Barr, Martin P.; Gray, Steven G., E-mail: sgray@stjames.ie [Trinity College Dublin, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James Hospital, James Street, Dublin 8 (Ireland)

    2011-03-17

    Non-small cell lung cancer (NSCLC) is the most common cause of cancer related death in the world. Cisplatin and carboplatin are the most commonly used cytotoxic chemotherapeutic agents to treat the disease. These agents, usually combined with drugs such as gemcitabine or pemetrexed, induce objective tumor responses in only 20–30% of patients. Aberrant epigenetic regulation of gene expression is a frequent event in NSCLC. In this article we review the emerging evidence that epigenetics and the cellular machinery involved with this type of regulation may be key elements in the development of cisplatin resistance in NSCLC.

  8. Effect of neoadjuvant chemotherapy on low-density lipoprotein (LDL) receptor and LDL receptor-related protein 1 (LRP-1) receptor in locally advanced breast cancer

    International Nuclear Information System (INIS)

    Low-density lipoprotein (LDL) receptors are overexpressed in most neoplastic cell lines and provide a mechanism for the internalization and concentration of drug-laden nanoemulsions that bind to these receptors. The aim of the present study was to determine whether the administration of standard chemotherapeutic schemes can alter the expression of LDL and LDL receptor-related protein 1 (LRP-1) receptors in breast carcinoma. Fragments of tumoral and normal breast tissue from 16 consecutive volunteer women with breast cancer in stage II or III were obtained from biopsies before the beginning of neoadjuvant chemotherapy and after chemotherapy, from fragments excised during mastectomy. Tissues were analyzed by immunohistochemistry for both receptors. Because complete response to treatment was achieved in 4 patients, only the tumors from 12 were analyzed. Before chemotherapy, there was overexpression of LDL receptor in the tumoral tissue compared to normal breast tissue in 8 of these patients. LRP-1 receptor overexpression was observed in tumors of 4 patients. After chemotherapy, expression of both receptors decreased in the tumors of 6 patients, increased in 4 and was unchanged in 2. Nonetheless, even when chemotherapy reduced receptors expression, the expression was still above normal. The fact that chemotherapy does not impair LDL receptors expression supports the use of drug carrier systems that target neoplastic cells by the LDL receptor endocytic pathway in patients on conventional chemotherapy

  9. Effect of neoadjuvant chemotherapy on low-density lipoprotein (LDL) receptor and LDL receptor-related protein 1 (LRP-1) receptor in locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pires, L.A. [Laboratório de Metabolismo de Lípides, Instituto do Coração, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP (Brazil); Departamento de Ginecologia, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP (Brazil); Hegg, R. [Departamento de Ginecologia, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP (Brazil); Freitas, F.R.; Tavares, E.R.; Almeida, C.P. [Laboratório de Metabolismo de Lípides, Instituto do Coração, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP (Brazil); Baracat, E.C. [Departamento de Ginecologia, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP (Brazil); Maranhão, R.C. [Laboratório de Metabolismo de Lípides, Instituto do Coração, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP (Brazil); Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP (Brazil)

    2012-05-04

    Low-density lipoprotein (LDL) receptors are overexpressed in most neoplastic cell lines and provide a mechanism for the internalization and concentration of drug-laden nanoemulsions that bind to these receptors. The aim of the present study was to determine whether the administration of standard chemotherapeutic schemes can alter the expression of LDL and LDL receptor-related protein 1 (LRP-1) receptors in breast carcinoma. Fragments of tumoral and normal breast tissue from 16 consecutive volunteer women with breast cancer in stage II or III were obtained from biopsies before the beginning of neoadjuvant chemotherapy and after chemotherapy, from fragments excised during mastectomy. Tissues were analyzed by immunohistochemistry for both receptors. Because complete response to treatment was achieved in 4 patients, only the tumors from 12 were analyzed. Before chemotherapy, there was overexpression of LDL receptor in the tumoral tissue compared to normal breast tissue in 8 of these patients. LRP-1 receptor overexpression was observed in tumors of 4 patients. After chemotherapy, expression of both receptors decreased in the tumors of 6 patients, increased in 4 and was unchanged in 2. Nonetheless, even when chemotherapy reduced receptors expression, the expression was still above normal. The fact that chemotherapy does not impair LDL receptors expression supports the use of drug carrier systems that target neoplastic cells by the LDL receptor endocytic pathway in patients on conventional chemotherapy.

  10. 18F-FDG PET/CT and PET for evaluation of pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis

    International Nuclear Information System (INIS)

    Background. Neoadjuvant chemotherapy is increasingly the treatment for patients with inoperable breast cancer. Considering the side-effects of chemotherapy, there is a need for early evaluating response to neoadjuvant chemotherapy. Purpose. To determinate the diagnostic performance of 18F-fluorodeoxyglucose position emission tomography/computed tomography (FDG PET/CT) and FDG PET for evaluating response to neoadjuvant chemotherapy in patients with breast cancer. Material and Methods. 'PubMed' (MEDLINE included) database, EMBASE, and Cochrane Database of Systematic Reviews were searched for relevant articles. We assessed the methodological quality of included study with Quality Assessment of Diagnosis Accuracy Studies (QUADAS) score tool, and used 'Meta-DiSc' statistic software to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve. Results. Seventeen studies (a total of 781 subjects) met the inclusion criteria. The pooled sensitivity was 0.840 (95% confidence interval [CI] 0.796-0.878). The pooled specificity was 0.713 (95% CI 0.667-0.756). For FDG PET/CT (10 studies included), the pooled sensitivity was 0.847 (95% CI 0.793-0.892), the pooled specificity was 0.661 (95% CI 0.598-0.720). The pooled likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were 2.835 (95% CI 1.640-4.900), 0.221 (95% CI 0.160-0.305), and 17.628 (95% CI 7.431-41.818). The area under the SROC curve (AUC) was 0.8934. For FDG PET (7 studies included), the pooled sensitivity and specificity were 0.826 (95% CI 0.741-0.892) and 0.789 (95% CI 0.719-0.849). The pooled LR + , LR-, and DOR were 3.601 (95% CI 2.601-4.986), 0.242 (95% CI 0.157-0.374), and 13.641 (95% CI 7.433-25.030). The AUC was 0.8764. Conclusion. Our results indicate that FDG PET/CT and PET have reasonable sensitivity in evaluating response to neoadjuvant chemotherapy in breast cancer; however, the specificity

  11. Angiographic evaluation of the response to neoadjuvant chemotherapy in osteogenic sarcoma

    International Nuclear Information System (INIS)

    Modern therapeutic osteosarcoma protocols, including both pre- and post-operative cycles of chemotherapy, have helped improving the quality of the prognosis and marking the local control of the neoplasm more reliable, with a subsequent increase in conservative surgery. Angiographic results of the chemotherapeutic response in 76 patients with primitive high-grade bone to repeat angiographic controls under the same technical conditions is emphasized. The comparison of above findings with data from the histological evaluation of the specimen, shows that angiography is a reliable means of evaluating the response to chemiotherapy. Angiography is thus emphasized as a valid method in an early evaluation of the efficacy of chemiotherapy

  12. Correlation of clinico-pathologic and radiologic parameters of response to neoadjuvant chemotherapy in breast cancer

    Directory of Open Access Journals (Sweden)

    P Mukherjee

    2014-01-01

    Full Text Available Context: As of today, there is no validated standard method to assess clinical response of breast cancer to neo- adjuvant chemotherapy (NACT. Some centers use clinical dimensions while others use radiological measurements to evaluate response according to RECIST criteria. Aims: The aim was to correlate and compare the clinical, radiological, and pathological parameters for assessing the tumor response in patients of breast cancer receiving NACT. Settings and Design: Single institution, prospective nonrandomized study conducted over a 2-year period. Materials and Methods: Patients with diagnosed breast cancer were assessed for response to NACT prior to surgery using clinical and radiological techniques. This was correlated with pathological reponse which was assessed by measuring gross dimensions and Miller-Payne grading of response to chemotherapy. Statistical Analysis Used: Spearman′s rho nonparametric. RESULTS: Fifty two patients completed the evaluation (out of 313 cases of ca breast treated during the same period with a median age of 52.5 years. We noted a 26.9% clinical complete response (CR and 19.2% had pathological CR. Clinical evaluation had a sensitivity and specificity of 73.5% and 88.5% respectively compared to 14.2% and 100% respectively for radiological assessment. Conclusions: Clinical assessment of response to NACT shows a higher sensitivity compared to radiological assessment. However the overall low sensitivity and specificity rates of clinical assessment mandate a search for a better method of evaluation.

  13. BRCA1 mRNA expression as a predictive and prognostic marker in advanced esophageal squamous cell carcinoma treated with cisplatin- or docetaxel-based chemotherapy/chemoradiotherapy.

    Directory of Open Access Journals (Sweden)

    Yong Gao

    Full Text Available BACKGROUND: The molecular backgrounds that determine therapeutic effectiveness in esophageal cancer remain largely unknown. Breast cancer susceptibility gene 1 (BRCA1 expression has been found to switch the response to cisplatin- or paclitaxel-based chemotherapy. It remains unclear how variations in BRCA1 expression influence clinical outcomes in esophageal cancer. PATIENTS AND METHODS: Quantitative real-time polymerase chain reaction (qPCR was performed to examine BRCA1 mRNA expressions in paraffin-embedded specimens from 144 patients with advanced or metastatic esophageal squamous cell carcinoma who received cisplatin- or docetaxel-based first-line treatments. RESULTS: Low BRCA1 mRNA expression correlated with increased response rate (RR; P = 0.025 and 0.017, respectively and median overall survival (mOS; P = 0.002 and P<0.001, respectively in cisplatin-based chemotherapy or chemoradiotherapy group and also correlated with decreased RR (P = 0.017 and 0.024, respectively and mOS (both P<0.001 in docetaxel-based chemotherapy or chemoradiotherapy group. Multivariate analysis revealed that low BRCA1 expression was an independent prognostic factor in cisplatin-based chemotherapy (HR 0.29; 95%CI 0.12-0.71; P = 0.007 or chemoradiotherapy (HR 0.12; 95%CI 0.04-0.37; P<0.001 group and higher risk for mortality in docetaxel-based chemotherapy (HR 5.02; 95%CI 2.05-12.28; P<0.001 or chemoradiotherapy (HR 7.02; 95%CI 2.37-27.77; P<0.001 group. CONCLUSIONS: BRCA1 mRNA expression could be used as a predictive and prognostic marker in esophageal cancer who underwent first-line cisplatin- or docetaxel-based treatments.

  14. Successful treatment of multiple lung metastases of hepatocellular carcinoma by combined chemotherapy with docetaxel, cisplatin and tegafur/uracil

    Institute of Scientific and Technical Information of China (English)

    Atsunori Tsuchiya; Michitaka Imai; Hiroteru Kamimura; Tadayuki Togashi; Kouji Watanabe; Kei-ichi Seki; Toru Ishikawa; Hironobu Ohta; Toshiaki Yoshida; Tomoteru Kamimura

    2009-01-01

    We report the successful treatment of multiple lung metastases after hepatic resection for hepatocellular carcinoma (HCC) with combined docetaxel, cisplatin (CDDP), and enteric-coated tegafur/uracil (UFT-E). A 68-year-old man was diagnosed with multiple lung metastases of HCC 7 mo after partial hepatectomy for HCC. Oral UFT-E was given daily and docetaxel and CDDP were given intra-arterially (administered just before the bronchial arteries) every 2 wk via a subcutaneous injection port. One month after starting chemotherapy, levels of tumor marker, protein induced by vitamin K absence Ⅱ (PIVKA-Ⅱ), decreased rapidly, and after a further month, chest X-ray and computed tomography revealed the complete disappearance of multiple liver metastases. Two years after the combined chemotherapy, HCC recurred in the liver and was treated but no pulmonary recurrence occurred. In the absence of a standardized highly effective therapy, this combined chemotherapy with docetaxel, CDDP and UFT-E may be an attractive option for multiple lung metastases of HCC.

  15. Intra-arterial ACNU and carboplatin versus intravenous chemotherapy with cisplatin and BCNU in newly diagnosed patients with glioblastoma.

    Science.gov (United States)

    Silvani, A; Eoli, M; Salmaggi, A; Erbetta, A; Fariselli, L; Boiardi, A

    2002-12-01

    Thirty glioblastoma patients treated at our institute between April 1998 and September 1999 were randomized in a two-arm study to receive carboplatin plus ACNU intraarterial (IA) chemotherapy (arm A) or cisplatin plus BCNU intravenous (IV) treatment (arm B). After the second course of chemotherapy and before the third cycle they also received concomitant radiotherapy, consisting of a median dose of 56.5 Gy. There were 3 (21.4%) partial responses and 11 (78.6%) disease stabilizations in group A. There were 5 (33%) partial responses and 10 disease stabilizations in group B. Time to tumor progression was 5.2 and 5.8 months for IA and IV treatment respectively. Median survival time was 18.3 months for arm A patients and 18.6 for arm B patients. Our IA chemotherapy schedule has produced no conclusive evidence of benefit compared with intravenous treatment. Moreover, its cost-benefit ratio is not good enough to justify its continued pursuit. PMID:12522677

  16. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    International Nuclear Information System (INIS)

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  17. Magnetic resonance metabolic profiling of breast cancer tissue obtained with core needle biopsy for predicting pathologic response to neoadjuvant chemotherapy.

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    Ji Soo Choi

    Full Text Available The purpose of this study was to determine whether metabolic profiling of core needle biopsy (CNB samples using high-resolution magic angle spinning (HR-MAS magnetic resonance spectroscopy (MRS could be used for predicting pathologic response to neoadjuvant chemotherapy (NAC in patients with locally advanced breast cancer. After institutional review board approval and informed consent were obtained, CNB tissue samples were collected from 37 malignant lesions in 37 patients before NAC treatment. The metabolic profiling of CNB samples were performed by HR-MAS MRS. Metabolic profiles were compared according to pathologic response to NAC using the Mann-Whitney test. Multivariate analysis was performed with orthogonal projections to latent structure-discriminant analysis (OPLS-DA. Various metabolites including choline-containing compounds were identified and quantified by HR-MAS MRS in all 37 breast cancer tissue samples obtained by CNB. In univariate analysis, the metabolite concentrations and metabolic ratios of CNB samples obtained with HR-MAS MRS were not significantly different between different pathologic response groups. However, there was a trend of lower levels of phosphocholine/creatine ratio and choline-containing metabolite concentrations in the pathologic complete response group compared to the non-pathologic complete response group. In multivariate analysis, the OPLS-DA models built with HR-MAS MR metabolic profiles showed visible discrimination between the pathologic response groups. This study showed OPLS-DA multivariate analysis using metabolic profiles of pretreatment CNB samples assessed by HR- MAS MRS may be used to predict pathologic response before NAC, although we did not identify the metabolite showing statistical significance in univariate analysis. Therefore, our preliminary results raise the necessity of further study on HR-MAS MR metabolic profiling of CNB samples for a large number of cancers.

  18. Exploratory Cost-Effectiveness Analysis of Response-Guided Neoadjuvant Chemotherapy for Hormone Positive Breast Cancer Patients.

