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Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
The management of patients with breast cancer involves surgery, radiotherapy, drug, and/or biological agent therapy or a combination of these, and the overall therapeutic strategy will vary depending on factors such as patient age, tumor size and grade, degree of involvement of the axillary lymph nodes, menopausal status, the presence of key receptors associated with the tumor cells (e.g., estrogen, progesterone, or HER2 receptors), and the extent and aggressiveness of the cancer. Depending on the stage of the disease, surgery and radiotherapy are generally used first to remove the tumor mass, followed by adjuvant drug therapy (i.e., drug treatment following surgery) with the aim of reducing the risk of developing invasive cancer or disease recurrence by killing any remaining viable tumor cells. Neoadjuvant drug therapy (i.e., drug treatment before surgery) is sometimes used to reduce the size of a tumor in order to limit axillary lymph node involvement and to allow breast-conserving surgery.
Neuroblastoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Early surgery is appropriate for localized tumors where resection can be undertaken safely, unless the patient qualifies for an observation-only approach. For those with locally advanced or disseminated disease, the initial use of neoadjuvant chemotherapy followed by surgery allows for a more complete resection.
Metastatic Colorectal Cancer
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Ganesh Nagarajan, Kaushal Kundalia
Upfront resection is an option which will involve resection of the tumors with a sufficient margin. While the right lobe lesions can be excised with a 0.5 cm margin, the left lobe lesion can have a wide local excision or, a left lateral hepatectomy can be performed if the portal pedicle is involved. Alternatively, these patients may be treated with neoadjuvant chemotherapy prior to resection. The only difficulty in neoadjuvant chemotherapy is that if too many cycles of chemotherapy are given, some of the metastasis may disappear on further imaging. As discussed earlier, most patients with a disappearing lesion on CT or PET scan will still harbor viable disease and this will manifest as a recurrence in the near future. Hence, it is important to keep the patient under surveillance while on chemotherapy with serial scans after every two to three cycles. In case of small lesions, if one plans to administer neoadjuvant chemotherapy, ultrasound-guided fiducial markers may be placed. These help locate the lesion after neoadjuvant chemotherapy during the surgery.
Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study
Published in Nutrition and Cancer, 2023
Gang Tang, Feng Pi, Zhengqiang Wei, Xiangshu Li
A total of 147 cases were included in the glutamine group, and 61 in the non-glutamine group on the basis of the inclusion criteria (Table 1). Of these, 114 received neoadjuvant chemoradiotherapy, 92 received neoadjuvant chemotherapy, and two received neoadjuvant radiotherapy. A protective ostomy was performed in 53.7% of the cases. Although the glutamine and non-glutamine groups were mostly comparable in terms of patient demographics (male, age, body mass index, tumor location and stage), comorbidities (chronic obstructive pulmonary disease, hypertension, diabetes mellitus, coronary artery disease, and American Society of Anesthesiologists physical status classification), malnutrition (preoperative prealbumin, preoperative total protein, and albumin), and surgical data (surgical approach, intraoperative blood loss, intraoperative transfusion, and conversion) prior to matching, a higher proportion of patients in the former had undergone stoma (P = 0.026). In addition, the duration of surgery (P = 0.022) and type of neoadjuvant therapy (P = 0.000) differed between the two groups. The incidence of complications was observed to be lower in the glutamine group than in the non-glutamine group (P = 0.000).
New and emerging drugs for the treatment of advanced cutaneous squamous cell carcinoma
Published in Expert Opinion on Emerging Drugs, 2023
Flavia Bonini, Luana Guimarães de Sousa, Renata Ferrarotto
Leveraging the strong rationale for using PD-1 inhibitors in patients with advanced CSCC, researchers have assessed the potential of using these agents as neoadjuvant therapy in resectable advanced CSCC. Neoadjuvant therapy might lead to less destructive surgery, reduce the need of adjuvant radiation therapy, and potentially improve cosmetic, functional, and oncologic outcomes. A pilot phase II study of two cycles of neoadjuvant cemiplimab in 20 patients with newly or recurrent stage III–IVA CSCC reported promising results: ORR per RECIST (Response Evaluation Criteria in Solid Tumors) was 30%, but 75% (15/20) of patients achieved either a pathological complete response (absence of viable tumor in the posttreatment surgical specimens) or a major pathologic response (≤10% viable tumor) [73]. More recently, a larger, multicenter, phase II study evaluated neoadjuvant cemiplimab in 79 patients with resectable stage II, III or IV (M0) CSCC and confirmed the results of the pilot study with a reported pathological complete response of 51% and a major pathological response rate of 13% [74]. Results of the second part of this study, which allowed for optional adjuvant cemiplimab therapy, adjuvant radiation therapy, or observation per investigator discretion, are awaited.
Reverse lateral upper arm flaps for treating large soft tissue defects extending from the elbow to the forearm
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hideki Okamoto, Yohei Kawaguchi, Shinji Miwa, Hisaki Aiba, Hiroya Senda, Satona Murakami, Kazuo Hayakawa, Yuji Joyo, Hideki Murakami, Hiroaki Kimura
Case 1: The patient was a 61-year-old man. After undergoing biopsy at a dermatology department in a general hospital, he was referred to our department for a left forearm tumor. After resection of the myxofibrosarcoma by open biopsy, wide resection and full-thickness skin grafting were performed. There was no range of motion limitation in elbow and forearm function. One year later, the tumor recurred, and the patient underwent a second surgery after neoadjuvant therapy with chemotherapy and radiotherapy (Figure 1). Wide resection was performed on the tissue defect, including the portion that had been skin grafted in the previous surgery. A 19 × 6.5 cm reverse lateral upper arm flap was implanted for extensive soft tissue defects (Figure 2). Eight years and three months postoperatively, the extension of the elbow was 0°, flexion was 140°, and International Society of Limb Salvage score was 27 points, which indicated adequate function preservation in the elbow and forearm (Figure 3).