Neo-adjuvant chemotherapy followed by either continuous hyper-fractionated accelerated radiation therapy week-end less or conventional chemo-radiotherapy in locally advanced NSCLC-A randomised prospective single institute study

Context: Better locoregional control and increased overall survival by continuous hyper fractionated accelerated radiotherapy have been shown in unresectable nonsmall cell lung carcinoma (NSCLC). Dose escalation and neoadjuvant chemotherapy (NACT) along with continuous hyperfractionated accelerated radiotherapy week end-less (CHARTWEL) were also tried for improved survival. In this present study, we compared the results of NACT followed by CHARTWEL against NACT followed by conventional concurrent chemo-radiation therapy. Aims: The aim of this study is to compare the locoregional control and toxicities in NSCLC Stage IIIA and B in both arms. Settings and Design: Randomized, prospective single-institutional study with a study population comprising all locally advanced unresectable NSCLC patients enrolled in 2014 at our institute. Subjects and Methods: All enrolled patients were randomized into two arms-CHARTWEL and concomitant chemo-radiotherapy (CCRT), after three weeks of the fourth cycle of NACT. In CHARTWEL arm 30 patients received two-dimensional radiotherapy (RT) 58.5 Gy/39 fr/2.5 weeks while in CCRT arm 30 received 66 Gy/33 fr/6.5 weeks. Disease response was evaluated at 6 months and toxicity assessment during and after treatment completion. Data were analyzed using tools such as percentage, mean, Chi-square test and P value. Chi-square and P value was calculated by statistical online software (http://quantpsy.org). Results: 28% of patients in study arm and 20% in control arm had complete response at 6 months after RT. Locoregional disease control was observed in 44% in study arm and 32% in control arm of patients. There was no statistical difference in grades of toxicities or overall survival (OS)/disease-free survival except persistent esophagitis Grade III seen in two patients of study arm. Conclusions: Study suggests that CHARTWEL in combination with NACT is an effective strategy to treat patients with locally advanced lung cancer with the advantage of a smaller dose and shorter duration. Although large multivariate studies still needed

Role of neo-adjuvant chemotherapy followed by surgery in cervical cancer: a review

Incidence of cervical cancer is predominantly found in developing countries. In Indian set up, it is most commonly found in rural locations in younger population. Chemotherapy was initially introduced for the treatment of recurrent/metastatic cervix cancer and has subsequently been explored in primary treatment either as neo-adjuvant prior to radiation or surgery in an attempt to reduce the incidence of loco-regional recurrence. The review study tries to evaluate the role of neoadjuvant chemotherapy (NACT) followed by surgery in cervical cancer management. Randomized trials and meta-analysis were analysed. Most of them used short course chemotherapy course of 4-6 weeks followed by surgery. patients with high risk pathological features received postoperative RT. The results of trials indicated significant reduction in the risk of death with NACT, but there were few differences between the trials. NACT followed by surgery is found to be associated with an improved response rate and progression-free survival. However, the impact on overall survival remains to be confirmed.

Transcatheter arterial infusion chemotherapy followed by surgery in patients with unresectable stage III non-small cell lung cancer / 肿瘤