    Directory of Open Access Journals (Sweden)

    Anna Miquel-Cases

    Full Text Available Guiding response to neoadjuvant chemotherapy (guided-NACT allows for an adaptative treatment approach likely to improve breast cancer survival. In this study, our primary aim is to explore the expected cost-effectiveness of guided-NACT using as a case study the first randomized controlled trial that demonstrated effectiveness (GeparTrio trial.As effectiveness was shown in hormone-receptor positive (HR+ early breast cancers (EBC, our decision model compared the health-economic outcomes of treating a cohort of such women with guided-NACT to conventional-NACT using clinical input data from the GeparTrio trial. The expected cost-effectiveness and the uncertainty around this estimate were estimated via probabilistic cost-effectiveness analysis (CEA, from a Dutch societal perspective over a 5-year time-horizon.Our exploratory CEA predicted that guided-NACT as proposed by the GeparTrio, costs additional €110, but results in 0.014 QALYs gained per patient. This scenario of guided-NACT was considered cost-effective at any willingness to pay per additional QALY. At the prevailing Dutch willingness to pay threshold (€80.000/QALY cost-effectiveness was expected with 78% certainty.This exploratory CEA indicated that guided-NACT (as proposed by the GeparTrio trial is likely cost-effective in treating HR+ EBC women. While prospective validation of the GeparTrio findings is advisable from a clinical perspective, early CEAs can be used to prioritize further research from a broader health economic perspective, by identifying which parameters contribute most to current decision uncertainty. Furthermore, their use can be extended to explore the expected cost-effectiveness of alternative guided-NACT scenarios that combine the use of promising imaging techniques together with personalized treatments.

  19. Quality of pathologic response and surgery correlate with survival for completely resected bladder cancer following neoadjuvant chemotherapy

    Science.gov (United States)

    Sonpavde, Guru; Goldman, Bryan H.; Speights, V.O.; Lerner, Seth P.; Wood, David P.; Vogelzang, Nicholas J.; Trump, Donald L.; Natale, Ronald B.; Grossman, H. Barton; Crawford, E. David

    2010-01-01

    BACKGROUND In a retrospective study of SWOG-S8710/INT-0080 (radical cystectomy [RC] alone vs 3 cycles of MVAC neoadjuvant chemotherapy [NC] before RC for bladder cancer), factors associated with improved overall survival (OS) included pathologic complete response (pCR) defined as P0, treatment with NC, completion of RC with negative margins and ≥10 pelvic lymph nodes (LNs) removed. METHODS We used stratified Cox regression to retrospectively study the association of quality of pathologic response post-RC with OS in the subset of S8710 patients that received NC and RC with negative margins. RESULTS Of 154 patients who received NC, 68 (44.2%) were

  20. A new histological therapeutic classification system to predict eradicated and residual lymph nodes in breast cancer after neoadjuvant chemotherapy.

    Science.gov (United States)

    Morohashi, Satoko; Yoshizawa, Tadashi; Seino, Hiroko; Hirai, Hideaki; Haga, Toshihiro; Ota, Rie; Wu, Yunyan; Yoshida, Eri; Hakamada, Kenichi; Kijima, Hiroshi

    2016-05-01

    The indication for neoadjuvant chemotherapy (NAC) has recently broadened to include its use in the treatment of initial stage breast cancer. Axillary lymph node metastasis after NAC in breast cancer is a poor prognostic factor. Thus, the prediction of lymph node metastasis is important to estimate the prognosis of breast cancer patients after NAC. Therefore, we focused on residual carcinoma patterns of primary breast tumors after NAC and examined the correlation between the patterns and lymph node metastasis. In this study, we examined 50 breast cancer specimens and associated dissected lymph nodes after NAC. We divided 40 cases into an eradicated lymph node group and a residual lymph node group to analyze residual carcinoma patterns of primary breast tumors. Residual carcinoma patterns were classified according to the cell density of carcinoma cells: dense, focal/nested and sporadic/in-situ. There were significant differences in residual carcinoma patterns (P<0.01) among the three pattern groups. There was a high incidence of dense patterns in the residual lymph node group and a high incidence of sporadic/in-situ patterns in the eradicated lymph node group. Analysis of residual carcinoma patterns of primary breast tumors and clinicopathological factors demonstrated that there were significant differences in tumor reduced ratio on CT (P<0.001), primary tumor area before NAC (P<0.01), primary tumor area after NAC (P<0.00001), intrinsic subtype (P<0.01), Ki-67 labeling index (P<0.01), histological grade (P<0.05) and mitotic count (P<0.01) between the dense and non-dense groups. Therefore, our results suggest that the residual carcinoma pattern is useful for predicting eradicated or residual lymph nodes and the malignant potential in breast cancer after NAC. PMID:26935647

  1. The clinical significance of axillary sentinel lymph node biopsy in different clinical stages breast cancer patients after neoadjuvant chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Juan Xu; Xinhong Wu; Yaojun Feng; Feng Yuan; Wei Fan

    2013-01-01

    Objective:We aimed to study the success and false negative rate of sentinel lymph node biopsy (SLNB) in dif-ferent clinical stages breast cancer patients being carried out with neoadjuvant chemotherapy (NAC), and the clinical signifi-cance of SLNB, we conducting this trial. Methods:One hunderd and thirty-seven cases were enrol ed in this clinical research from March 2003 to March 2007. Al of the patients’ sentinel lymph nodes were detected with 99mTc-Dx and methylene blue. There were 61 patients with stage T1-2N0M0 carried SLNB without NAC (group A), 76 cases were carried out NAC 3-4 cycles before SLNB, including 39 T2-4N0-1M0 cases (group B) and 27 T2-4N2-3M0 cases (group C). The success and false negative rate of SLNB were analysed with chi-square test. Results:In group A, the successful and false negative rate of SLNB were 92.31%(36/39), 8.57%(3/35), and in group B and C were 92.31%(36/39), 8.57%(3/35) and 74.07%(20/27), 18.52%(5/27), respectively. The successful rate of group C decreased and false negative rate increased significantly compared with group A and B (P0.05). Conclusion:The SLNB can accurately predict lymph node status of axil ary lymph node in N0-1 stage patients with NAC, but in N2-3 stage patients the success rate decreased and false rate increased negative significantly.

  2. Dynamic contrast-enhanced magnetic resonance imaging for prediction of response to neoadjuvant chemotherapy in breast cancer

    Science.gov (United States)

    Fu, Juzhong; Fan, Ming; Zheng, Bin; Shao, Guoliang; Zhang, Juan; Li, Lihua

    2016-03-01

    Breast cancer is the second leading cause of women death in the United States. Currently, Neoadjuvant Chemotherapy (NAC) has become standard treatment paradigms for breast cancer patients. Therefore, it is important to find a reliable non-invasive assessment and prediction method which can evaluate and predict the response of NAC on breast cancer. The Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) approach can reflect dynamic distribution of contrast agent in tumor vessels, providing important basis for clinical diagnosis. In this study, the efficacy of DCE-MRI on evaluation and prediction of response to NAC in breast cancer was investigated. To this end, fifty-seven cases of malignant breast cancers with MRI examination both before and after two cycle of NAC were analyzed. After pre-processing approach for segmenting breast lesions and background regions, 126-dimensional imaging features were extracted from DCE-MRI. Statistical analyses were then performed to evaluate the associations between the extracted DCE-MRI features and the response to NAC. Specifically, pairwise t test was used to calculate differences of imaging features between MRI examinations before-and-after NAC. Moreover, the associations of these image features with response to NAC were assessed using logistic regression. Significant association are found between response to NAC and the features of lesion morphology and background parenchymal enhancement, especially the feature of background enhancement in normal side of breast (P=0.011). Our study indicate that DCE-MRI features can provide candidate imaging markers to predict response of NAC in breast cancer.

  3. Association between dynamic features of breast DCE-MR imaging and clinical response of neoadjuvant chemotherapy: a preliminary analysis

    Science.gov (United States)

    Huang, Lijuan; Fan, Ming; Li, Lihua; Zhang, Juan; Shao, Guoliang; Zheng, Bin

    2016-03-01

    Neoadjuvant chemotherapy (NACT) is being used increasingly in the management of patients with breast cancer for systemically reducing the size of primary tumor before surgery in order to improve survival. The clinical response of patients to NACT is correlated with reduced or abolished of their primary tumor, which is important for treatment in the next stage. Recently, the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is used for evaluation of the response of patients to NACT. To measure this correlation, we extracted the dynamic features from the DCE- MRI and performed association analysis between these features and the clinical response to NACT. In this study, 59 patients are screened before NATC, of which 47 are complete or partial response, and 12 are no response. We segmented the breast areas depicted on each MR image by a computer-aided diagnosis (CAD) scheme, registered images acquired from the sequential MR image scan series, and calculated eighteen features extracted from DCE-MRI. We performed SVM with the 18 features for classification between patients of response and no response. Furthermore, 6 of the 18 features are selected to refine the classification by using Genetic Algorithm. The accuracy, sensitivity and specificity are 87%, 95.74% and 50%, respectively. The calculated area under a receiver operating characteristic (ROC) curve is 0.79+/-0.04. This study indicates that the features of DCE-MRI of breast cancer are associated with the response of NACT. Therefore, our method could be helpful for evaluation of NACT in treatment of breast cancer.

  4. Early Prediction and Evaluation of Breast Cancer Response to Neoadjuvant Chemotherapy Using Quantitative DCE-MRI1

    Science.gov (United States)

    Tudorica, Alina; Oh, Karen Y; Chui, Stephen Y-C; Roy, Nicole; Troxell, Megan L; Naik, Arpana; Kemmer, Kathleen A; Chen, Yiyi; Holtorf, Megan L; Afzal, Aneela; Springer, Charles S; Li, Xin; Huang, Wei

    2016-01-01

    The purpose is to compare quantitative dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) metrics with imaging tumor size for early prediction of breast cancer response to neoadjuvant chemotherapy (NACT) and evaluation of residual cancer burden (RCB). Twenty-eight patients with 29 primary breast tumors underwent DCE-MRI exams before, after one cycle of, at midpoint of, and after NACT. MRI tumor size in the longest diameter (LD) was measured according to the RECIST (Response Evaluation Criteria In Solid Tumors) guidelines. Pharmacokinetic analyses of DCE-MRI data were performed with the standard Tofts and Shutter-Speed models (TM and SSM). After one NACT cycle the percent changes of DCE-MRI parameters Ktrans (contrast agent plasma/interstitium transfer rate constant), ve (extravascular and extracellular volume fraction), kep (intravasation rate constant), and SSM-unique τi (mean intracellular water lifetime) are good to excellent early predictors of pathologic complete response (pCR) vs. non-pCR, with univariate logistic regression C statistics value in the range of 0.804 to 0.967. ve values after one cycle and at NACT midpoint are also good predictors of response, with C ranging 0.845 to 0.897. However, RECIST LD changes are poor predictors with C = 0.609 and 0.673, respectively. Post-NACT Ktrans, τi, and RECIST LD show statistically significant (P < .05) correlations with RCB. The performances of TM and SSM analyses for early prediction of response and RCB evaluation are comparable. In conclusion, quantitative DCE-MRI parameters are superior to imaging tumor size for early prediction of therapy response. Both TM and SSM analyses are effective for therapy response evaluation. However, the τi parameter derived only with SSM analysis allows the unique opportunity to potentially quantify therapy-induced changes in tumor energetic metabolism. PMID:26947876

  5. Neutrophil gelatinase-associated lipocalin (NGAL predicts response to neoadjuvant chemotherapy and clinical outcome in primary human breast cancer.

    Directory of Open Access Journals (Sweden)

    Antonia Sophie Wenners

    Full Text Available In our previous work we showed that NGAL, a protein involved in the regulation of proliferation and differentiation, is overexpressed in human breast cancer (BC and predicts poor prognosis. In neoadjuvant chemotherapy (NACT pathological complete response (pCR is a predictor for outcome. The aim of this study was to evaluate NGAL as a predictor of response to NACT and to validate NGAL as a prognostic factor for clinical outcome in patients with primary BC. Immunohistochemistry was performed on tissue microarrays from 652 core biopsies from BC patients, who underwent NACT in the GeparTrio trial. NGAL expression and intensity was evaluated separately. NGAL was detected in 42.2% of the breast carcinomas in the cytoplasm. NGAL expression correlated with negative hormone receptor (HR status, but not with other baseline parameters. NGAL expression did not correlate with pCR in the full population, however, NGAL expression and staining intensity were significantly associated with higher pCR rates in patients with positive HR status. In addition, strong NGAL expression correlated with higher pCR rates in node negative patients, patients with histological grade 1 or 2 tumors and a tumor size <40 mm. In univariate survival analysis, positive NGAL expression and strong staining intensity correlated with decreased disease-free survival (DFS in the entire cohort and different subgroups, including HR positive patients. Similar correlations were found for intense staining and decreased overall survival (OS. In multivariate analysis, NGAL expression remained an independent prognostic factor for DFS. The results show that in low-risk subgroups, NGAL was found to be a predictive marker for pCR after NACT. Furthermore, NGAL could be validated as an independent prognostic factor for decreased DFS in primary human BC.

  6. Could the extent of lymphadenectomy be modified by neoadjuvant chemotherapy in cervical cancer? A large-scale retrospective study.

    Directory of Open Access Journals (Sweden)

    Ting Hu

    Full Text Available The effect of neoadjuvant chemotherapy (NACT on topographical distribution patterns of lymph node metastasis in cervical cancer was unknown.Patients with FIGO stage IB1-IIB who underwent radical surgery with or without NACT were enrolled (3527 patients. A matched-case comparison design was used to compare the effects of NACT on lymph node metastasis.We analyzed groups of 167 and 140 patients who were diagnosed with lymph node metastasis in the matched primary surgery group and NACT group, respectively, and no significant difference was observed (p = 0.081. The incidence of lymph node metastasis was significantly decreased in the NACT-responsive group compared to the non-responsive group (18.4% vs. 38.6%, P<0.001. The metastatic rates for every lymph node group also declined in the NACT-responsive group except for the deep inguinal and the para-aortic lymph node groups. Clinical response, deep stromal, parametrial and lymph vascular invasions were independent risk factors for lymph node metastasis in the NACT group. Furthermore, deep stromal invasion and lymph vascular invasion, but not the response to NACT, were independently associated with upper LNM. The number of lymph nodes involved, response to NACT, tumor histology and a positive vaginal margin were independent prognostic factors affecting DFS or OS rates in node-positive patients treated with NACT plus radical surgery.The frequency and topographic distribution of LNM are not modified by NACT, and clinical non-responders showed more involved LNs. A systemic and extensive lymphadenectomy should be performed in patients treated with NACT plus surgery regardless of the response to NACT.

  7. Obesity or overweight is associated with worse pathological response to neoadjuvant chemotherapy among Chinese women with breast cancer.

