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Adjuvant radiotherapy has become an important part of the standard treatment for breast cancer. Compared with the traditional postoperative radiotherapy, neoadjuvant radiotherapy has the theoretical advantages of more accurate target delineation, optimization of radiation strategy for breast reconstruction, increase of breast conservation surgery with tumor down-staging and avoiding breast surgery by improving pathological complete response rate, which have been confirmed by recent clinical research. Prospective studies are still needed for the optimal target delineation, dose fractionation, radiation-surgery interval, and combination with systemic therapies, aiming to provide the optimal treatment option for patients with early breast cancer.
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Objective@#Short-course neoadjuvant radiotherapy (SCRT) combined with delayed surgery seems to be safer than SCRT in combination with immediate surgery. However, the clinical efficacy between SCRT and long-course neoadjuvant radiotherapy (LCRT) combined with delayed surgery has not been compared. Therefore, this meta-analysis was performed to compare the safety and efficacy between SCRT and LCRT followed by delayed surgery in patients with locally advanced rectal cancer.@*Methods@#Relevant literatures were searched using relevant databases. Baseline characteristics and treatment results of patients were extracted. The included studies were subject to bias risk assessment. Evidence assessment and data analysis were conducted.@*Results@#A total of 7 studies with 4967 patients were included. Meta-analysis results illustrated no statistical significance between two groups in terms of sphincter preservation rate, R0 resection rate, postoperative complications, local recurrence rate (LRR), distant metastasis, recurrence-free survival (RFS), overall survival (OS), length of hospital stay and acute radiotherapy toxicity (all P>0.05). Compared with SCRT with delayed surgery, LCRT with delayed surgery was associated with a significant increase in the tumor downstaging rate (RR=0.84, 95%CI=0.76-0.93, P<0.05) and a considerable increase in pathologically complete remission rate (RR=0.46, 95%CI=0.34-0.61, P<0.05).@*Conclusions@#SCRT with delayed surgery is as effective as LCRT with delayed surgery in terms of sphincter preservation rate, R0 resection rate, postoperative complications, LRR, RFS, OS, grade Ⅲ-Ⅳ acute toxicity and length of hospital stay. However, LCRT in combination with delayed surgery enhances the tumor downstaging rate and pathologically complete remission rate.
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Objective@#To compare the effect of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on the survival of patients with esophageal cancer.@*Methods@#Clinical data of 275 cases of thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were analyzed retrospectively. The data of treatment and follow-up were complete and analyzable. There were 70 cases in the NCRT group and 205 cases in the NCT group. The survival rate was calculated by Kaplan-Meier method and statistically compared by log-rank test, and multivariate analysis was performed by Cox regression model.@*Results@#The median follow-up time was 32(3-84) months. The median survival time and recurrence-free survival time was 42(3-84) months and 30(3-84) months, respectively. The overall 3-and 5-year survival rates were 56.8% and 45.9%, respectively, and the 3-and 5-year recurrence-free survival rates were 45.1% and 38.9%, respectively. The median survival time in the NCRT and NCT groups was 46(7-84) and 40(4-74) months, and the median recurrence-free survival time was 31(3-84) and 28(3-69) months, respectively. The 3-and 5-year overall survival of the two groups were 59.1%, 47.1% and 56.3%, 47.5%(P=0.515), and the 3-and 5-year recurrence-free survival were 44.5%, 40.1% and 47%, 39%, respectively. There was no significant difference in the survival between two neoadjuvant therapy modes (P=0.554). Multivariate analysis showed that postoperative pathological TNM staging was an independent factor affecting the prognosis of patients with esophageal cancer (P=0.001).@*Conclusions@#The survival results of NCRT are similar to those of NCT. Postoperative pathological staging is an independent survival factor.
