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Esophageal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jennifer Kahan, Carys Morgan, Kieran Foley, Thomas Crosby
The role of preoperative treatment in early, localized disease is uncertain. A randomized controlled trial (RCT) of 195 patients with early (Stage I and II) esophageal cancer showed that the addition of neoadjuvant CRT with cisplatin and fluorouracil did not improve R0 resection rates or survival and in fact, worsened postoperative mortality.54 A retrospective multicenter European study showed that the addition of neoadjuvant therapy had no effect upon survival or recurrence, and no significant difference was observed between groups in terms of morbidity and mortality. Nodal disease was observed in 50% of patients at the time of surgery, with 20% of patients having pN2/N3 disease.55 Based on current evidence, early disease (cT2N0) should be managed with surgery alone despite the high rate of nodal involvement.
Paranasal sinus and nasal cavity neoplasms
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Consensus statements for the use of chemotherapy in the treatment of sinonasal tumours do not exist because of the lack of adequately powered, randomized evidence. Chemotherapy is usually cisplatin based and may be given as a short course induction and/or neoadjuvant regimen pre-RT or surgery for rapid symptom control and/or concurrently as a radiation sensitizer. Neoadjuvant therapy is not associated with improved overall outcomes but is a practical solution to pre-RT tumour shrinkage and helps achieve a static patient contour for accurate and safe administration of the dose (106). Concurrent use of chemotherapy and RT is associated with a small, but measurable, improvement in survival for SCCs of the head and neck in general, with improved 5-year OS and DSS of 67% and 70%, respectively. There is currently no strong randomized evidence for the use of chemotherapy in rarer tumour types, but small studies have reported a benefit in undifferentiated, neuroendocrine, and small cell carcinomas. Neoadjuvant chemotherapy reduces tumour burden in two-thirds of patients with ON and is used as concomitant treatment, prior to and during RT (72,73). The role of chemotherapy in paranasal sinus malignancy is limited to the following settings: as part of triple therapy (e.g. embryonal rhabdomyosarcoma), concurrently with radiation in locally advanced disease (e.g. SCC of the maxilla), for disseminated lymphoproliferative malignancy, and for palliation (e.g. poorly differentiated SCC with disseminated disease) (1).
Hereditary Breast and Ovarian Cancer
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Chemotherapy consists of (i) preoperative therapy (or neoadjuvant therapy), given before surgery to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery; (ii) postoperative therapy (or adjuvant therapy), given after surgery to kill any cancer cells that are left and to lower the risk that the cancer will come back.
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).