    Directory of Open Access Journals (Sweden)

    Sheng Chen

    Full Text Available BACKGROUND: To evaluate the relationship between body mass index (BMI and response to neoadjuvant chemotherapy (NCT for breast cancer among Chinese women. PATIENTS AND METHODS: A total of 307 eligible patients were assigned to receive four cycles of paclitaxel and carboplatin before standard surgery for breast cancer from 2007 to 2011 at Shanghai Cancer Hospital. The patients were categorized as obese, overweight, normal weight, or underweight based on BMI according to World Health Organization (WHO criteria. Pathological complete response (pCR was defined as no invasive cancer in the breast or axillary tissue. A logistic regression and the Chi-squared test were used for detecting the predictors of pCR and determining the relationship between BMI category and pCR rate in the subgroup analysis with respect to other variables. RESULTS: Categorical BMI, estrogen receptor (ER, and progesterone receptor (PR status were independent predictors of pCR according to the multivariate analysis. Patients with BMI≥25 were less likely to achieve a pCR to NCT compared with patients with BMI<25 (Odds ratio: 0.454, p = 0.033, multivariate analysis. In the subgroup analysis, the predictive value of BMI for pCR to NCT was significantly shown in post-menopausal patients (p = 0.004 and hormonal receptor status-negative patients (p = 0.038. The incidence of treatment-induced toxicity was similar among the different BMI categories. CONCLUSION: Higher BMI was associated with worse pCR to NCT. Further approaches to investigating the mechanism of this influence of BMI on treatment response and a more appropriate schedule for calculating NCT dose for high-BMI-patients should be considered.

  8. Stent placement above the sphincter of Oddi permits implementation of neoadjuvant chemotherapy in patients with initially unresectable Klatskin tumor

    Science.gov (United States)

    Kubota, Kensuke; Hasegawa, Sho; Iwasaki, Akito; Sato, Takamitsu; Fujita, Yuji; Hosono, Kunihiro; Nakajima, Atsushi; Mori, Ryutaro; Matsuyama, Ryusei; Endo, Itaru

    2016-01-01

    Background and study aims: Neoadjuvant chemotherapy (NAC) may lead to a successful margin-negative resection in patients with initially unresectable locally advanced Klatskin tumor (IULAKT). Use of removable plastic stents is preferable for the safe implementation of NAC in patients with IULAKT to reduce the risk of recurrent cholangitis. Our aim was to evaluate the efficacy associated with the use of plastic stents placed across the stenosis and above the papilla (above stent) during NAC. Patients and methods: In this study, we stratified the patients into two groups chronologically with respect to the period of stent placement: above stent group (n = 17) and across stent group (n = 23) (plastic stent across the sphincter of Oddi). Results: The median stent patency period was 99 days in the above stent group and 31 days in the across stent group (P < 0.0001). The number of stents (P = 0.017) and the rate of emerging undrained cholangitis areas (P = 0.025) were significantly reduced in the above stent group than the counterpart. Regarding time to recurrent biliary obstruction, the above stent group had a longer duration than the across stent group (log rank test, P = 0.004). Length of hospital stay was significantly shorter for the above stent group than the across stent group (P = 0.0475). Multivariate analysis revealed that above stent placement (odds ratio = 33.638, P = 0.0048) was significantly associated with stent patency over a period of 90 days. Conclusions: Above stent placement should be considered for the relief of biliary obstruction and potentially reduces the cost for patients with IULAKT scheduled to receive NAC. PMID:27092322

  9. Exploratory Cost-Effectiveness Analysis of Response-Guided Neoadjuvant Chemotherapy for Hormone Positive Breast Cancer Patients

    Science.gov (United States)

    Miquel-Cases, Anna; Retèl, Valesca P.; Lederer, Bianca; von Minckwitz, Gunter; Steuten, Lotte M. G.; van Harten, Wim H.

    2016-01-01

    Purpose Guiding response to neoadjuvant chemotherapy (guided-NACT) allows for an adaptative treatment approach likely to improve breast cancer survival. In this study, our primary aim is to explore the expected cost-effectiveness of guided-NACT using as a case study the first randomized controlled trial that demonstrated effectiveness (GeparTrio trial). Materials and Methods As effectiveness was shown in hormone-receptor positive (HR+) early breast cancers (EBC), our decision model compared the health-economic outcomes of treating a cohort of such women with guided-NACT to conventional-NACT using clinical input data from the GeparTrio trial. The expected cost-effectiveness and the uncertainty around this estimate were estimated via probabilistic cost-effectiveness analysis (CEA), from a Dutch societal perspective over a 5-year time-horizon. Results Our exploratory CEA predicted that guided-NACT as proposed by the GeparTrio, costs additional €110, but results in 0.014 QALYs gained per patient. This scenario of guided-NACT was considered cost-effective at any willingness to pay per additional QALY. At the prevailing Dutch willingness to pay threshold (€80.000/QALY) cost-effectiveness was expected with 78% certainty. Conclusion This exploratory CEA indicated that guided-NACT (as proposed by the GeparTrio trial) is likely cost-effective in treating HR+ EBC women. While prospective validation of the GeparTrio findings is advisable from a clinical perspective, early CEAs can be used to prioritize further research from a broader health economic perspective, by identifying which parameters contribute most to current decision uncertainty. Furthermore, their use can be extended to explore the expected cost-effectiveness of alternative guided-NACT scenarios that combine the use of promising imaging techniques together with personalized treatments. PMID:27124410

  10. The benefit of cisplatin-based polychemotherapy for adenocarcinoma of the lung. The Kyushu Lung Cancer Chemotherapy Study Group.

    Science.gov (United States)

    Hara, N; Ohta, M; Ichikawa, Y; Kanda, T; Shima, K; Tamura, K; Hokama, M

    1990-01-01

    We studied the efficacy of cisplatin-based polychemotherapy for adenocarcinoma of the lung. A total of 136 patients were randomized for treatment with either cyclophosphamide, Adriamycin, cisplatin and mitomycin C (CAPM) or mitomycin C, cytosine arabinoside and tegafur (MCT). Radiation was given to the chests of patients at stage III. The differences in the response rate (35% in the CAPM arm and 13% in the MCT arm) were statistically significant (P less than 0.01). However, the significant difference was observed in stage-IV patients (CAPM, 33%; MCT, 4%; P less than 0.001) and not in stage-III patients (CAPM, 40%; MCT, 40%). The median period of survival was 9.5 months for the CAPM arm and 5.5 months for the MCT arm (P less than 0.035, Wilcoxon-Gehan test; P less than 0.1, log-rank test). Improved median survival for the CAPM regimen was demonstrated only by stage-IV patients (CAPM, 10 months; MCT, 5.5 months; P less than 0.025, Wilcoxon-Gehan test; P less than 0.05, log-rank test). The duration of the response, including PRs and NCs, was significantly different depending on the treatment, showing 5 months for the CAPM arm and 3 months for the MCT arm (P less than 0.05). The significant difference was also only observed in stage-IV patients. Myelosuppression was more severe with CAPM than with the MCT regimen. Nausea and vomiting were significantly increased in patients receiving the CAPM regimen. However, all toxicities were acceptable and there were no treatment-related deaths. We concluded that cisplatin-based chemotherapy, CAPM therapy, was of more benefit to patients with adenocarcinoma of the lung than MCT therapy. PMID:2108816

  11. Toxicity of concurrent chemoradiotherapy and consolidation chemotherapy with docetaxel and cisplatin in stage III non-small cell lung cancer:a phase I trial

    International Nuclear Information System (INIS)

    Objective: To investigate the maximal tolerated dose (MTD) of docetaxel and cisplatin (DC) combined with concurrent radiation therapy (RT), and the appropriate interval between consolidation chemotherapy and concurrent chemoradiotherapy (CCRT) in patients with stage III non-small cell lung cancer (NSCLC). Methods: A total dose of 60-70 Gy was delivered to the primary tumor and positive lymph mode regions in 30-35 fractions by three dimensional conformal RT. Chemotherapy regimen consisted of docetaxel and cisplatin, which were administered at the same dose. MTD was defined as the dose level at which ≥ 2/6 patients developed dose-limiting toxicity (DLT). Concurrent chemotherapy was administered on day 1 and day 28 of RT. The initial dose level was 55 mg/m2, then increased by 10 mg/m2 each time until to 75 mg/m2. Consolidation chemotherapy at the same dose level was given 21 days per cycle for two cycles, which started 4, 5 or 6 weeks after RT. If ≥ 2/6 patients developed DLT during the consolidation chemotherapy, The second cycle would be postponed for 1 week. Results: All of the 12 patients who enrolled in the trial completed CCRT. Among them, 6 patients successfully received 2 cycles consolidation chemotherapy 4 weeks after the completion of RT. No DLTs occurred until the dose level reached 75 mg/m2. Two of three patients experienced DLT at the level of 75 mg/m2. Neutropenia was the main adverse effect. Conclusions: In the treatment of stage III NSCLC, a dose level of 65 mg/m2 was recommended for phase II study of CCRT and consolidation chemotherapy with docetaxel and cisplatin. Concurrent chemotherapy should be repeated every 4 weeks. Consolidation chemotherapy can be started 4 weeks after the completion of radiation and repeated every 3 weeks for 2 cycles. (authors)

  12. Role of diffusion-weighted imaging as an adjunct to contrast-enhanced breast MRI in evaluating residual breast cancer following neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Objective: To investigate whether the addition of diffusion-weighted imaging (DWI) to dynamic contrast-enhanced MRI (DCE-MRI) improves diagnostic performance in predicting pathologic response and residual breast cancer size following neoadjuvant chemotherapy. Materials and methods: A total of 78 consecutive patients who underwent preoperative breast MRI with DWI following neoadjuvant chemotherapy were enrolled. DWI was performed on a 1.5 T system with b values of 0 and 750 s/mm. or on a 3 T system with b values of 0 and 800 or 0 and 1000 s/mm. The images on DCE-MRI alone, DWI alone, and DCE-MRI plus DWI were retrospectively reviewed. We evaluated the diagnostic performances of the three MRI protocols for the detection of residual cancer. The tumor size as predicted by MRI was compared with histopathologic findings. Apparent diffusion coefficient (ADC) values were also compared between the groups with and without residual cancer. Results: Of the 78 patients, 59 (75.6%) had residual cancer. For detection of residual cancer, DCE-MRI plus DWI had higher specificity (80.0%), accuracy (91.0%), and PPV (93.2%) than DCE-MRI or DWI alone (P = 0.004, P = 0.007, and P = 0.034, respectively). The ICC values for residual cancer size between MRI and histopathology were 0.891 for DCE-MRI plus DWI, 0.792 for DCE-MRI, and 0.773 for DWI. ADC values showed no significant differences between residual cancer and chemotherapeutic changes (P = 0.130). Conclusions: The addition of DWI to DCE-MRI significantly improved diagnostic performance in predicting pathologic response and residual breast cancer size after neoadjuvant chemotherapy

  13. Phase II trial of weekly nab-paclitaxel and carboplatin treatment with or without trastuzumab as nonanthracycline neoadjuvant chemotherapy for locally advanced breast cancer

    OpenAIRE

    Huang L; Chen S; Yao L; Liu GY; Wu J; Shao ZM

    2015-01-01

    Liang Huang,1,2 Sheng Chen,1,2 Ling Yao,1,2 Guangyu Liu,1,2 Jiong Wu,1,2 Zhiming Shao1–3 1Department of Breast Surgery, Fudan University Shanghai Cancer Center/Cancer Institute, 2Department of Oncology, Shanghai Medical College, 3Institutes of Biomedical Science, Fudan University, Shanghai, People’s Republic of China Background: Neoadjuvant chemotherapy has become standard treatment for women with locally advanced breast cancer. The aim of this study was to compare the...

  14. Outcome of combined modality treatment including neoadjuvant chemotherapy of 128 cases of locally advanced breast cancer: Data from a tertiary cancer center in northern India

    OpenAIRE

    Raina, V.; M Kunjahari; N K Shukla; SVS Deo; Sharma, A.; Mohanti, B. K.; D N Sharma

    2011-01-01

    Background: Breast cancer is now the most common cancer in many parts of India and the incidence varies from 12 to 31/100000, and is rising. Locally advanced breast cancer (LABC) accounts for 30 - 35% of all cases of breast cancers in India. LABC continues to present a challenge and imposes a major health impact in our country. Materials and Methods: We carried out a analysis of our LABC patients who received neoadjuvant chemotherapy (NACT) at our hospital over a 10-year period, from January ...

  15. Tailored Selection of First-Line Cisplatin-Based Chemotherapy in Patients with Metastatic Urothelial Carcinoma of Bladder

    Science.gov (United States)

    Hsieh, Meng-Che; Huang, Cheng-Hua; Chiang, Po-Hui; Chen, Yen-Yang; Tang, Yeh; Su, Yu-Li

    2016-01-01

    Purpose: Methotrexate, vinblastine, doxorubicin plus cisplatin (MVAC) and gemcitabine plus cisplatin (GC) are both effective first-line chemotherapy. We explore the responsive variables of MVAC and GC for patients with metastatic urothelial carcinoma of bladder (mUCB). Materials and Methods: Patients who were initially diagnosed to have mUCB and received MVAC or GC as metastatic first-line chemotherapy between 2000 and 2014 at Kaohsiung Chang Gung Memorial Hospital were reviewed. Totally, 130 patients were enrolled into our study. Univariable Cox proportional hazard models were constructed for OS. Hazard ratio (HR) and 95% confidence intervals (CIs) was also presented. Results: There were 50 patients (38%) in the MVAC group and 80 patients (62%) in the GC group. The median OS was insignificantly different between MVAC and GC groups, accounting for 17.0 and 14.4 months (P = 0.214), respectively. OS of MVAC group was significantly longer with regard to age ≦ 60 years (HR: 0.38, 95% CI: 0.12-0.97, P = 0.036), pure urothelial carcinoma (HR: 0.56, 95% CI: 0.34-0.90, P = 0.015), > 1 metastatic sites (HR: 0.19, 95% CI: 0.08-0.44, P = 3(HR: 0.45, 95% CI: 0.25-0.81, P = 0.006), while OS with GC group was significantly longer with regard to variant urothelial carcinoma (HR: 0.56, 95% CI: 0.34-0.90, P = 0.015). Conclusions: Our study disclosed the predictive factors of different regimen for mUCB. These results have clinical implication for physicians who treat patients with mUCB. PMID:27390610

  16. Randomized Clinical Trial of Weekly vs. Triweekly Cisplatin-Based Chemotherapy Concurrent With Radiotherapy in the Treatment of Locally Advanced Cervical Cancer

    International Nuclear Information System (INIS)

    Purpose: To compare compliance, toxicity, and outcome of weekly and triweekly cisplatin administration concurrent with radiotherapy in locally advanced cervical cancer. Methods and Materials: In this open-label, randomized trial, 104 patients with histologically proven Stage IIB–IVA cervical cancer were randomly assigned by a computer-generated procedure to weekly (weekly cisplatin 40 mg/m2, six cycles) and triweekly (cisplatin 75 mg/m2 every 3 weeks, three cycles) chemotherapy arms during concurrent radiotherapy. The difference of compliance and the toxicity profiles between the two arms were investigated, and the overall survival rate was analyzed after 5 years. Results: All patients tolerated both treatments very well, with a high completion rate of scheduled chemotherapy cycles. There was no statistically significant difference in compliance between the two arms (86.3% in the weekly arm, 92.5% in the triweekly arm, p > 0.05). Grade 3–4 neutropenia was more frequent in the weekly arm (39.2%) than in the triweekly arm (22.6%) (p = 0.03). The overall 5-year survival rate was significantly higher in the triweekly arm (88.7%) than in the weekly arm (66.5%) (hazard ratio 0.375; 95% confidence interval 0.154–0.914; p = 0.03). Conclusions: Triweekly cisplatin 75-mg/m2 chemotherapy concurrent with radiotherapy is more effective and feasible than the conventional weekly cisplatin 40-mg/m2 regimen and may be a strong candidate for the optimal cisplatin dose and dosing schedule in the treatment of locally advanced cervical cancer.