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Objective To compare the efficacy of neoadjuvant radiotherapy and adjuvant radiotherapy in the treatment of patients who underwent radical esophagectomy for T3 N0 stage. Methods Totally 555 cases of T3 N0 , who underwent t neoadjuvant radiotherapy or adjuvant radiotherapy from 2004 to 2014, were selected from the SEER cancer registry in this study. 486 cases received neoadjuvant radiotherapy ( neoadjuvant radiotherapy group ) and 69 cases received adjuvant radiotherapy ( adjuvant radiotherapy group). Kaplan-Meier (KM) survival and multivariate Cox regression analyses were used to analyze the overall survival ( OS) and cancer specify survival ( CSS) of the two groups. A propensity score model was utilized to balance the baseline covariates. Results The CSS in the neoadjuvant radiotherapy group was significantly better than that in the adjuvant radiotherapy group (χ2 = 6. 030, P<0. 05 ) . Multivariate COX regression analysis showed that age, gender, and radiotherapy sequence with surgery were important factors influencing the prognosis of esophageal cancer with T3N0 stage ( Wald=10. 099, 10. 562, 4. 331, P<0. 05) . Compared with the neoadjuvant radiotherapy group, the adjuvant radiotherapy group had a worse CSS ( hazard ratio:1. 649, 95％CI 1. 173-2. 316, P=0. 004) and OS ( hazard ratio:1. 402, 95％CI 1. 020-1. 928, P=0. 037) . According to K-M survival analysis, the adjuvant radiotherapy group showed the worse CSS ( hazard ratio: 1. 813, 95％CI 1. 072-3. 069, P=0. 027) and OS ( hazard ratio: 1. 424, 95％ CI 0. 896-2. 262, P=0. 134) than the neoadjuvant radiotherapy in esophageal cancer with T3N0 stage, which was similar to the matched cohort. Conclusions Compared with postoperative adjuvant radiotherapy, neoadjuvant radiotherapy significantly improves the CSS and OS of T3 N0 patients with esophageal cancer.
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Neoadjuvant chemoradiotherapy followed by TME is a common treatment at present for locally advanced rectal cancer.Several studies abroad in recent years have shown that statins have a positive effect on cancer resistance.We discussed the mechanism and clinical application of statins in preoperative neoadjuvant chemoradiotherapy of locally advanced rectal cancer.
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Objective To screen out the potential gene to predict regional lymph node metastasis after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) and develop a 6-gene model using an artificial neural network (ANN).Methods The gene expression profiles (GSE46862) of locally advanced rectal cancer undergoing preoperative chemoradiotherapy from 64 specimens (21 with ypN-and 43 with ypN+) were downloaded from the gene expression omnibus (GEO) database.The differentially expressed genes were identified to screen out the potential biomarkers through the Gene-Cloud of Biotechnology Information (GCBI) platform.The top 6 genes were screened out for building model.An ANN model was trained and validated using the SPSS Modeler software.The study samples were allocated randomly into the training sample group and testing sample group with a 7∶3 ratio.The training samples and testing samples were respectively used for building an ANN model and independent back-substitution test.Observation indicators:(1) screening results of differentially expressed genes;(2) analysis results of ANN model.The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the predictive abilities of ANN and each biomarker.Results (1) Screening results of differentially expressed genes:A total of 50 genes were screened.Six top genes included IL6,AKR1B1,AREG,SELE,ROBO1 and CD274.(2) Analysis results of ANN model:Six top genes were selected to construct a three-layer ANN model with a 7-5-2 structure.The IL6 made the greatest effect on the ANN model,followed by ROBO1,AKR1B1,AREG,CD274 and SELE.The AUC was 0.929.The sensitivity and specificity of ANN model were 96.7％ and 85.7％,and accuracy of training samples was 93.2％.In the independent back-substitution test,sensitivity and specificity were 92.3％ and 85.7％,and accuracy of testing samples was 90.0％.Conclusion The prediction ANN model based on multiple molecular markers (IL6,ROBO1,AKR1B1,AREG,CD274 and SELE) for regional lymph node metastases in LARC patients after CRT would be beneficial in selecting potential candidates for rectum-preserving surgery following CRT for LARC.