Objective: To evaluate the clinical response, adverse reactions and prognosis of transcatheter arterial infusion (TAI) chemotherapy followed by surgery in patients with unresectable stage III non-small cell lung cancer (NSCLC). Methods: A retrospective study was performed in 81 patients with unresectable stage III NSCLC. All patients received 2 cycles of TAI chemotherapy. Surgical treatment was performed for patients with partial response or patients with stable disease and tumor reduction. The primary endpoint was overall survival (OS) and the secondary endpoints were disease control rate (DCR) and adverse reactions. Results: The results of response evaluation after 2 cycles of TAI chemotherapy were partial response in 40 patients (49.4%), stable disease in 30 patients (37.0%) and disease progression in 11 patients (13.6%); the DCR was 86.4% (70/81). The main adverse reactions were graded as I-II. In 55 patients undergoing TAI chemotherapy, the surgical resection rate was 94.5% (52/55), and the postoperative complication rate was 32.7% (18/55); the 1-, 2- and 3-year survival rates were 78.2%, 52.7% and 34.5%, respectively. The subgroup analysis showed that the OS of the patients with partial response was significantly better than that of the patients with stable disease; the median survival time were 37.0 and 21.0 months, respectively (P = 0.01 9). The median survival time (34.0 months) of the patients diagnosed of squamous cell carcinoma was longer than that of the patients diagnosed of adenocarcinoma (13.5 months), but the difference was not statistically significant (P = 0.101). The results of multivariate analysis showed that the short-term response was an independent prognostic factor, and the prognosis of patients achieving partial response was better than that of the patients achieving stable disease (the hazard ratio was 0.467, the 95% confdence interval was 0.238 to 0.916; P = 0.027). Conclusion: For patients with unresectable stage III NSCLC, TAI chemotherapy is an effective and safe neoadjuvant therapy, especially for patients with partial response or preoperative diagnosis of squamous cell carcinoma, and the postoperative survival benefits are more significant.

A Study to Evaluate the Effect of Neo-adjuvant Chemotherapy on Hormonal and Her-2 Receptor Status in Carcinoma Breast

Background: The advances in diagnosis and treatment, in the management of breast cancer have led to excellent cure rates for tumors detected in early stage. Even patients with stage III disease have 5 years survival rates in the range of 50-70%. The search for predictive and prognostic factors in breast cancer represents a major challenge. It is important to distinguish prognostic factors from predictive factors. Aim: The aim of the surgery was to compare the immunohistochemical expression of estrogen, progesterone and Her-2 receptor status in breast cancer before and after neo-adjuvant chemotherapy. Materials and methods: In this study, the total of 50 cases of locally advanced breast cancers was included. Cases of carcinoma breast requiring preoperative chemotherapy from January 2015 to January 2017 were recruited in to the study after informed consent. Results: In this study, the total of 50 cases of locally advanced breast cancers was included. Among them most of the cases belonged to the age group of 40 to 60. The extremes of ages (<30 and >60) comprised of only 14 % of the cases. In total of 50 cases 32 patients were pre-menopausal which was accounting for 64% of cases, and remaining patients were post-menopausal. Out of 20 cases of triple negative in this study complete response was seen in 6 cases accounting for about 30%. In our study there were a total of 24 changes in the receptor status post chemotherapy altogether out of which 11 changes were seen in Her2neu group. Changes in the ER and PR group accounted for 8 and 5 cases respectively. Out of 14 cases of ER positive before chemotherapy, conversion was seen in 8 cases accounting for change in ER status of 57%. Similarly 5 changes were seen in PR receptor expression E. Rajesh Goud, M. Muralidhar, M. Srinivasulu. A Study to Evaluate the Effect of Neo-adjuvant Chemotherapy on Hormonal and Her-2 Receptor Status in Carcinoma Breast. IAIM, 2018; 5(9): 83-90. Page 84 accounting for 62% of change. All the changes found were loss of expression of receptor after NACT means receptor positive cases became receptor negative. Conclusion: Breast cancer subtypes are associated with the response to NACT. The response rates for the HE and TN subtypes were significantly higher than for the luminal subtypes. So it is mandatory for a patient with breast cancer who is scheduled for NACT should be assessed for the subtype of breast cancer before NACT, by using IHC, for planning treatment. This study also revealed that change in receptor status did occur after neo-adjuvant chemotherapy.

Role of Neoadjuvant Chemotherapy with Cyclophosphamide, Adriamycin, 5-Fluorouracil (Caf Regimen) in Down Staging in Breast Cancer.