  17. Randomized Clinical Trial of Weekly vs. Triweekly Cisplatin-Based Chemotherapy Concurrent With Radiotherapy in the Treatment of Locally Advanced Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Sang-Young, E-mail: ryu@kcch.re.kr [Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Lee, Won-Moo; Kim, Kidong [Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Park, Sang-Il [Department of Gynecologic Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan (Korea, Republic of); Kim, Beob-Jong; Kim, Moon-Hong; Choi, Seok-Cheol [Department of Obstetrics and Gynecology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Cho, Chul-Koo [Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Nam, Byung-Ho [Cancer Biostatistics Branch, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Lee, Eui-Don [Department of Gynecologic Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan (Korea, Republic of)

    2011-11-15

    Purpose: To compare compliance, toxicity, and outcome of weekly and triweekly cisplatin administration concurrent with radiotherapy in locally advanced cervical cancer. Methods and Materials: In this open-label, randomized trial, 104 patients with histologically proven Stage IIB-IVA cervical cancer were randomly assigned by a computer-generated procedure to weekly (weekly cisplatin 40 mg/m{sup 2}, six cycles) and triweekly (cisplatin 75 mg/m{sup 2} every 3 weeks, three cycles) chemotherapy arms during concurrent radiotherapy. The difference of compliance and the toxicity profiles between the two arms were investigated, and the overall survival rate was analyzed after 5 years. Results: All patients tolerated both treatments very well, with a high completion rate of scheduled chemotherapy cycles. There was no statistically significant difference in compliance between the two arms (86.3% in the weekly arm, 92.5% in the triweekly arm, p > 0.05). Grade 3-4 neutropenia was more frequent in the weekly arm (39.2%) than in the triweekly arm (22.6%) (p = 0.03). The overall 5-year survival rate was significantly higher in the triweekly arm (88.7%) than in the weekly arm (66.5%) (hazard ratio 0.375; 95% confidence interval 0.154-0.914; p = 0.03). Conclusions: Triweekly cisplatin 75-mg/m{sup 2} chemotherapy concurrent with radiotherapy is more effective and feasible than the conventional weekly cisplatin 40-mg/m{sup 2} regimen and may be a strong candidate for the optimal cisplatin dose and dosing schedule in the treatment of locally advanced cervical cancer.

  18. Death by bleomycin pulmonary toxicity in ovarian dysgerminoma with pathologic complete response to chemotherapy. A case report

    OpenAIRE

    Calzas Rodríguez, Julia; Carmen Juarez Morales, María del; Casero, Miguel Angel Racionero

    2016-01-01

    With cisplatin-based chemotherapy, most patients with ovarian dysgerminoma will survive long-term. Bleomycin is an important part of ovarian germ cell tumors (OGCT) treatment, and its dose-limiting toxicity is the development of pulmonary toxicity and it is increased in patients older than 40 years. We report the case of an elderly patient with an unresectable ovarian dysgerminoma who received neoadjuvant chemotherapy and who developed fatal bleomycin pulmonary toxicity (BPT) after surgery. A...

  19. Mesoporous Silica Nanoparticles Loaded with Cisplatin and Phthalocyanine for Combination Chemotherapy and Photodynamic Therapy in vitro

    OpenAIRE

    Vivero-Escoto, Juan L.; Maram Elnagheeb

    2015-01-01

    Mesoporous silica nanoparticles (MSNs) have been synthesized and loaded with both aluminum chloride phthalocyanine (AlClPc) and cisplatin as combinatorial therapeutics for treating cancer. The structural and photophysical properties of the MSN materials were characterized by different spectroscopic and microscopic techniques. Intracellular uptake and cytotoxicity were evaluated in human cervical cancer (HeLa) cells by confocal laser scanning microscopy (CLSM) and 3-(4,5-dimethylthiazol-2-yl)-...

  20. The effects of Ginkgo biloba on nephrotoxicity induced by cisplatin-based chemotherapy protocols in rats

    OpenAIRE

    OKUYAN, BETÜL; Izzettin, Fikret Vehbi; Bingöl-Ozakpinar, Özlem; Turan, Pınar; Ozdemir, Zarife Nigar; Sancar, Mesut; Cirakli, Zeynep; Clark, Philip Martin; Ercan, Feriha

    2012-01-01

    The study was aimed at investigating the possible renoprotective effects of Ginkgo biloba on nephrotoxicity induced by cisplatin w/wo other antineoplastic agents (etoposide and gemcitabine) in rats. The animals were randomly divided into eight groups each consisting of six rats. Serum blood urea nitrogen (BUN) and creatinine values at baseline and after drug administration, kidney malondialdehyde (MDA), glutathione (GSH) levels, and myeloperoxidase activity (MPO) were measured, an...

  1. Phase II trial of docetaxel, cisplatin and 5FU chemotherapy in locally advanced and metastatic penis cancer (CRUK/09/001)

    OpenAIRE

    Nicholson, S.; Hall, E.; Harland, S. J.; Chester, J D; Pickering, L.; Barber, J.; Elliott, T; Thomson, A.; Burnett, S.; Cruickshank, C; Carrington, B.; Waters, R.; Bahl, A

    2013-01-01

    Background: Penis cancer is rare and clinical trial evidence on which to base treatment decisions is limited. Case reports suggest that the combination of docetaxel, cisplatin and 5-flurouracil (TPF) is highly active in this disease. Methods: Twenty-nine patients with locally advanced or metastatic squamous carcinoma of the penis were recruited into a single-arm phase II trial from nine UK centres. Up to three cycles of chemotherapy were received (docetaxel 75 mg m−2 day 1, cisplatin 60 mg m−...

  2. Challenges in management of patients with intracranial germ cell tumor and diabetes insipidus treated with cisplatin and/or ifosfamide based chemotherapy.

    Science.gov (United States)

    Afzal, Samina; Wherrett, Diane; Bartels, Ute; Tabori, Uri; Huang, Annie; Stephens, Derek; Bouffet, Eric

    2010-05-01

    Patients with intracranial germ cell tumor (IGCT) often present with pituitary dysfunction, including diabetes insipidus (DI). Recent protocols have used pre-radiation chemotherapy with combinations of etoposide, carboplatin and/or cisplatin, and ifosfamide. Management of DI in these patients requires monitoring of electrolytes and fluids during chemotherapy and hyperhydration. All consecutive patients treated with chemotherapy for an IGCT during the period 1990-2007 at the Hospital for Sick Children, Toronto were reviewed. Out of 32 patients who received chemotherapy, 21 had DI. Only cycles containing cisplatin and/or ifosfamide and hyperhydration were considered. DI and non-DI patients were compared for each cycle of chemotherapy. Patients were studied for number of days in hospital per chemotherapy course, daily fluid input and output, changes in dose, schedule and route of administration of desmopressin (DDAVP) during chemotherapy, daily variations in sodium level, electrolyte monitoring requirements per day, and complications related to fluid and electrolyte disturbances. Fifty-four cycles of chemotherapy in DI patients were compared to 25 cycles in non DI patients. All 21 patients with DI required daily change in dosage and schedule of DDAVP. Marked variations in daily sodium level were observed in the DI group. Seventeen courses required prolonged admission in the DI group (one in non DI patients) and 6 patients experienced serious complications. In conclusion, DI is a risk factor for complications when cisplatin and/or ifosfamide based protocols are used. The role of these agents in the management of ICGT should be carefully evaluated and guidelines for management of DI established. PMID:19820898

  3. Re-irradiation with cetuximab or cisplatin-based chemotherapy for recurrent squamous cell carcinoma of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Dornoff, Nicolas; Weiss, Christian; Roedel, Franz [J. W. Goethe University, Department of Radiotherapy and Oncology, Frankfurt a. M. (Germany); Wagenblast, Jens [J. W. Goethe University, Department of Otorhinolaryngology, Frankfurt a. M. (Germany); Ghanaati, Shahram [J. W. Goethe University, Department of Maxillofacial Surgery, Frankfurt a. M. (Germany); Atefeh, Nateghian; Roedel, Claus; Balermpas, Panagiotis [J. W. Goethe University, Department of Radiotherapy and Oncology, Frankfurt a. M. (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany); German Cancer Consortium (DKTK) partner site: Frankfurt, Frankfurt a. M. (Germany)

    2015-08-15

    Locoregional recurrence remains the main pattern of failure after primary combined modality treatment of squamous cell carcinoma of the head and neck (SCCHN). We compared the efficacy and toxicity of either cisplatin or cetuximab in combination with re-irradiation (ReRT) for recurrent unresectable SCCHN. Various clinicopathological factors were investigated to establish a prognostic score. Between 2007 and 2014, 66 patients with recurrent SCCHN originating in a previously irradiated area received cetuximab (n = 33) or cisplatin-based chemotherapy (n = 33) concomitant with ReRT. Toxicity was evaluated weekly and at every follow-up visit. Physical examination, endoscopy, CT or MRI scans were used to evaluate response and disease control. With a mean follow-up of 18.3 months, the 1-year overall survival (OS) rates for Re-RT with cetuximab and cisplatin-based chemotherapy were 44.4 and 45.5 % (p = 0.352), respectively. At 1 year, local control rates (LCR) were 46.4 and 54.2 % (p = 0.625), freedom from metastases (FFM) rates 73.6 and 81 % (p = 0.842), respectively. Haematological toxicity ≥ grade 3 occurred more often in the cisplatin group (p < 0.001), pain ≥ grade 3 was increased in the cetuximab group (p = 0.034). A physiological haemoglobin level and a longer interval between primary RT and ReRT, proved to be significant prognostic factors for OS (multivariate: p = 0.003, p = 0.002, respectively). Site of the recurrence and gross target volume (GTV) did not show a significant impact on OS in multivariate analysis (p = 0.160, p = 0.167, respectively). A prognostic-score (1-4 points) based on these four variables identified significantly different subgroups: 1-year OS for 0/1/2/3/4 prognostic points: 10, 38, 76, 80 and 100 %, respectively (p < 0.001). Both cetuximab- and cisplatin-based ReRT of SCCHN recurrences are feasible and effective treatment options with comparable results in terms of tumour control and survival. Acute adverse events may differ slightly

  4. TIP (Paclitaxel, Ifosfamide, Cisplatin) 療法が著効した鼠径リンパ節転移を有する陰茎癌の1例

    OpenAIRE

    久保田, 恵章; 仲野, 正博; 永井, 真吾; 松岡, 加恵; 荒川, 裕貴; 堀江, 憲吾; 出口, 隆; 加藤,久和

    2015-01-01

    Carcinoma of the penis is rare, and the prognosis of penile cancer with inguinal metastases is extremely poor. Standard chemotherapy for advanced penile cancer has not been established because of its rarity. A case of penile cancer with inguinal metastases that responded well to neoadjuvant chemotherapy with paclitaxel, ifosfamide and cisplatin (TIP) is described. A 55-year-old Japanese male visited our hospital for a penile tumor and fixed, 4 cm, right inguinal lymph nodes. Computed tomograp...

  5. CyberKnifeR and neo-adjuvant chemotherapy for locally advanced breast tumours: results of the dose escalation phase I

    International Nuclear Information System (INIS)

    CyberKnife allows the performance of stereotactic radiotherapy of thorax tumours with accuracy and with a real time target tracking system. The authors aimed at demonstrating the interest of this system for the treatment of breast cancers. They report a phase I study of dose escalation. A neo-adjuvant based chemotherapy is associated with the irradiation. Breast surgery is performed six to eight weeks after the sixth chemotherapy session cycle. The aim was to determine the maximum tolerated dose for the hypo-fractionated radiotherapy. Cutaneous toxicity is the limiting factor. 25 patients have been treated with different dose levels (from 18,5 to 31,5 Gy). Results are promising and must be confirmed, notably through a randomized multicentre phase II study. Short communication

  6. The study of relationship between apparent diffusion coefficient value and maximal diameter of the breast cancer with Ki-67 expression during neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Objective: Study the ADC value and the maximal diameter and their changes of breast cancer before and after neoadjuvant chemotherapy, to determine the relationship with different expression level of Ki-67. Methods: Forty eight patients with breast cancer confirmed by biopsy underwent MR DWI and enhanced scan before and after 4 cycles neoadjuvant chemotherapy. Review the MR images retrospectively. The ADC value and the maximum diameter(D)of the cancer foci were measured before and after chemotherapy, and the rate of their changes ΔADC% and ΔD% were calculated. Using different Ki-67 index level, all the foci were divided into three groups: group A with Ki-67 60%. Using nonparameter test to compare the ADC values, ΔADC%, D and ΔD% of the three groups before and after chemotherapy, determine whether there were differences. Results: Before chemotherapy, the ADC value of group A (n=15) was 1.1 × 10-3 mm2/s [(0.9 × 10-3 - 1.2 × 10-3) mm2/s], which was higher than that of group B [n=8, 0.9 × 10-3 mm2/s (0.9 × 10-3 - 1.0 × 10-3) mm2/s] and C [n=25, 0.9 × 10-3 mm2/s (0.7 × 10-3 - 1.2 × 10-3) mm2/s], and the difference was statistically significant (P-3 mm2/s [(0.2 × 10-3 - 1.4 × 10-3) mm2/s], which was higher than that of group A [1.1 × 10-3 mm2/s, (1.0 × 10-3 - 1.2 × 10-3) mm2/s] and B [1.1 × 10-3 mm2/s, (1.0 × 10-3 - 1.1 × 10-3) mm2/s], and the differences were statistically significance (P<0.01); the ADC change rate (ΔADC%) of group C was 45.5% (-12.0% - 78.6%), which was greater than group A [45.5% (-12.0% - 78.6%)] and B [45.5% (-12.0% - 78.6%)], the difference was significant (P<0.01). The maximum diameters of group A were 2.2 cm (2.0-2.4 cm) and 1.0 cm (0.0-1.4 cm) before and after chemotherapy, lower than those of group B [3.7 cm (3.6-3.9 cm) before NAC, 2.9 cm (0.0-3.1 cm) after NAC] and group C [3.4 cm (2.7-4.2 cm) before NAC, 1.9 cm (0.0-2.2 cm) after NAC], and the differences were statistically significant (P<0.05); the change rate of the

  7. Tolerance of weekly metronomic paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin

    Directory of Open Access Journals (Sweden)

    S B Dessai

    2016-01-01

    Full Text Available Objective: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to examine the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. Methods: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m 2 and carboplatin AUC-2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (Common Terminology Criteria for Adverse Events version 4.02, and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented. Results: Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy-related mortality. Grade 3-4 life-threatening complications were seen in two patients. The post NACT response rate was 100%. Conclusions: Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.