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Objective To explore the change and clinical significance of the serum carcinoembryonic antigen (CEA)and carbohydrate antigen 724(CA724)in patients with rectal cancer before and after neoadjuvant ra-diotherapy and chemotherapy.Methods The serum levels of CEA and CA724 of 30 patients with rectal carci-noma were detected by electrochemiluminescence method and were compared with those in 30 healthy people. Results The serum levels of CEA and CA724 in rectal carcinoma patients before neoadjuvant radiotherapy and chemotherapy were significantly higher than those in the healthy people,the difference was statistically significant(P<0.05).The serum levels in complete remission and partial remission patients after eight-week neoadjuvant radiotherapy and chemotherapy were significantly lower than those before treatment,the differ-ence was statistically significant(P<0.05),and the reduction levels were obviously higher than those in the stable group,the difference was statistically significant(P< 0.05).The CEA and CA724 levels in the stable treatment patients were also lower than those of before neoadjuvant radiotherapy and chemotherapy,the difference was statistically significant(P<0.05).The serum levels in the progression group were higher than those of before treatment(P<0.05).The serum levels of CEA and CA724 before neoadjuvant radiotherapy and chemotherapy existed a positive correlation(r=0.862,P=0.000).Conclusion The serum levels of CEA and CA724 in rectal cancer are highly expressed,suggesting that both of them are closely related to the occur-rence and development of rectal carcinoma,the measurement of the serum level changes of CEA and CA724 in patients with rectal cancer before and after treatment contributes to estimate the efficacy of neoadjuvant radio-therapy and chemotherapy and tumor progression.
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Soft tissue sarcomas (STS) consist of a heterogeneous group of rare malignancies with mesenchymal origin. Surgical resec-tion is the primary treatment for STS, but radiation therapy (RT) also plays an important role in the treatment. Radiotherapy for STS has advanced significantly over the past 50 years. Both preoperative and postoperative radiotherapies are equivalent in local control but are associated with different toxicity profiles. Boost techniques for STS include brachytherapy, intraoperative radiation therapy (IORT), and external beam. Long-term toxicities of RT to normal tissues have been reduced because of improvements in image guid-ance and intensity-modulated radiotherapy, which significantly increase the precision and delivery of RT. This review discusses RT tech-nologies and their acceptable treatment principles.
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Objective To study the expression of cyclooxygenase-2 (COX-2) in colorectal cancer,and its relationship with the sensitivity of rectal cancer neoadjuvant radiotherapy.Methods 102 rectal cancer patients with preoperative radiotherapy were selected from January 2013 to January 2016.The COX-2 expression of samples were detected by immunohistochemical.We analyzed the relationship of tumor and adjacent to carcinoma tissue COX-2 expression,radiation sensitivity and the prognosis of patients.Results 71 cases with radiation sensitivity and 31 radiation resistance cases,radiation sensitive rate was 69.6％.The COX-2 expression in the tumor tissue was significantly higher than adjacent tissue (P ＜ 0.05),radiation sensitive patient proportion with positive and strong positive COX-2 expression was significantly lower than the radiation resistance (P ＜ 0.05).The adjacent to carcinoma tissue's COX-2 positive expression of radiation resistance group proportion was significantly higher than the radiation sensitive group (P ＜ 0.05).The tumor COX-2 positive OR strongly positive (OR:4.21,95％ CI:1.26-7.17),tissue adjacent to carcinoma COX-2 positive (OR:8.15,95％ CI:1.43-38.21) were risk factors for neoadjuvant radiotherapy resistance.The survival analysis showed that tumor tissue COX-2 expression of negative OR weakly positive patients survival significantly extended.Conclusions There were significant correlations between the expression of COX-2,neoadjuvant radiotherapy sensitivity and prognosis in colorectal cancer patients.the joint detection biopsy COX-2 expression in colorectal cancer patients with tumor and cancer adjacent tissues,may screening out patients sensitive to radiation and chemotherapy,which making patient better prognosis.
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Objective To investigate the effect and clinical significance of neoadjuvant radiotherapy for the expression of CD44v6 in lung squamous cell carcinoma tissues. Methods Fifty cases lung squamous cell carcinoma patients confirmed by aspiration biopsy from May 2013 to January 2015 were collected in Yangquan Coal Mine Group Genernal Hospital,including 20 cases of patients with stageⅢA were treated with neoadjuvant radiotherapy before surgery,and then performed surgery after neoadjuvant therapy. The expression of CD44v6 was detected by immunohistochemistry. The correlation between CD44v6 and clinicopathological features was analyzed by chi?square test. Results Immunohistochemical staining of CD44v6 was performed in tumor tissue of puncture biopsy, the positive rate expression of CD44v6 was 72%( 36/50 ) , it was associated with lymphatic metastasis(χ2 =3. 964, P=0. 046 ) and advanced TNM stage (Ⅲ+Ⅳstage ) (χ2 =4. 276, P=0. 039 ) . The positive expression of CD44v6 protein in tumor tissue was significantly decreased in 20 patients with neoadjuvant radiotherapy compared with before radiotherapy(7. 23±1. 45 vs. 11. 42±1. 31,t=2. 524,P=0. 025). Conclusion Positive expression of CD44v6 in human lung squamous cell carcinoma is related to the malignant clinicopathological features. Neoadjuvant radiotherapy before operation may improve prognosis via down?regulating CD44v6 expression.
