Objective To assess the clinical efficacy of neoadjuvant chemotherapy （NAC） for breast invasive ductal carcinoma with MR diffusion weighted imaging. Methods Thirty patients with breast invasive ductal carcinoma underwent conventional MRI scanning and diffusion weighted imaging examination before and after preoperative neoadj-uvant chemotherapy. Two experienced radiologists independently analyzed and measured the maximum lesion diameter and apparent diffusion coefficient （ADC） values before and after treatment，respectively. Statistical analysis was performed for testing the tumor maximum diameter and ADC values change by using the paired t-test. Results After NAC treatment，the maximum tumor diameter of invasive ductal breast carcinoma sharply reduced〔（4.33±0.83） cm vs. （2.04±0.64） cm，P＜0.001〕. When b value was 1 000，the mean ADC values of breast massess were significantly changed after NAC treatment〔（1.89±0.15） ×10-3mm2/s vs. （1.14±0.31） ×10-3mm2/s， P＜0.05〕. Conclusion MR diffusion weighted imaging can non-invasively and accurately assess the NAC efficacy， which are helpful for making surgical strategies.
ObjectiveTo evaluate the effects of CTX, EADM, VCR, and Pred (CHOP) as preoperative regional intra-arterial infusion chemotherapy in primary gastric malignant lymphoma (PGML). MethodsForty-one patients with PGML underwent preoperative regionalarterial infusion chemotherapy. The regimen consisting of CTX 600 mg/m2, EADM 50 mg/m2, VCR 1.4 mg/m2, and Pred 60 mg/m2, was administrated 14－21 d before operation. Another 33 patients with similar PGML during the same period underwent surgery directly. The response of the tumor and chemotherapy toxicity were observed, together with the survival of the cases. ResultsAmong the 33 patients undergoing surgery directly, 24 cases (72.7%) had curative resection, the 5-year survival rate was 58.3% (14/24). All 41 patients of the neoadjuvant chemotherapy group completed the planned regimen of chemotherapy and surgery successfully. The most common related adverse effects were grade Ⅰ-Ⅱ gastrointestinal discomfort (22 cases) and bone marrow suppression (14 cases). Thirtyseven cases (90.2%) underwent curative resection, the 5year survival rate was 67.7% (21/31). There was no significant difference between two groups in 5year survival rate (χ2=0.517， P＝0.471), while with significant difference in curative resection rate (P＝0.041). ConclusionsNeoadjuvant intra-arterial infusion chemotherapy (CHOP) has been wellrated; it appears to have improved the resectable rate of the PGML patients studied.
Objective To explore the tumor shrinking model, the accurate image evaluation of the residual tumor, and the selection criteria for breast-conserving surgery after neoadjuvant chemotherapy. Methods To review literature on the clinical, imaging, and pathologic study of breast cancer after neoadjuvant chemotherapy. Results The possibility of breast-conserving for patients with large primary tumor is enhanced with neoadjuvant chemotherapy. The tumor shrinking mode after neoadjuvant chemotherapy and its correlation factors are still unclear. MRI is the most accurate image evaluation of the residual tumor at present. M.D.Anderson prognostic index and the American National Cancer Institute selection criteria for breast-conserving surgery after neoadjuvant chemotherapy are helpful for selection of surgical type. Conclusion Tumor shrinking mode and its accurate image evaluation is a key to the selection of breast-conserving surgery and the control of local recurrence after neoadjuvant chemotherapy, and is the research direction in future.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
ObjectiveTo evaluate the effect of neoadjuvant chemotherapy and find the mechanism of multidrug resistance. MethodsTwenty patients with gastric cancer and 31 patients with colorectal cancer underwent neoadjuvant chemotherapy and then operations. The preoperative specimens were stained by immunohistochemical techniques for testing p53,multidrug resistanceassociated protein (MRP), glutathione S transferase（GST）, telomerase. Resection specimens were evaluated for chemotherapy effect by routine histology; at the same time, the postoperative morbidity and mortality were observed. ResultsIn 51 patients, the response rate of neoadjuvant chemotherapy was 27.45%(14/51),so multidrug resistance was a kind of common phenomena in gastrointestinal carcinomas. The postoperative morbidity was 15.69%(8/15), the main operation complication was infection,the mortality was 1.96%(1/51),only one person died from severe infection.The expression rate of p53, MRP, GST, telomerase was 58.0%,51.0%,66.7%,74.0%respectively, the location of p53 was at cell nucleus,location of MRP,GST was at cell memberane and cytoplasm,location of telomerase was at cytoplasm.The response rate had nothing to do with age, sex and metastasis. But it was related with p53 and telomerase expression. ConclusionNeoadjuvant chemotherapy is an effective, safe therapy. But the rate of drug resistance is high in gastrointestinal carcinomas, and the response rate is related to p53, telomerase expression.
Objective To assess the efficacy and safety of neoadjuvant intraarterial chemotherapy in the treatment of advanced cervical cancer. Methods We searched databases including PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBMdisc, conference articles, and Ongoing Controlled Trial for Random Controlled Trials and quasi-Random Controlled Trials up to October 2009. For homogeneous studies, we performed meta-analysis. Results Fifteen studies involving 1 331 participants with advanced cervical cancer were included. Twelve studies showed that the efficacy of the NIC group was 6.72 times than that of the traditional group. Several studies showed that the survival rate of the NIC group was better than that of the traditional group. Meanwhile, the adverse events of the NIC group were fewer than those of the traditional group. Conclusions The results of this system review show that, NIC which is more effective than conventional treatments with less adverse reactions provides a new adjunct for clinical treatment of advanced cervical cancer . However, due to the current clinical treatment for the disease is the coexistence of multiple chemotherapy program status, the higher quality and more focused clinical research which will compare NIC with a variety of conventional chemotherapy are needed in the further.