  8. Role of mammography in evaluating residual cancer of locally advanced breast carcinoma after neo-adjuvant chemotherapy : compared with clinical examination

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Byoung Wook; Kim, Eun Kyung; Oh, Ki Keun; Cho, Jae Min; Chung, Hyun Cheol; Lee, Byung Chan; Lee, Kyong Sik; Lee, Yong Hee [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-06-01

    To compare the usefulness of mammography and clinical examination in the evaluation of residual cancer of locally-advanced breast carcinoma treated with neoadjuvant chemotherapy. Among 67 patients with locally advanced breast carcinoma who were treated with neoadjuvant chemotherapy, 18, aged 35-67 (mean, 48) years, underwent mammography before and after this therapy. The 18 sets of mammographs were analyzed retrospectively and compared with the results of clinical examination based on histologic diagnosis. On histologic examinations, 16 of 18 patients (89%) were found to have residual cancer, but in one of these 16, mammography did not show this same result. On mammography, residual cancer was found in 16 patients, but in one of this group, histologic examination did not reveal the same finding. Clinically, a complete response was shown by four patients, and a partial response by 11 ; three showed no response. On histolgogic examination, three of the four patients with complete clinical response were found to have residual cancer. Post-treatment mammographic findings showed that 11 patients had measurable mass ; all of these had residual cancer (positive predictive value : 100%). However, five of seven patients in whom no measurable mass was evident also had residual cancer. Seven of 8 patients in whom microcalcifications were seen on mammography were found to have residual cancer (positive predictive value : 88%). The sensitivity of mammography in predicting residual cancer was greater than that of clinical examination (94% vs 81%), even when microscopic residual cancer was considered as a complete response (92% vs 77%). The specificity of mammography was the same as that of clinical examination(50% vs 50%, 20% vs 20%). In evaluating residual cancer of locally-advanced breast carcinoma after neoadjuvant chemotheragy, mammography is more accurate and informative than clincal examination. In predicting residual cancer, however, it is not accurate enough to replace

  9. Pre-treatment differences and early response monitoring of neoadjuvant chemotherapy in breast cancer patients using magnetic resonance imaging: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Prevos, R.; Wildberger, J.E. [Maastricht University Medical Center, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Smidt, M.L. [Maastricht University Medical Center, Department of Surgery, Maastricht (Netherlands); Tjan-Heijnen, V.C.G. [Maastricht University Medical Center, Department of Medical Oncology, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Goethem, M. van [University Hospital of Antwerp, Department of Radiology, Antwerp (Belgium); Beets-Tan, R.G.; Lobbes, M.B.I. [Maastricht University Medical Center, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands)

    2012-12-15

    To assess whether magnetic resonance imaging (MRI) can identify pre-treatment differences or monitor early response in breast cancer patients receiving neoadjuvant chemotherapy. PubMed, Cochrane library, Medline and Embase databases were searched for publications until January 1, 2012. After primary selection, studies were selected based on predefined inclusion/exclusion criteria. Two reviewers assessed study contents using an extraction form. In 15 studies, which were mainly underpowered and of heterogeneous study design, 31 different parameters were studied. Most frequently studied parameters were tumour diameter or volume, K{sup trans}, K{sub ep}, V{sub e}, and apparent diffusion coefficient (ADC). Other parameters were analysed in only two or less studies. Tumour diameter, volume, and kinetic parameters did not show any pre-treatment differences between responders and non-responders. In two studies, pre-treatment differences in ADC were observed between study groups. At early response monitoring significant and non-significant changes for all parameters were observed for most of the imaging parameters. Evidence on distinguishing responders and non-responders to neoadjuvant chemotherapy using pre-treatment MRI, as well as using MRI for early response monitoring, is weak and based on underpowered study results and heterogeneous study design. Thus, the value of breast MRI for response evaluation has not yet been established. (orig.)

  10. Outcomes of Positron Emission Tomography–Staged Clinical N3 Breast Cancer Treated With Neoadjuvant Chemotherapy, Surgery, and Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: To evaluate the treatment outcome and efficacy of regional lymph node irradiation after neoadjuvant chemotherapy (NCT) and surgery in positron emission tomography (PET)–positive clinical N3 (cN3) breast cancer patients. Methods and Materials: A total of 55 patients with ipsilateral infraclavicular (ICL), internal mammary (IMN), or supraclavicular (SCL) lymph node involvement in the absence of distant metastases, as revealed by an initial PET scan, were retrospectively analyzed. The clinical nodal stage at diagnosis (2002 AJCC) was cN3a in 14 patients (26%), cN3b in 12 patients (22%), and cN3c in 29 patients (53%). All patients were treated with NCT, followed by mastectomy or breast-conserving surgery and subsequent radiotherapy (RT) with curative intent. Results: At the median follow-up of 38 months (range, 9–80 months), 20 patients (36%) had developed treatment failures, including distant metastases either alone or combined with locoregional recurrences that included one ipsilateral breast recurrence (IBR), six regional failures (RF), and one case of combined IBR and RF. Only 3 patients (5.5%) exhibited treatment failure at the initial PET-positive clinical N3 lymph node. The 5-year locoregional relapse-free survival, disease-free survival (DFS), and overall survival rates were 80%, 60%, and 79%, respectively. RT delivered to PET-positive IMN regions in cN3b patients and at higher doses (≥55 Gy) to SCL regions in cN3c patients was not associated with improved 5-year IMN/SCL relapse-free survival or DFS. Conclusion: NCT followed by surgery and RT, including the regional lymph nodes, resulted in excellent locoregional control for patients with PET-positive cN3 breast cancer. The primary treatment failure in this group was due to distant metastasis rather than RF. Neither higher-dose RT directed at PET-positive SCL nodes nor coverage of PET-positive IMN nodes was associated with additional gains in locoregional control or DFS.

  11. Randomized Controlled Trial of Zoledronic Acid plus Chemotherapy versus Chemotherapy Alone as Neoadjuvant Treatment of HER2-Negative Primary Breast Cancer (JONIE Study.

    Directory of Open Access Journals (Sweden)

    Yoshie Hasegawa

    Full Text Available Zoledronic acid (ZOL is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption by inhibiting the mevalonate pathway. Its benefit for the prevention of skeletal complications due to bone metastases has been established. However, the antitumor efficacy of ZOL, although suggested by multiple preclinical and clinical studies, has not yet been clinically proven. We performed the present randomized Phase 2 trial to investigate the antitumor effect of ZOL with chemotherapy (CT.Asian patients with HER2-negative invasive breast cancer were randomly assigned to either the CT or CT+ZOL (CTZ group. One hundred and eighty-eight patients were randomized to either the CT group (n = 95 or the CTZ group (n = 93 from March 2010 to April 2012, and 180 patients were assessed. All patients received four cycles of FEC100 (fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 500 mg/m2, followed by 12 cycles of paclitaxel at 80 mg/m2 weekly. ZOL (4 mg was administered three to four times weekly for 7 weeks to the patients in the CTZ group. The primary endpoint was the pathological complete response (pCR rate, which was defined as no invasive cancer in the breast tissue specimen. Safety was assessed in all patients who received at least one dose of the study drug.This randomized controlled trial indicated that the rates of pCR in CTZ group (14.8% was doubled to CT group (7.7%, respectively (one-sided chi-square test, p = 0.068, though the additional efficacy of zoledronic acid was not demonstrated statistically. The pCR rate in postmenopausal patients was 18.4% and 5.1% in the CTZ and CT groups, respectively (one-sided Fisher's exact test, p = 0.071, and that in patients with triple-negative breast cancer was 35.3% and 11.8% in the CTZ and CT groups, respectively (one-sided Fisher's exact test, p = 0.112. Thus the addition of ZOL to neoadjuvant CT has potential anticancer benefits in postmenopausal patients and

  12. Long-term follow-up of neoadjuvant intraarterial chemotherapy using an original four-lumen double-balloon (4L-DB) catheter for locally advanced uterine cervical cancer

    International Nuclear Information System (INIS)

    We report the therapeutic potential, long-term survival, and toxicity of neoadjuvant intraarterial chemotherapy (NAIC) using an original four-lumen double-balloon (4L-DB) catheter followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer. Sixty patients with stage IIB-IVA cervical squamous cell cancer were treated with NAIC which included cisplatin (60-70 mg/m2, day 1), mitomycin-C (10-20 mg/m2, day 1), and pirarubicin hydrochloride (THP; 10-20 mg/m2, day 1) for two courses every 21 days. The median follow up among surviving patients was 93.7 months. Among 60 eligible patients, 22 had a complete response (CR; 36.7%) including 12 with a pathologic CR (20.0%). Thirty-six patients had a partial response (60.0%), and stable disease was observed in only 2 patients (3.3%). Moreover, we found that the platinum concentration in the cervix was correlated with the clinical response (P<0.001). The 10-year progression-free survival (PFS) and 10-year survival were 90.9% and 90.9%, respectively, in patients with stage IIB disease and 66.0% and 70.7%, respectively, in patients with stage III disease. Leukopenia occurred in 86.7% of patients, but it was not very severe (grade 3, 4 in 13.3% of patients). Our results with NAIC using the 4L-DB catheter in locally advanced cervical cancer demonstrate that a high platinum concentration has beneficial effects on primary lesions and improves long-term progression-free and overall survival. (author)

  13. Cisplatin-based chemotherapy: the only alternative in chemoradiation of head and neck cancer? Experience of the Institute of Oncology, Ljubljana, Slovenia

    International Nuclear Information System (INIS)

    Background: Concomitant chemoradiation is a widely used therapeutic concept in intensified locoregional treatment of high risk head and neck cancer patients. In this context, cisplatin monotherapy or in combination with other chemotherapeutics is recognized as the most effective drug to be added to radiotherapy. Aim: The aim of this review is to present the rationale for combining radiotherapy with cisplatin in the treatment of head and neck cancer and to summarize the experience of the Institute of Oncology Ljubljana, Slovenia, gained through two prospective randomized trials on chemoradiation with mitomycin C and bleomycin in operable as well as inoperable head and neck cancer patients. Furthermore, recent developments in technology and biological drug modeling are discussed, which are considered to have a potential to add significantly to the locoregional effectiveness of radiotherapy. Materials/Methods: References were retrieved using the online data base of the National Library of Medicine (PubMed: http://www.ncbi.nlm.nih.gov/PubMed). Terms used included: head and neck carcinoma, squamous cell carcinoma, concomitant chemoradiotherapy, cisplatin, mitomycin C, bleomycin. The results of studies using cisplatin- based chemoradiation regimens in the treatment of patients with inoperable tumors and on postoperative stetting were compared with the results of the studies, conducted at the Institute of Oncology and ENT Department at the Clinical Center Ljubljana, Slovenia. Results; When comparing mitomycin C-bleomycin chemotherapy with other comparable series on exclusively inoperable oropharyngeal cancer, but with cisplatin (or carboplatin) and 5-fluorouracil chemotherapy, and to standard dose cisplatin regimen used in postoperative setting, the effectiveness of our unconventional drug combination appeared to be at least equivalent to the well established platinum based chemotherapy standard. Conclusions: At the moment, concomitant chemoradiation with cisplatin

  14. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: A study in mastectomy specimens using simulation lumpectomy

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    Viswambharan Jaiganesh

    2005-01-01

    Full Text Available BACKGROUND : The response of locally advanced breast cancer (LABC to neoadjuvant chemotherapy (NACT offers these patients previously treated by mastectomy, the chance for breast conservation. AIM : This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor 5 cm. SETTINGS, DESIGN : Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS : Thirty patients with LABC whose tumors reduced with NACT to 5 cm were included. Simulation lumpectomy was performed on the mastectomy specimens to achieve 1 to 2 cm clearance from tumor and hence margin negativity. Multiple sections of the inked margin were studied. STATISTICAL ANALYSIS : Margin positivity was correlated with patient factors. Chi square test and Fisher′s exact test used as appropriate. P value 0.05 was considered significant. RESULTS AND CONCLUSIONS : After three cycles of NACT, 4 patients (13% had complete clinical response including 2 with complete pathological response. Twenty-two (73% showed partial response and 4, no response. Fourteen out of thirty (47% had tumor involvement of margins. Tumors with post-chemotherapy size> 4 cm were margin positive in 10/13 (77%. Tumors with post-chemotherapy size>3 cm were margin positive in 13/24 (54%. Tumors with post-chemotherapy size 3 cm were margin negative in 5/6 (83%. Pre-chemotherapy tumor size and post-chemotherapy tumor size were significantly associated with margin positivity (P=0.003. Tumors in the subareolar location had significantly higher incidence of residual tumor in the nipple areola complex. (P=0.04. Margin positivity of lumpectomy on downstaged tumors can be reduced by removing the nipple areola complex in subareolar tumors and by limiting breast conservation to tumors with post-chemotherapy size 3 cm.

  15. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: A study in mastectomy specimens using simulation lumpectomy

    Directory of Open Access Journals (Sweden)

    Viswambharan Jaiganesh

    2005-01-01

    Full Text Available BACKGROUND: The response of locally advanced breast cancer (LABC to neoadjuvant chemotherapy (NACT offers these patients previously treated by mastectomy, the chance for breast conservation. AIM: This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor 5 cm. SETTINGS, DESIGN: Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS: Thirty patients with LABC whose tumors reduced with NACT to 5 cm were included. Simulation lumpectomy was performed on the mastectomy specimens to achieve 1 to 2 cm clearance from tumor and hence margin negativity. Multiple sections of the inked margin were studied. STATISTICAL ANALYSIS: Margin positivity was correlated with patient factors. Chi square test and Fisher′s exact test used as appropriate. P value 0.05 was considered significant. RESULTS AND CONCLUSIONS: After three cycles of NACT, 4 patients (13% had complete clinical response including 2 with complete pathological response. Twenty-two (73% showed partial response and 4, no response. Fourteen out of thirty (47% had tumor involvement of margins. Tumors with post-chemotherapy size >4 cm were margin positive in 10/13 (77%. Tumors with post-chemotherapy size>3 cm were margin positive in 13/24 (54%. Tumors with post-chemotherapy size 3 cm were margin negative in 5/6 (83%. Pre-chemotherapy tumor size and post-chemotherapy tumor size were significantly associated with margin positivity (P=0.003. Tumors in the subareolar location had significantly higher incidence of residual tumor in the nipple areola complex. (P=0.04. Margin positivity of lumpectomy on downstaged tumors can be reduced by removing the nipple areola complex in subareolar tumors and by limiting breast conservation to tumors with post-chemotherapy size 3 cm.