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Objective: To evaluate the clinical efficacy and safety of neoadjuvant chemoradiotherapy (nCRT) versus neoadjuvant radiotherapy (nRT) for patients with stages II-III rectal cancer. Methods: A computer-based online search of PubMed, EMBase, Cochrane Library, China Journal Full-text Database, Wanfang Database and Chinese sci-tech periodical full-text database was performed to include randomized controlled trials (RCTs) about nCRT vs nRT (including neoadjuvant short-course radiotherapy, nSRT) in patients with stages II-III rectal cancer in accordance with the inclusion and exclusion criteria. The relevant literatures and conference proceedings were also manually searched to include eligible RCTs. After evaluating the quality of included trials and extracting data, the data analysis was conducted using RevMan 5.2 software. Results: A total of six randomized controlled trials (RCTs) involving 2 602 patients with stages II-III rectal cancer were included. The results of Meta-analysis showed that the nCRT group had higher radical resection rate (odds ratio: 1.62, 95% confidence interval: 1.14-2.30; P = 0.008), pathological complete response rate (odds ratio: 3.17, 95% confidence interval: 2.28-4.40; P < 0.000 01), and rate of severe side effects (grades 3-4) (odds ratio: 2.66, 95% confidence interval: 1.29-5.46; P = 0.008), as compared with nRT group. The five-year local recurrence (LR) rate in the nCRT group was obviously lower than that in the nRT group (odds ratio: 0.51, 95% confidence interval: 0.39-0.67, P < 0.000 01). Regarding nCRT vs nSRT, the radical resection rate (odds ratio: 2.40, 95% confidence interval: 1.25-4.63; P = 0.009) and the pathological complete response rate (odds ratio: 4.28, 95% confidence interval: 1.72-10.68, P = 0.002) were also higher in the nCRT group than those in the nSRT group. Furthermore, there were no differences in two-, three- and five-year survival rates between nCRT and nRT groups (P < 0.05). Conclusion: As compared with nRT, the nCRT can obviously improve the radical resection rate and complete pathologic response rate, and reduce the local recurrence rate in patients with stages II-III rectal cancer, but it can cause more severe toxicities.
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Neoadjuvant radiotherapy could decrease the local recurrence rate,increase the probability of the anal sphincter preservation,improve survival rate and the quality of patients' lives.For stage Ⅲpatients with rectal cancer,the recurrence rate is higher in short-course radiotherapy compared with conventionally radiotherapy.Molecular markers combined with gene technology can be used as radiosensitivity indicators.Conventional radiotherapy has a definite effect and radiotherapy combined with chemotherapy has better efficacy.The extensive researches of diverse molecular markers,gene expression profiling and gene chips for rectal cancer provide the basis of personalized treatment.
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Surgical resection is the best treatment for operable metastatic liver cancer. Large metastatic cancer usually has low operability, so a debulking modality of mass is needed to increase operability. Chemotherapy and radiotherapy were commonly used as neoadjuvant treatments. Cyberknife stereotactic radiosurgery systems were only considered as one of the palliative treatment modalities for inoperable or surgically complex tumors. But, in this case, we applied Cyberknife as the preoperative debulking modality for large hepatic metastasis of adrenocortical carcinoma. After Cyberknife treatment 3 cyclex2,700 cGY, tumor size decreased (metastatic liver mass decreased to 15x9 cm from 19x12.5 cm, adrenal mass decreased to 5x3 cm from 7.4x4.5 cm). We could then resect the tumor completely by extended right hemihepatectomy & right adrenalectomy. A preoperative multidisciplinary approach, including chemotherapy and radiation therapy can be considered to increase operability. So, cyberknife can be considered an additional modality as a neoadjuvant radiotherapy.