Objective To evaluate the effect of neoadjuvant chemotherapy (NAC) on breast conserving surgery and the outcomes of treatment for women with operable breast cancer. Methods We searched The Cochrane Library (Issue 1, 2007), CENTRAL (1970 to 2007), PUBMED (1978 to March 2007), CBM (1978 to 2006), CNKI (1994 to 2007), CMCC (1994 to May 2007) and other relevant databases and journals. We identified randomized controlled trials (RCTs) comparing NAC plus breast conserving therapy (BCT) or mastectomy versus BCT or mastectomy plus postoperative chemotherapy in women with operable breast cancer. Two reviewers independently assessed trial quality and extracted data. Meta-analyses were performed for homogenous studies by using The Cochrane Collaboration’s RevMan 4.2.10. Results Three eligible studies involving 2 391 women were included. The median follow-up in the studies ranged from 17 to 137 months. The methodological quality of the three RCTs was high. Meta-analyses showed that NAC had no significant effect on overall survival (OS) (RR 0.99, 95%CI 0.92 to 1.07), disease-free survival (RR 1.04, 95%CI 0.94 to 1.15) and ipsilateral breast cancer recurrence (RR 1.34, 95%CI 0.84 to 2.13). Two RCTs revealed that NAC significantly increased the rate of BCT in operable breast cancer patients, but the other RCT reported similar rates of BCT in both groups. One RCT indicated that NAC did not increase the incidence of surgery-related local complications. Conclusions NAC is safe for the treatment of women with operable breast cancer, which may increase the rate of BCT and help to evaluate chemosensitivity. There is insufficient evidence to assess the effect of NAC on conserving surgery procedure and survival rate in operable BCT patients. More large-scale RCTs are needed to define further the role of NAC in the treatment of operable breast cancer patients.
Objective To analyze the influence factors of amenorrhea in premenopausal breast cancer women treated with neoadjuvant chemotherapy and the relationship of neoadjuvant chemotherapy-related amenorrhea （NCRA） to down-staging of tumor. Methods Two hundred and twenty-four premenopausal breast cancer patients undergoing neoadjuvant chemotherapy from March 2006 to March 2011 in this hospital were investigated retrospectively. The effects of age， chemotherapy regiment， ER/PR status， Her-2 status， and tamoxifen （TAM） on NCRA and recovery of menstru-ation were assessed. The average age of the patients who had accepted different chemotherapy cycles when NCRA occurred was described， and the effect of different chemotherapy cycles on recovery of menstruation was evaluated. Tumor volume change was estimated to analysis the relation between NCRA and tumor response to chemotherapy. Results One hundred and sixty-six （74.11%） cases occurred NCRA， 40 （26.49%） cases returned to normal menstruation apart from 15 cases who had accepted oophorectomy or the luteinizing hormone-releasing hormone analog goserelin before menstrual status change. The results of univariate analysis and multivariate analysis indicated that the NCRA and menstruation recovery were both related to age at diagnosis （P＜0.001，P=0.001）， and only menstruation recovery was related to chemotherapy regiments （P＜0.001）. However， the NCRA and menstruation recovery were not related to ER/PR status， Her-2 status，and TAM （P＞0.05）. Chemotherapy cycles when NCRA occurred decreased with the increase of age， and wasn’t assoc-iated with menstruation recovery （P＞0.05）. There was no correlation between NCRA and downstage of tumor after neoadjuvant chemotherapy （P＞0.05）. Conclusions Amenorrhea resulted from neoadjuvant chemotherapy in most of breast cancer patients， which occurs more commonly in elder ones with less chemotherapy cycles. Quite a few patients resume menses after NCRA， which is associated with age and chemotherapy regiments. NCRA doesn’t influence tumor response to chemotherapy.
Objective To explore the effectiveness of neoadjuvant chemotherapy on postoperative risk of colorectal cancer by use of estimation of physiologic ability and surgical stress （E-PASS）. Methods A total of 161 patients with colorectal cancer according to the inclusion criteria from January 2009 to December 2009 in West China Hospital of Sichuan University were analyzed retrospectively，who were assigned to neoadjuvant chemotherapy group （NC group, 78 patients） and non-NC group （83 patients）. The postoperative risk of each group was assessed by the E-PASS scale including preoperative risk score （PRS），surgical stress score （SSS），and comprehensive risk score （CRS）. Results The baseline of two groups had no significant difference （P＞0.05）. The postoperative complication incidence of two groups had no significant difference either （P＞0.05）， which was 10.26% （8/78） in the NC group，and 7.23% （6/83） in the non-NC group. The PRS was 78.42 in the NC group and 83.42 in the non-NC group （P=0.497）. The SSS was 80.77 in the NC group and 81.22 in the non-NC group （P=0.951）. The CRS was 80.74 in the NC group and 81.24 in the non-NC group （P=0.976）. The accuracy of the postoperative risk assessment was 70 cases and 78 cases in the NC group and non-NC group，respectively. There was no significant difference of accuracy between two groups （P=0.325）. Conclusions Neoadjuvant chemotherapy does not increase the risk of patients with colorectal cancer after operation，and the results suggest that E-PASS scale can provide a more accurate assessment of neoadjuvant chemotherapy in patients with surgical risk.