  16. Intraperitoneal (IP) 166Holmium-chitosan complex (166Ho-CHICO) with systemic cisplatin based chemotherapy in the patients with intractable ovarian cancer

    International Nuclear Information System (INIS)

    This study was conducted sequentially to evaluate the following three issues: (I) the synergistic cytotoxic effect of 166Ho-CHICO and cisplatin in vitro; (ii) the biodistribution and dosimetry of intraperitoneal 166Ho-CHICO in mice; (iii) and the biodistribution, dosimetry, toxicity, and response of IP 166Ho-CHICO with systemic cisplatin based chemotherapy in the patients with intractable ovarian cancer. 166Holmium labeled biodegradable polymer chitosan was prepared by Korea Atomic Energy Research Institute. In vitro, synergistic cytotoxic effects were observed with combination of 166Holimium and cisplatin by MTT assays on SK-OV-3 cell line. 166Ho-CHICO was injected into the peritoneal cavity of mice, and whole body autoradiographs were taken at 6 hrs and 24 hrs later to determine the biodistribution and dosimetry. 97-99% of 166HO-CHICO was localized within the peritoneal cavity of mice. IP 166HO-CHICO with systemic cisplatin based chemotherapy was diministered for 14 cycles in 5 patients. All patients showed improved ascites control with four stable disease and one progressive disease. Grade 4 severe diarrhea which might be a unique complication related to IP 166HO-CHICO were observed in only one cycle. IP 166HO-CHICO may be a promising adjuvant treatment modality with acceptable toxicity in the patients with intractable ovarian cancer, in particular to control malignant ascites

  17. Effectiveness of 5-flurouracil-based neoadjuvant chemotherapy in locally-advanced gastric/gastroesophageal cancer: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Lei Ge; Hai-Jiang Wang; Dong Yin; Cheng Lei; Jin-Feng Zhu; Xiao-Hui Cai; Guo-Qing Zhang

    2012-01-01

    AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy (NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the flurouracilbased NAC for gastroesophageal and gastric cancer,and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery.Studies that included patients with metastases at enrollment were excluded.Primary endpoint was the odds ratio (OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer.Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gastroesophageal and gastric cancer.Safety analyses were also performed.The OR was the principal measurement of effect,which was calculated as the treatment group (NAC plus surgery) vs control group (surgery alone) and was presented as a point estimate with 95% confidence intervals (CI).All calculations and statistical tests were performed using RevMan 5.1 software.RESULTS:Seven RCTs were included for the analysis.A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group (n =620) and control group (n =629).The quality scores of the RCTs were assessed according to the method of Jadad.The RCT quality scores ranged from 2 to 7 (5-point scale),with a mean of 3.75.The median follow-up time in these studies was over 3 years.The meta-analysis showed that NAC improved the overall survival rate (OR 1.40,95%CI 1.11-1.76; P =0.005),which was statistically significant.The 3oyear progression-free survival rate was significantly higher in treatment group than in control group (37.7% vs 27.3%) (OR 1.62,95%CI 1.21-2.15; P =0.001).The tumor down-stage rate was higher in treatment group than in control group (55.76% vs 41.38%) (OR 1

  18. PD-L1 polymorphism can predict clinical outcomes of non-small cell lung cancer patients treated with first-line paclitaxel-cisplatin chemotherapy.

    Science.gov (United States)

    Lee, Shin Yup; Jung, Deuk Kju; Choi, Jin Eun; Jin, Cheng Cheng; Hong, Mi Jeong; Do, Sook Kyung; Kang, Hyo-Gyoung; Lee, Won Kee; Seok, Yangki; Lee, Eung Bae; Jeong, Ji Yun; Shin, Kyung Min; Yoo, Seung Soo; Lee, Jaehee; Cha, Seung Ick; Kim, Chang Ho; Park, Jae Yong

    2016-01-01

    This study was conducted to investigate whether polymorphisms of genes involved in immune checkpoints can predict the clinical outcomes of patients with advanced stage non-small cell lung cancer (NSCLC) after 1st line paclitaxel-cisplatin chemotherapy. A total of 379 NSCLC patients were enrolled. Twelve single nucleotide polymorphisms (SNPs) of PD-1, PD-L1, and CTLA-4 genes were selected and genotyped. The associations of SNPs with chemotherapy response and overall survival (OS) were analyzed. Among the 12 SNPs investigated, PD-L1 rs2297136T > C and rs4143815C > G were significantly associated with clinical outcomes after chemotherapy. The rs2297136T > C was significantly associated with both better chemotherapy response and better OS, and the rs4143815C > G had a significantly better response to chemotherapy. Consistent with the individual genotype analyses, rs2297136C-rs4143815G haplotype (ht4) carrying variant alleles at both loci was significantly associated with better chemotherapy response and OS compared with combined other haplotypes. Patients with at least one ht4 had significantly better chemotherapy response and OS compared to those without ht4. PD-L1 rs2297136T > C and rs4143815C > G polymorphisms may be useful for the prediction of clinical outcome of 1(st) line paclitaxel-cisplatin chemotherapy in NSCLC. Further studies are needed to confirm our findings and to understand the role of PD-L1 in the chemotherapy outcome of NSCLC patients. PMID:27181838

  19. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer

    DEFF Research Database (Denmark)

    Scagliotti, G.V.; Parikh, P.; Pawel, J. von;

    2008-01-01

    Purpose Cisplatin plus gemcitabine is a standard regimen for first-line treatment of advanced non-small-cell lung cancer (NSCLC). Phase II studies of pemetrexed plus platinum compounds have also shown activity in this setting. Patients and Methods This noninferiority, phase III, randomized study...... neutropenia (P = .002); and alopecia (P common. Conclusion In advanced NSCLC, cisplatin/pemetrexed provides similar efficacy with better tolerability and more convenient administration than cisplatin....../gemcitabine. This is the first prospective phase III study in NSCLC to show survival differences based on histologic type Udgivelsesdato: 2008/7/20...

  20. Comparison of concurrent chemoradiotherapy versus neoadjuvant chemotherapy followed by radiation in patients with advanced nasopharyngeal carcinoma in endemic area: experience of 128 consecutive cases with 5 year follow-up

    OpenAIRE

    Wu, Shang-Yin; Wu, Yuan-Hua; Yang, Ming-Wei; Hsueh, Wei-Ting; Hsiao, Jenn-Ren; Tsai, Sen-Tien; Chang, Kwang-Yu; Chang, Jeffrey S.; Yen, Chia-Jui

    2014-01-01

    Background Combined radiotherapy and chemotherapy is considered the standard of care for locally advanced nasopharyngeal carcinoma (LA-NPC) in Epstein-Barr virus infection endemic area. This study compared the long-term outcomes between LA-NPC patients treated with neoadjuvant chemotherapy followed by radiotherapy (NACT) and those treated with concurrent chemoradiotherapy (CCRT). Methods From 2003 to 2007, a total of 128 histopathologically proven LA-NPC patients receiving either NACT or CCRT...

  1. Association between SPARC mRNA expression, prognosis and response to neoadjuvant chemotherapy in early breast cancer: a pooled in-silico analysis.

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    Hatem A Azim

    Full Text Available INTRODUCTION: SPARC is an important regulator of the extracellular matrix and has been suggested to improve delivery of albumin-bound cytotoxics. However, little is known regarding its role in breast cancer (BC. METHODS: We conducted a pooled analysis of publically available datasets, in which BC patients who received no systemic therapy or received neoadjuvant chemotherapy were eligible. Patients were assigned to molecular subtypes using PAM-50. We computed a SPARC module (SPARC7, composed of genes with an absolute correlation with SPARC >0.7. In the systemically untreated cohort, we evaluated 1 expression of SPARC/SPARC7 according to breast cancer subtype, 2 association between SPARC/SPARC7 and biological processes related to proliferation, immune and stroma, and 3 association between SPARC/SPARC7 and relapse-free survival in a Cox model in all patients and in the different molecular subtypes adjusted for tumor size, nodal status, histological grade, and age. In the neoadjuvant cohort, we evaluated the association between SPARC and pCR in a logistic regression model, adjusted for the same clinicopathologic factors. RESULTS: 948 (10 datasets, and 791 (8 datasets patients were included in the systemically untreated and neoadjuvant cohorts, respectively. High SPARC expression was associated with small tumor size, low histological grade and luminal-A tumors (all p<0.0001. There was a positive correlation between SPARC and stroma-related modules but negative correlation with proliferation modules. High SPARC expression was associated with poor prognosis in patients with basal and HER2+ breast cancer even after adjusting for clinicopathologic parameters. In the neoadjuvant cohort, a subgroup analysis suggested that high SPARC is associated with low rates of pCR in the HER2 subtype. Same results were observed on replacing SPARC by SPARC7. CONCLUSION: This analysis suggests a potential role of SPARC in determining prognosis and response to primary

  2. Role of 99mTc-Sestamibi scintimammography in assessing response to neoadjuvant chemotherapy in patients with locally advanced breast cancer

    International Nuclear Information System (INIS)

    Neoadjuvant chemotherapy (NACT) is an essential part of multi-disciplinary management of locally advanced breast cancer (LABC). In this study, we aimed at evaluating the role of 99mTc-Sestamibi scinti-mammography in assessing response to NACT in patients with LABC. A total of 42 patients of histologically proven LABC were enrolled in this prospective study. Imaging was performed according to pre-defined protocol at 10 min and 4 h after injection of tracer before the start of chemotherapy, 48 h after start of chemotherapy and at the end of chemotherapy. Quantitative parameters were obtained by calculating the ratio of activity in a region of interest (ROI) drawn over the tumor and the same sized ROI drawn in corresponding location in contra lateral breast. Early response assessment in patients with LABC to NACT with 99mTc-Sestamibi scintimammography is feasible and if confirmed by further studies can find routine clinical application in differentiating responders from non-responders. (author)

  3. Enhancement of Intratumoral Chemotherapy with Cisplatin with or without Microwave Ablation and Lipiodol. Future Concept for Local Treatment in Lung Cancer

    OpenAIRE

    Hohenforst-Schmidt, Wolfgang; Zarogoulidis, Paul; Stopek, Joshua; Kosmidis, Efstratios; Vogl, Thomas. J.; Linsmeier, Bernd; Tsakiridis, Kosmas; Lampaki, Sofia; Lazaridis, George; Mpakas, Andreas; Browning, Robert; Papaiwannou, Antonis; Drevelegas, Antonis; Baka, Sofia; Karavasilis, Vasilis

    2015-01-01

    Novel therapies for lung cancer are being explored nowadays with local therapies being the tip of the arrow. Intratumoral chemotherapy administration and local microwave ablation have been investigated in several studies. It has been previously proposed that lipiodol has the ability to modify the microenvironment matrix. In our current study we investigated this theory in BALBC mice. In total 160 BALBC mice were divided in eight groups: a) control, b) cisplatin, c) microwave, d) microwave and...

  4. Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer

    International Nuclear Information System (INIS)

    To compare the use of diffusion-weighted MR imaging (DWI) and 18F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy. Thirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis. After surgery, 7/34 patients (20.6%) were found to have pCR. Az values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI. DWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR. (orig.)

  5. Alterations in EGFR and related genes following neo-adjuvant chemotherapy in Chinese patients with non-small cell lung cancer.

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    Shuhang Wang

    Full Text Available INTRODUCTION: Genetic aberrancies within epidermal growth factor receptor (EGFR pathway are associated with therapeutic outcomes of EGFR-tyrosine kinase inhibitors (TKIs in advanced non-small cell lung cancer (NSCLC. However, the impact of chemotherapy on EGFR-related genes alterations has not been defined in NSCLC. Our study aims to investigate the impact of neoadjuvant chemotherapy (Neoadj-Chemo on EGFR activating mutations and associated EGFR-TKIs resistance-related genes. PATIENTS AND METHODS: Matched tumor samples were obtained retrospectively from 66 NSCLC patients (stages IIb-IIIb corresponding to pre- and post- Neoadj-Chemo. EGFR mutations were detected by denaturing high performance liquid chromatography (DHPLC and confirmed by Amplification Refractory Mutation System technology (ARMS, KRAS mutations, T790M mutation and c-MET amplification were identified using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP, ARMS, and real-time PCR, respectively. RESULTS: Before Neoadj-Chemo, EGFR mutations were identified in 33.3% (22/66 of NSCLC patients. Only 18.2% (12/66 of patients carried EGFR mutations after Neoadj-Chemo (p = 0.013. The median peak value of EGFR 19 exon mutations decreased non-significantly after Neoadj-Chemo. KRAS mutation rate decreased from 4.6% (3/66 to 3.0% (2/66 with Neoadj-Chemo. Although the overall percentage of patients exhibiting c-MET amplifications (6.1% [4/66] did not change with Neoadj-Chemo, two patients transitioned from negative to positive c-MET amplification, and two patients reversed these changes post-Neoadj-Chemo. T790M mutations were absent from all samples. CONCLUSION: Neoadjuvant chemotherapy tends to decrease the mutation frequency of EGFR mutation and downstream genes, which suggests that real-time samples analysis for genetic aberrancies within EGFR pathways have important value to delineate specific patient populations and facilitate individualized treatment.

  6. Prediction of tumour necrosis fractions using metabolic and volumetric 18F-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma

    International Nuclear Information System (INIS)

    The utility of combined metabolic and volumetric 18F-FDG PET/CT indices for predicting tumour necrosis fractions following neoadjuvant chemotherapy has not been extensively studied in osteosarcoma. Furthermore, little is known of the early PET/CT responses after only one chemotherapy course. Enrolled in the study were 20 children and young adults with resectable osteosarcoma who had undergone 18F-FDG PET/CT scans before and after neoadjuvant chemotherapy. Maximum standardized uptake value (mSUV), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were measured. From among the 20 patients, 14 were prospectively recruited and underwent an additional PET/CT scan after one chemotherapy course. Histopathological necrosis fractions were compared with the above-mentioned PET/CT indices and their ratios. MTV at the SUV threshold of 2 g/ml was closely correlated with the magnetic resonance image volumes before therapy (r = 0.91). In the prospective cohort, five patients were classified as good responders and nine as poor responders. All the metabolic indices (mSUV and its ratio) and combined metabolic/volumetric indices (MTV, TLG, and their ratios) except the mSUV ratio determined after therapy showed significant differences between good and poor responders (P 18F-FDG PET/CT indices (either combined metabolic/volumetric or metabolic indices) determined after neoadjuvant chemotherapy were useful in predicting tumour responses. This held true after only one chemotherapy course. (orig.)

  7. Concomitant chemobrachyradiotherapy with ifosfamide and cisplatin followed by consolidation chemotherapy in locally advanced squamous cell carcinoma of the uterine cervix: Results of a phase II study

    International Nuclear Information System (INIS)

    Purpose: To evaluate the efficacy and toxicity of ifosfamide and cisplatin administered concomitantly with low-dose-rate brachytherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell cervical carcinoma (LASCC). Methods and materials: Forty-four patients with biopsy-proven LASCC were enrolled. FIGO Stages IB2 bulky to IVA were entered into this study. Patients were assigned to receive external radiotherapy (50 Gy in 25 fractions); then ifosfamide 2 g/m2 plus cisplatin 75 mg/m2 was applied during two low-dose-rate brachytherapy applications, and 4 cycles of consolidation chemotherapy with the same drug combination were given after completion of radiotherapy. The planned dose to point A was 85 Gy. Results: All patients received both courses of concomitant chemobrachytherapy and at least 1 cycle of consolidation chemotherapy. The average duration of radiation was 45.1 days. The clinical complete response rate was 100%. Grade 3 and 4 leukopenia occurred in 25% and 11% of the cycles, respectively. After a median follow-up of 34 months (range, 20-54 months), the recurrence-free and the overall survival rates were 84% and 91%, respectively. Major delayed local complications occurred in 7 cases (16%). Conclusions: These results indicate that concomitant chemobrachyradiotherapy with ifosfamide and cisplatin is a feasible combination for patients with LASCC of the cervix uteri. A randomized trial is planned

  8. Cell Line Derived Multi-Gene Predictor of Pathologic Response to Neoadjuvant Chemotherapy in Breast Cancer: A Validation Study on US Oncology 02-103 Clinical Trial

    Directory of Open Access Journals (Sweden)

    Shen Kui

    2012-11-01

    Full Text Available Abstract Background The purpose of this study is to assess the predictive accuracy of a multi-gene predictor of response to docetaxel, 5-fluorouracil, epirubicin and cyclophosphamide combination chemotherapy on gene expression data from patients who received these drugs as neoadjuvant treatment. Methods Tumor samples were obtained from patients with stage II-III breast cancer before starting neoadjuvant chemotherapy with four cycles of 5-fluorouracil/epirubicin/cyclophosphamide (FEC followed by four cycles of docetaxel/capecitabine (TX on US Oncology clinical trial 02-103. Most patients with HER-2-positive cancer also received trastuzumab (H. The chemotherapy predictor (TFEC-MGP was developed from publicly available gene expression data of 42 breast cancer cell-lines with corresponding in vitro chemotherapy sensitivity results for the four chemotherapy drugs. No predictor was developed for treatment with trastuzumab. The predictive performance of TFEC-MGP in distinguishing cases with pathologic complete response from those with residual disease was evaluated for the FEC/TX and FEC/TX plus H group separately. The area under the receiver-operating characteristic curve (AU-ROC was used as the metric of predictive performance. Genomic predictions were performed blinded to clinical outcome. Results The AU-ROC was 0.70 (95% CI: 0.57-0.82 for the FEC/TX group (n=66 and 0.43 (95% CI: 0.20-0.66 for the FEC/TX plus H group (n=25. Among the patients treated with FEC/TX, the AU-ROC was 0.69 (95% CI: 0.52-0.86 for estrogen receptor (ER-negative (n=28 and it was 0.59 (95% CI: 0.36-0.82 for ER-positive cancers (n=37. ER status was not reported for one patient. Conclusions Our results indicate that the cell line derived 291-probeset genomic predictor of response to FEC/TX combination chemotherapy shows good performance in a blinded validation study, particularly in ER-negative patients.

