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Cancer Biology and Genetics for Non-Biologists
Published in Trevor F. Cox, Medical Statistics for Cancer Studies, 2022
When chemotherapy is given after surgery to remove a tumour or part of the tumour, it is called adjuvant chemotherapy. When chemotherapy is given before surgery, in order to shrink the tumour first, it is called neoadjuvant chemotherapy.
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.
Urological cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Whilst chemotherapy is not effective alone as a primary treatment, there is now good evidence that the use of neoadjuvant chemotherapy, i.e. preceding definitive surgery or radiotherapy, will result in improved results for both local control and survival. The absolute benefit, however, is relatively modest with an overall survival advantage of 5% in favour of adding chemotherapy. It is now usual to include three cycles of chemotherapy prior to cystectomy or radical radiotherapy for locally advanced bladder cancer. The standard combinations are gemcitabine with cisplatin (GC) or methotrexate, vinblastine and cisplatin (MVC) to which may also be added Adriamycin (MVAC).
Predicting response to neoadjuvant chemotherapy in patients with oesophageal adenocarcinoma
Published in Acta Oncologica, 2021
Rebecca K. Bott, Gincy George, Ricardo McEwen, Janine Zylstra, William R. C. Knight, Cara R. Baker, Mark Kelly, Nyree Griffin, Naami McAddy, Nick Maisey, Mieke Van Hemelrijck, James A. Gossage, Jesper Lagergren, Andrew R. Davies
A variety of parameters were assessed at baseline and following completion of neoadjuvant chemotherapy. All patients had a computed-tomography (CT) scan performed as part of their initial staging investigations. A CT scan was then repeated after neoadjuvant treatment, prior to surgical resection. Radiological factors assessed included CT staging using the 7th edition of the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) TNM staging system [14], a RECIST (Response Evaluation Criteria in Small Tumours) 1.0 score [15] allocated by a specialist consultant gastrointestinal radiologist in addition to measurements of tumour height, width and volume. The volume of the primary tumour was calculated by measuring the longest axial and craniocaudal diameter of the tumour using the axial source images and sagittal reformats. The radiological tumour volume (RTV) was then derived using a validated conical volume formula [16]; v= (ab2)π/6 where v = volume, a = maximum length of tumour and b = maximum width of tumour. This validated formula assumes that the estimated RTV is determined as the sum of two truncated cones [16]. All volume calculations were performed by two dedicated senior radiologists with experience in gastrointestinal oncology. A previous study from our institution demonstrated very high levels of correlation between the volume formula, CT volume software (open source, MAC-based DICOM Viewer, OsiriX 3.9) [17] and pathological tumour volume [18].
A molecular signature of well-differentiated oral squamous cell carcinoma reveals a resistance mechanism to metronomic chemotherapy and novel therapeutic candidates
Published in Journal of Drug Targeting, 2021
Shinichiro Kina, Reika Kawabata-Iwakawa, Sho Miyamoto, Akira Arasaki, Hajime Sunakawa, Takao Kinjo
In our study, metronomic neoadjuvant chemotherapy increased the overall survival of patients with poorly or moderately differentiated tongue tumours, but not that of patients with well-differentiated tongue tumours. We offer one potential explanation for this. Metronomic neoadjuvant chemotherapy was found to be associated with pathological complete response more frequently in patients with poorly or moderately differentiated tumours than in those with well-differentiated tumours [8]. Previous studies demonstrated that the response to chemotherapy was associated with overall survival among patients who received neoadjuvant chemotherapy [17]. In addition, poorly differentiated squamous cell carcinomas are more responsive to chemotherapy than well-differentiated squamous cell carcinomas because of their higher microvessel density [8,9]. Thus, it is plausible that metronomic neoadjuvant chemotherapy increased the overall survival of the patients with poorly or moderately differentiated tumours.
Radiomics in surgical oncology: applications and challenges
Published in Computer Assisted Surgery, 2021
Travis L. Williams, Lily V. Saadat, Mithat Gonen, Alice Wei, Richard K. G. Do, Amber L. Simpson
Chemotherapy and surgery are the mainstay treatments for many tumor types [2,3]. While surgery remains the curative treatment for many solid tumors, combined surgical treatment with chemotherapy has been associated with improved survival and systemic disease control [4,5]. Neoadjuvant chemotherapy, which refers to the administration of systemic treatment before surgery, is routinely administered for inoperable breast, colorectal and lung cancers, and is also an option for other solid tumors [6–9]. Such upfront therapy is intended to reduce the size of the tumor and control progression of disease. Downstaging the tumor with upfront systemic therapy may increase margin-negative resections, make previously inoperable tumors resectable, and help manage micro-metastatic disease [10–12]. Adjuvant chemotherapy is provided after surgical intervention and is designed to reduce recurrence of disease [13]. Adjuvant chemotherapy is routinely used in high-risk patients with breast, colon, testicular, ovarian, lung, and pancreatic cancers [14].