  9. Analysis of contributing factors with high renal uptake of 99mTc-MDP after anti-cancer chemotherapy including cisplatin

    International Nuclear Information System (INIS)

    We studied the effect of anti-cancer chemotherapy including cis-platin (CDDP) on renal high uptake of 99mTc-MDP using renal accumulation index (RAI) which was defined as a ratio of the densities between kidneys and lumbar bodies. We analyzed 21 cases who received bone scintigraphy within 30 days after chemotherapy. High RAIs were observed in 15 cases (71.4%). We compared the relationship between the RAI and time interval of CDDP administration and bone scintigraphy, total dose of CDDP, BUN and age. High RAIs were inversely related to the time interval and no patient showed high RAI when bone scintigraphy were studied later than 17 days after chemotherapy. BUN level were related to RAI. But, dose of CDDP and ages were unlikely responsible for the RAI values in this study. We summarized that high renal uptake of 99mTc-MDP was likely to be due to short time interval after chemotherapy. (author)

  10. Prevention of cisplatin nephrotoxicity

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    Hayati Fatemeh

    2016-01-01

    Full Text Available Cisplatin has a well-established role in the treatment of broad spectrum of malignancies; however its use is limited because of cisplatin-induced nephrotoxicity (CIN which can be progressive in more than 50% of cases. The most important risk factors for CIN include higher doses of cisplatin, previous cisplatin chemotherapy, underlying kidney damage and concurrent treatment with other potential nephrotoxin agents, such as aminoglycosides, nonsteroidal anti-inflammatory agents, or iodinated contrast media. Different strategies have been offered to diminish or prevent nephrotoxicity of cisplatin. The standard approach for prevention of CIN is the administration of lower doses of cisplatin in combination with full intravenous hydration prior and after cisplatin administration. Cisplatin-induced oxidative stress in the kidney may be prevented by natural antioxidant compounds. The results of this review show that many strategies for prevention of CIN exist, however, attention to the administration of these agent for CIN is necessary.

  11. Effect of adding gefitinib to neoadjuvant chemotherapy in estrogen receptor negative early breast cancer in a randomized phase II trial

    DEFF Research Database (Denmark)

    Bernsdorf, M.; Ingvar, C.; Jorgensen, L.;

    2011-01-01

    Gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, has shown both anti-proliferative and anti-tumoral activity in breast cancer. This study was designed to determine the effect of adding gefitinib to neoadjuvant epirubicin and cyclophosphamide (EC) on tumor response rates. ...

  12. Evaluation of the effect of neoadjuvant chemotherapy on tumor and axillary lymph nodes in locally advanced breast cancer:a study of 50 patients

    Institute of Scientific and Technical Information of China (English)

    Ali H.Meebed; Ihab S.Fayek; Amany Saber; Reda H.Tabashy; Mona A.Sakr

    2014-01-01

    The purpose of the study was to correlate between ef ect of pre neoadjuvant chemotherapy (NACT) and post NACT clinical, sonographic and pathologic features of the tumor and axil ary lymph nodes (ALNs) and to raise the possibility of applying the concept of sentinel lymph node biopsy (SLNB) in patients with initial y positive ALNs before NACT. Methods:A prospective study of 50 female patients with local y advanced breast cancer (LABC) with clinical y palpable and cytological y (under ultrasonographic guidance) positive ALNs. Al patients received NACT and then referred for ultrasono graphic assessment of the axil a regarding any detectable sonographic criteria of metastatic deposits in ALNs as wel as the tumor size in relation to its pre chemotherapy size. Al patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results:Patients’ mean age was 47.7 ± 9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm;stage IIIA that was presented in 32 patients (64%) and IIIB was presented in 18 patients (36%). Chemotherapy was given for a median of 4 cycles. there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm (P<0.001). Clinical response was complete in 5 (10%) tumors, complete pathological tumor response (post neoadjuvant) was detected in 8 (16%) of patients. Complete clinical nodal response (post neoadjuvant) in 23 (46%) axil ae, on sonographic assessment of the axil a, response was complete in 17 (34%) axil ae. Complete pathological nodal response occurred in 16 (32%) axil ae. Out of 17 axil ae that showed complete sonographic response 11 axil ae showed complete pathological nodal response (P<0.001). Conclusion:Formal axil ary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete

  13. Excision repair cross complementation group 1 is a chemotherapy-tolerating gene in cisplatin-based treatment for non-small cell lung cancer.

    Science.gov (United States)

    Wang, Shoufeng; Pan, Hong; Liu, Desen; Mao, Naiquan; Zuo, Chuantian; Li, Li; Xie, Tong; Huang, Dingming; Huang, Yaoyuan; Pan, Qi; Yang, Li; Wu, Junwei

    2015-02-01

    This study aimed to evaluate the biological functions of excision repair cross complementation goup 1 (ERCC1) in cell proliferation, cell cycle, invasion and cisplatin response of non-small cell lung cancer (NSCLC) cells. Firstly, ERCC1 gene was successfully transfected into H1299 cells by gene cloning and transfection techniques. Then, cell proliferation was determined with the cell growth curve and colony-forming assays. Flow cytometry (FCM) was employed to investigate the cell cycle distribution. The ability of cell invasion was estimated by means of Matrigel invasion assays. Response of NSCLC cells to cisplatin was detected utilizing MTT assays, and the intracellular drug concentrations were determined by the high performance liquid chromatography (HPLC) analysis. Expression of the two cell membrane proteins, P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP), was also evaluated utilizing FCM technique. By contrast, ERCC1 expression in the NSCLC A549 cells was silenced by small interfering RNA (siRNA) through RNAi technique. In addition, the cytotoxic effect of cisplatin on A549 cells was detected by MTT assays. In the present study, the results demonstrated that ERCC1 had no effect on cell proliferation, cell cycle and the ability of invasion, but showed significant impact on cisplatin response of the NSCLC H1299 cells. Furthermore, siRNA-induced suppression of ERCC1 evidently enhanced sensitivity to cisplatin of NSCLC A549 cells. Therefore, it is confirmed that ERCC1 is a chemotherapy-tolerating gene and a promising predictor in tailoring chemotherapy of NSCLC. PMID:25434755

  14. Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy

    International Nuclear Information System (INIS)

    Since the definition of different histologic subtypes of urothelial carcinomas by the World Health Organization (WHO) 2004 classification, description of molecular features and clinical behavior of these variants has gained more attention. We reviewed 205 tumor samples of patients with locally advanced bladder cancer mainly treated within the randomized AUO-AB05/95 trial with radical cystectomy and adjuvant cisplatin-based chemotherapy for histologic subtypes. 178 UC, 18 plasmacytoid (PUC) and 9 micropapillary (MPC) carcinomas of the bladder were identified. Kaplan Meier analysis and backward multivariate Cox’s proportional hazards regression analysis were performed to compare overall survival between the three histologic subtypes. Patients suffering from PUC have the worst clinical outcome regarding overall survival compared to conventional UC and MPC of the bladder that in turn seem have to best clinical outcome (27.4 months, 62.6 months, and 64.2 months, respectively; p=0.013 by Kaplan Meier analysis). Backward multivariate Cox´s proportional hazards regression analysis (adjusted to relevant clinicopathological parameters) showed a hazard ratio of 3.2 (p=0.045) for PUC in contrast to patients suffering from MPC. Histopathological diagnosis of rare variants of urothelial carcinoma can identify patients with poor prognosis

  15. Feasibility Study of Moderately Accelerated Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin After Induction Chemotherapy in Locally Advanced Head-and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate the feasibility and efficacy of moderately accelerated intensity-modulated radiation therapy (IMRT) along with weekly cisplatin, after induction chemotherapy, in patients with locally advanced unresectable head and neck cancer (HNC). Methods and Materials: Patients with Stage III or IV locally advanced HNC, without progressive disease after three courses of induction chemotherapy, received concurrent chemo-IMRT (weekly cisplatin 30 mg/m2 plus simultaneous integrated boost IMRT). A total of 67.5 Gy in 30 fractions were delivered to primary tumor and involved nodes, 60 Gy in 30 fractions to high-risk nodal areas, and 55.5 Gy in 30 fractions to low-risk nodal areas. Results: In all, 36 patients (median age, 56 years) with International Union Against Cancer (UICC) Stage III (n = 5) and IV (n = 31) were included. Of the 36 patients, 17 had received CF (cisplatin and 5-fluorouracil (CF) and 19 had received docetaxel cisplatin and 5-fluorouracil (DCF). During concurrent chemoradiation, 11 of 36 patients (30.5%) experienced Grade III mucositis (CF, 47%; DCF, 15%; p < 0.04). Grade III pharyngeal-esophageal toxicity was observed in 5 of 19 patients (26.3%; CF, 0.0%; DCF, 26.3%; p = 0.02). Two patients died of complications (5.5%). After chemoradiation, the complete response rate was 63.8%. Two-year local control was 88.7%. Two-year progression free survival and overall survival were 74.5% and 60.9%, respectively. Conclusions: In our experience, a moderately accelerated chemo-IMRT was feasible after induction chemotherapy. However, a noteworthy early death rate of 5.5% was observed. Intensive supportive care strategies should be defined to better manage radiation-induced toxic effects. Longer follow-up is required to determine the incidence of late radiation toxicities and tumor control rates.

  16. Prediction of tumour necrosis fractions using metabolic and volumetric {sup 18}F-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Im, Hyung Jun; Kim, Tae Sung; Kim, Seok-ki [National Cancer Center, Department of Nuclear Medicine, Goyang-si, Gyeonggi-do (Korea, Republic of); Park, Seog-Yun; Min, Hye Sook [National Cancer Center, Department of Pathology, Goyang-si, Gyeonggi-do (Korea, Republic of); Kim, June Hyuk; Kang, Hyun Guy [National Cancer Center, Orthopedic Oncology Clinic, Goyang-si, Gyeonggi-do (Korea, Republic of); Park, Seung Eun [National Cancer Center, Cancer Biostatistics Branch, Goyang-si, Gyeonggi-do (Korea, Republic of); Kwon, Mi Mi; Yoon, Jong Hyung; Park, Hyeon Jin; Park, Byung-Kiu [National Cancer Center, Center for Pediatric Oncology, Goyang-si, Gyeonggi-do (Korea, Republic of)

    2012-01-15

    The utility of combined metabolic and volumetric {sup 18}F-FDG PET/CT indices for predicting tumour necrosis fractions following neoadjuvant chemotherapy has not been extensively studied in osteosarcoma. Furthermore, little is known of the early PET/CT responses after only one chemotherapy course. Enrolled in the study were 20 children and young adults with resectable osteosarcoma who had undergone {sup 18}F-FDG PET/CT scans before and after neoadjuvant chemotherapy. Maximum standardized uptake value (mSUV), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were measured. From among the 20 patients, 14 were prospectively recruited and underwent an additional PET/CT scan after one chemotherapy course. Histopathological necrosis fractions were compared with the above-mentioned PET/CT indices and their ratios. MTV at the SUV threshold of 2 g/ml was closely correlated with the magnetic resonance image volumes before therapy (r = 0.91). In the prospective cohort, five patients were classified as good responders and nine as poor responders. All the metabolic indices (mSUV and its ratio) and combined metabolic/volumetric indices (MTV, TLG, and their ratios) except the mSUV ratio determined after therapy showed significant differences between good and poor responders (P <0.05). Differences were also noted for all of these indices determined after one chemotherapy course. Furthermore, most of these indices determined after therapy as well as after one chemotherapy course had good sensitivity, specificity, positive predictive value and negative predictive value with respect to predicting histological response to chemotherapy. In our osteosarcoma patient population, {sup 18}F-FDG PET/CT indices (either combined metabolic/volumetric or metabolic indices) determined after neoadjuvant chemotherapy were useful in predicting tumour responses. This held true after only one chemotherapy course. (orig.)

  17. Bleomycin-induced pulmonary fibrosis after tumor lysis syndrome in a case of advanced yolk sac tumor treated with bleomycin, etoposide and cisplatin (BEP) chemotherapy.

    Science.gov (United States)

    Doi, Mihoko; Okamoto, Yohei; Yamauchi, Masami; Naitou, Hiroyuki; Shinozaki, Katsunori

    2012-10-01

    Ovarian yolk sac tumor (YST) is a highly aggressive malignancy arising in young women. Chemotherapy has dramatically improved the prognosis, and bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy appears to be the most effective combination regimen. A 23-year-old woman was admitted to our hospital with worsening abdominal distention and a lower abdominal mass. She was diagnosed with a stage IIIc pure YST of the right ovary, and right salpingo-oophorectomy was performed; there were numerous disseminated peritoneal tumors within the abdominal cavity. A few days postoperatively, massive ascites developed, and right hydronephrosis occurred. Chemotherapy with BEP was started, and after 24 h of administration, oliguria and tumor lysis syndrome (TLS) developed. Continuous hemodiafiltration was started, and hemodialysis was initiated following full-dose standard cisplatin and etoposide on days 2-5 of the 1st cycle. After the electrolyte abnormalities and the elevation of creatinine became normal, the patient received an additional three cycles of BEP and achieved complete remission. However, she also suffered from severe non-hematological toxicities, including grade 3 left ventricular dysfunction and grade 4 pulmonary fibrosis. In the case of rapidly progressing and high-volume YST treated with BEP chemotherapy, special attention should be paid to bleomycin-induced pulmonary toxicity following TLS. Further study is required to optimize drug exposure to ensure efficacy and reduce the risk of side effects in this population. PMID:22127348

  18. Value of Breast Cancer Molecular Subtypes and Ki67 Expression for the Prediction of Efficacy and Prognosis of Neoadjuvant Chemotherapy in a Chinese Population

    Science.gov (United States)

    Wang, Jiayu; Sang, Die; Xu, Binghe; Yuan, Peng; Ma, Fei; Luo, Yang; Li, Qing; Zhang, Pin; Cai, Ruigang; Fan, Ying; Chen, Shanshan; Li, Qiao

    2016-01-01

    Abstract The aim of the study was to determine the predictive role of breast cancer subtypes in the efficacy and prognosis of neoadjuvant chemotherapy (NCT) regimens combining taxanes and anthracyclines. Data from 240 patients with breast cancer who received surgery after 4 to 6 weeks of NCT were retrospectively analyzed. The patients were classified into luminal A, luminal B, HER2 overexpression, and triple negative breast cancer (TNBC) as well as low Ki67 (≤ 14%) and high Ki67 (> 14%) expression groups using immunohistochemistry. NCT outcome parameters were pathological complete response (pCR), clinical complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) 4 weeks after surgery. Long-term outcome parameters were disease-free survival (DFS) with a follow-up time of 3 to 56 months. pCR rates were 1.6%, 13.4%, 22.6%, and 23.8% in patients with luminal A, luminal B, HER2, and TNBC cancers, respectively. High pCR rates correlated with high Ki67 expression (> 40%) (P the DFS rate of luminal A breast cancer was the highest compared to all other groups, but only significantly higher compared to luminal B (P = 0.035, HR = 1.480, 95% CI: 1.060–1.967) patients and correlated with Ki67 expression > 40% (P = 0.005). Luminal A type patients derived the least benefit from neoadjuvant chemotherapy but had better long-term prognoses. ER status and Ki67 expression served as efficacy predictors for NCT, whereas only Ki67 expression > 40% correlated with long-term treatment outcomes. PMID:27149453

  19. The Impact of Skin-Sparing Mastectomy With Immediate Reconstruction in Patients With Stage III Breast Cancer Treated With Neoadjuvant Chemotherapy and Postmastectomy Radiation

    International Nuclear Information System (INIS)

    Purpose: The safety and efficacy of skin-sparing mastectomy (SSM) with immediate reconstruction (IR) in patients with locally advanced breast cancer are unclear. The purpose of this study is to compare the outcomes of women with noninflammatory Stage III SSM with IR vs. non–SSM-treated women who underwent neoadjuvant chemotherapy and adjuvant radiation therapy (XRT). Methods and Materials: Between October 1997 and March 2010, 100 consecutive patients (40 SSM with IR vs. 60 non-SSM) with Stage III breast cancer received anthracycline- and/or taxane-based neoadjuvant chemotherapy, mastectomy, and adjuvant XRT. Clinical stage (SSM with IR vs. for non-SSM) was IIIA (75% vs. 67%), IIIB (8% vs. 18%), and IIIC (8% vs. 8%). Tumors greater than 5 cm were found in 74% vs. 69%; 97% of patients in both groups were clinically node positive; and 8% vs. 18% had T4b disease. Results: The time from initial biopsy to XRT was prolonged for SSM–IR patients (274 vs. 254 days, p = 0.04), and there was a trend toward XRT delay of more than 8 weeks (52% vs. 31%, p = 0.07) after surgery. The rate of complications requiring surgical intervention was higher in the SSM–IR group (37.5% vs. 5%, p < 0.001). The 2-year actuarial locoregional control, breast cancer–specific survival, and overall survival rates for SSM with IR vs. non-SSM were 94.7% vs. 97.4%, 91.5% vs. 86.3%, and 87.4% vs. 84.8%, respectively (p = not significant). Conclusions: In our small study with limited follow-up, SSM with IR prolonged overall cancer treatment time and trended toward delaying XRT but did not impair oncologic outcomes. Complication rates were significantly higher in this group. Longer follow-up is needed.

  20. Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

    Directory of Open Access Journals (Sweden)

    Mishra Ashwani

    2011-02-01

    Full Text Available Abstract Background Sentinel lymph node biopsy (SLNB is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC after neo-adjuvant chemotherapy (NACT is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB using "dye alone" (methylene blue method in patients with LABC following NACT. Materials and methods Thirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil were subjected to SLNB (using methylene blue dye followed by complete axillary lymph node dissection (levels I-III. The sentinel node(s was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed. Conclusions This study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.

  1. The Impact of Skin-Sparing Mastectomy With Immediate Reconstruction in Patients With Stage III Breast Cancer Treated With Neoadjuvant Chemotherapy and Postmastectomy Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Roshan; Godette, Karen [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States); Carlson, Grant; Losken, Albert; Gabram, Sheryl [Winship Cancer Institute, Emory University, Atlanta, GA (United States); Department of Surgery, Emory University, Atlanta, GA (United States); Fasola, Carolina [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States); O' Regan, Ruth; Zelnak, Amelia [Winship Cancer Institute, Emory University, Atlanta, GA (United States); Department of Hematology and Medical Oncology, Emory University, Atlanta, GA (United States); Torres, Mylin, E-mail: matorre@emory.edu [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States)

    2012-03-15

    Purpose: The safety and efficacy of skin-sparing mastectomy (SSM) with immediate reconstruction (IR) in patients with locally advanced breast cancer are unclear. The purpose of this study is to compare the outcomes of women with noninflammatory Stage III SSM with IR vs. non-SSM-treated women who underwent neoadjuvant chemotherapy and adjuvant radiation therapy (XRT). Methods and Materials: Between October 1997 and March 2010, 100 consecutive patients (40 SSM with IR vs. 60 non-SSM) with Stage III breast cancer received anthracycline- and/or taxane-based neoadjuvant chemotherapy, mastectomy, and adjuvant XRT. Clinical stage (SSM with IR vs. for non-SSM) was IIIA (75% vs. 67%), IIIB (8% vs. 18%), and IIIC (8% vs. 8%). Tumors greater than 5 cm were found in 74% vs. 69%; 97% of patients in both groups were clinically node positive; and 8% vs. 18% had T4b disease. Results: The time from initial biopsy to XRT was prolonged for SSM-IR patients (274 vs. 254 days, p = 0.04), and there was a trend toward XRT delay of more than 8 weeks (52% vs. 31%, p = 0.07) after surgery. The rate of complications requiring surgical intervention was higher in the SSM-IR group (37.5% vs. 5%, p < 0.001). The 2-year actuarial locoregional control, breast cancer-specific survival, and overall survival rates for SSM with IR vs. non-SSM were 94.7% vs. 97.4%, 91.5% vs. 86.3%, and 87.4% vs. 84.8%, respectively (p = not significant). Conclusions: In our small study with limited follow-up, SSM with IR prolonged overall cancer treatment time and trended toward delaying XRT but did not impair oncologic outcomes. Complication rates were significantly higher in this group. Longer follow-up is needed.

  2. Role of lymph node irradiation in patients free of nodal involvement after neoadjuvant chemotherapy for breast cancer; Role de l'irradiation ganglionnaire chez les patientes indemnes d'envahissement ganglionnaire apres chimiotherapie neoadjuvante pour un cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Daveau, C.; Stevens, D.; Brain, E.; Berges, O.; Gardner, M.; Villette, S.; Moisson, P.; De la Lande, B.; Labib, A.; Le Scodan, R. [Centre Rene-Huguenin, 92 - Saint-Cloud (France)

    2009-10-15

    The results suggest that an only breast irradiation is not associated to a higher risk of local recurrence or death in patients with a classified pN0 breast cancer after neoadjuvant chemotherapy. (N.C.)

  3. Stages III and IV squamous cell carcinoma of the mouth: Three-year experience with superselective intraarterial chemotherapy using cisplatin prior to definitive treatment

    International Nuclear Information System (INIS)

    Purpose: This study was designed to assess the 3-year experience with superselective intraarterial chemotherapy prior to definitive treatment for stages III and IV squamous cell carcinomas of the mouth.Methods: Twenty-two patients prospectively received superselective intraarterial chemotherapy using relatively low-dose cisplatin via a transfemoral approach. The locations of the tumors were the tongue (n=12), gingiva (n=5), buccal mucosa (n=2), hard palate (n=1), floor of the mouth (n=1), and lip (n=1). After intraarterial chemotherapy, 21 patients underwent surgery (n=14), radiation therapy (n=6), or both (n=1). The survival rate of 25 patients who underwent surgery with/without radiationtherapy until 1992 at Kumamoto University Hospital was also evaluated as a historical control. The survival curve was calculated with the Kaplan-Meier method, and the statistical difference between survival curves was determined with the generalized Wilcoxon test.Results: The overall response rate was 95% [complete response (tumor completely resolved), 24%; partial response (tumor reduction ≥50%), 71%]. Fifty-two intraarterial infusions were performed without any catheter-related complications. Mild and transient local toxicity such as edema or mucositis of the infused area was relatively common. One patient died of renal failure from cisplatin. After a median follow-up of 20 months (range 2-41 months), the estimated 3-year survival rate for patients who underwent intraarterial chemotherapy plus surgery was 91%. The survival of the patients who underwent intraarterial chemotherapy plus surgery tended to be longer than that of the historical control.Conclusions: Early tumor reduction without delay of subsequent treatments can be obtained by intraarterial chemotherapy while minimizing complications and possibly improving survival. Further investigations of long-term survival with larger series need to be performed.

  4. Clinical Evaluation of Neoadjuvant Chemotherapy for Cervical Cancer%宫颈癌新辅助化疗的临床评价

    Institute of Scientific and Technical Information of China (English)

    王芙霞

    2011-01-01

    宫颈癌新辅助化疗(NACT)在宫颈癌治疗中具有潜在的优势.近二十余年来国内外学者对宫颈癌NACT联合手术或放疗的治疗模式进行了一些探索,取得一定经验.但NACT在宫颈癌治疗中的地位仍未明确,且对其化疗方案选择目前无统一认识.现对NACT多种化疗方案应用于宫颈癌的疗效及其发展趋势进行综述,以期在分子学水平更准确地评价NACT疗效及预测化疗敏感性.%Neoadjuvant chemotherapy( NACT )has potential advantage in cervical cancer. NACT refers to systemic chemotherapy given to patients before local treatment. Scholars from both China and abroad have explored the modality therapy for NACT combined with surgery or radiotherapy on cervical cancer over the last two decades and they have learned certain experiences in this area. But the status of NACT is not clear yet and there is no consensuson how to choose its appropriate chemotherapy protocol. The latest therapeutic progress of NACT, the effect of various regimens, and their development trends now are being reviewed. In order to more accurately in molecular level,evaluate NACT treatment and predict chemotherapy sensitivity.

  5. Comparison of long-term efficacy between intensity-modulated radiotherapy with concurrent chemotherapy and neoadjuvant chemotherapy followed by intensity-modulated radiotherapy with concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Objective: To compare the long-term efficacy between two radiochemotherapy regimens for locally advanced nasopharyngeal carcinoma (NPC): intensity-modulated radiotherapy with concurrent chemotherapy (CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT. Methods: A retrospective analysis was performed on the clinical data of 278 patients with locally advanced NPC who were admitted to our hospital from 2001 to 2008. Of the 278 patients, 133 received CCRT, and 145 received NACT followed by CCRT (NACT + CCRT). Results: The follow-up rate was 96.6%. The 5-year overall survival (OS),distant metastasis-free survival (DMFS), recurrence-free survival (RFS), and progression-free survival (PFS) were 78.1%, 78.0%, 90.6%, and 72.0%, respectively. There were no significant differences between the CCRT group and NACT + CCRT group in 5-year OS (79.9% vs. 76.4%, P=0.443), DMFS (77.1% vs. 78.9%, P=0.972), RFS (91.6% vs. 89.8%, P=0.475), and PFS (71.6% vs. 72.2%, P=0.731). Subgroup analysis showed that compared with CCRT, NACT + CCRT did not significantly improve 5-year RFS in T3-4N0-1 patients (90.7% vs. 86.9%, P=0.376) and did not significantly improve 5-year DMFS in patients with advanced N-stage disease (57.6% vs. 69.7%, P=0.275). There were significantly higher numbers of individuals with neutropenia,decrease in hemoglobin, and upper gastrointestinal reactions in patients treated with NACT + CCRT than in those treated with CCRT (100 vs. 52, P=0.000; 64 vs. 35, P=0.010; 90 vs. 63, P=0.044). Conclusions: Compared with CCRT,NACT + CCRT does not significantly improve the prognosis in patients with locally advanced NPC and leads to significant increases in grade ≥ 3 toxicities (neutropenia, decrease in hemoglobin, and upper gastrointestinal reactions). The role of NACT in the treatment of locally advanced NPC needs further study. (authors)

  6. Enhancement of Intratumoral Chemotherapy with Cisplatin with or without Microwave Ablation and Lipiodol. Future Concept for Local Treatment in Lung Cancer

    Science.gov (United States)

    Hohenforst-Schmidt, Wolfgang; Zarogoulidis, Paul; Stopek, Joshua; Kosmidis, Efstratios; Vogl, Thomas; Linsmeier, Bernd; Tsakiridis, Kosmas; Lampaki, Sofia; Lazaridis, George; Mpakas, Andreas; Browning, Robert; Papaiwannou, Antonis; Drevelegas, Antonis; Baka, Sofia; Karavasilis, Vasilis; Mpoukovinas, Ioannis; Turner, J Francis; Zarogoulidis, Konstantinos; Brachmann, Johannes

    2015-01-01

    Novel therapies for lung cancer are being explored nowadays with local therapies being the tip of the arrow. Intratumoral chemotherapy administration and local microwave ablation have been investigated in several studies. It has been previously proposed that lipiodol has the ability to modify the microenvironment matrix. In our current study we investigated this theory in BALBC mice. In total 160 BALBC mice were divided in eight groups: a) control, b) cisplatin, c) microwave, d) microwave and lipiodol, e) cisplatin and lipiodol, f) microwave and cisplatin, g) lipiodol and h) lipiodol, cisplatin and microwave. Lewis lung carcinoma cell lines (106) were injected into the right back leg of each mouse. After the 8th day, when the tumor volume was about 100mm3 the therapy application was initiated, once per week for four weeks. Magnetic resonance imaging was performed for each tumor when a mouse died or when sacrificed if they were still alive by the end of the experiment (8-Canal multifunctional spool; NORAS MRI products, Gmbh, Germany). Imaging and survival revealed efficient tumor apoptosis for the groups b,c,d,e and f. However; severe toxicity was observed in group h and no follow up was available for this group after the second week of therapy administration. Lipiodol in its current form does assist in a more efficient way the distribution of cisplatin, as the microwave apoptotic effect. Future modification of lipiodol might provide a more efficient method of therapy enhancement. Combination of drug and microwave ablation is possible and has an efficient apoptotic effect. PMID:25663938

  7. A phase II study of cisplatin with intravenous and oral vinorelbine as induction chemotherapy followed by concomitant chemoradiotherapy with oral vinorelbine and cisplatin for locally advanced non-small cell lung cancer

    International Nuclear Information System (INIS)

    Concomitant platinum-based chemotherapy and radiotherapy (CT-RT) is the recommended treatment for unresectable locally advanced stage III non-small cell lung cancer (NSCLC). We conducted a phase II study to evaluate the efficacy and safety of fractionated oral vinorelbine with cisplatin as induction CT followed by CT-RT. Patients with stage III NSCLC received 2 induction cycles of intravenous vinorelbine 25 mg/m2 and cisplatin 80 mg/m2 on day 1 and oral vinorelbine 60 mg/m2 on day 8. Responding patients received 2 more cycles of cisplatin 80 mg/m2 on day 1 and oral vinorelbine 20 mg on days 1, 3 and 5 concomitantly with radiotherapy 2 Gy daily, 5 days/week for a total of 66 Gy. Seventy patients, median age 61 years, were enrolled. Overall response rate (ORR) was 50.0%; Disease Control Rate was 81.42%. Median PFS was 14.58 months [95% CI, 10.97-18.75]. Median OS was 17.08