Background: The aim of the study is to assess the tumor response to neoadjuvant chemotherapy with cyclophosphamide, adriamycin, 5-fluorouracial (CAF regimen) in terms of decrease in breast tumor size (partial or complete clinically).To assess clinically the axillary lymph node status after neoadjuvant chemotherapy (conversion from palpable to nonpalpable). Methods: Thirty female patients of breast cancer were studied for down staging with two cycles of CAF regimen given at interval of 21 days. After 21 days of second cycle patient’s staging noted for effects. Results: Thirty female patients of breast cancer were studied. Maximum no. of patients between 31-40 years, mean age 46 years and median age 45 years, youngest patients 18 years, oldest patients 70 years, 22 patients responded to chemotherapy, out of 22, 1 (3.3%) showed a complete clinical response, 21 (70%) partial clinical response. Pre-menopausal 9/13 (69.2%) and post menopausal 13/17 (76.4%) showed clinical response, statistically not significant difference (df=1, x2=1.33, p>0.05). Change in tumor size 40.09±25.20 sq, cm mean size to 21.88±27.43 sq. cm after chemotherapy was highly significant change (t=6.242, p<0.001). Overall response to chemotherapy was 73.3%, in stage II-87.5%, stage IIIA-75% and stage IIIB-50%. The overall response to axillary lymph node was 56.6%, statistically highly significant (p<0.001). Main side effects nausea and vomiting (60%) and hair loss, 43.3%, but none necessitated stoppage of chemotherapy. As a consequence to primary chemotherapy, conservation surgery (lumpectomy with axillary clearance) could be done in 43.3% of patients.Conclusion: CAF Preoperative chemotherapy regime is a satisfactory modality of treatment for stage II and III breast cancer with positive response rate of 73.3%. The down staging thus obtained permits breast conservation surgery in 43.3% of patients. The chemotherapy regime is well accepted by patients.

Consequence of neo-adjuvant chemotherapy on morphology of breast carcinoma: A systematic evaluation.

BACKGROUND: Neo‑adjuvant chemotherapy (NAC) in locally advanced breast cancer is the present trend. Following NAC, a considerable alteration of morphology occurs in the tumor. AIMS: To study effects of NAC on morphology of breast carcinoma and to evaluate the pathologic response (PR). MATERIALS AND METHODS: A total of 39 surgically resected mastectomy specimens of patients of invasive locally advanced breast carcinoma who received NAC were evaluated for macroscopic and microscopic (by routine stains and immunohistochemistry) alteration of morphology. RESULTS: Macroscopically well‑defined tumor noted in 25 cases (64.1%) and in the rest (14 cases, 35.9%), only fibrotic areas identified. Microscopic examination identified malignant cells in 29 (74.4%), significant chronic inflammation in 24 (61.5%), hyalinized fibrosed stroma in 25 (64.1%) and necrosis in 11 (28.2%) cases. Immunohistochemistry assisted in differentiating malignant cells from histiocytes. In 15 cases (38.5%), axillary lymph nodes isolated where fibrosis seen in 12 (30.8%) and malignant cell in 8 (20.5%) cases. In 34 cases where the pre‑treatment biopsy were available, complete pathologic response (pCR) and partial pathologic response (pPR) were achieved in 7 (20.6%) and 23 (67.4%) cases respectively. DISCUSSION: Protocol of systematic evaluation of morphological changes is different in cases of a patient treated by NAC. Nature of malignancy was difficult to categorize as morphology of typical breast carcinomas were altered. Sometimes, immunohistochemistry is advantageous as routine H and E stains are not sufficient to isolate malignant cells in fibrotic and necrotic areas. Appropriate morphological evaluation of the mastectomy specimen is absolutely crucial for assessment of PR and subsequent management.

Role of neo‑adjuvant chemotherapy in locally advanced breast cancer.

BACKGROUND AND AIMS: Locally advanced breast cancer (LABC) is common in developing countries. The advancement of disease leads to decreased probability of radical cure and increase in treatment cost. The study evaluated neo adjuvant chemotherapy with MRM and MRM followed by adjuvant chemotherapy and also the effectiveness of neo‑adjuvant chemotherapy in down staging advanced disease and offering radical cure. SETTINGS AND DESIGN: A rural hospital‑based prospective comparative study. MATERIALS AND METHODS: All histologically proven and investigated LABC (T3 N0, T3N1, Any T4, Any N2/N3, M0) were selected as subjects and divided into two groups. One group received neo adjuvant chemotherapy (5 fluorouracil, adriamycin and cyclophosphamide) followed by modified radical mastectomy and other group received adjuvant chemotherapy after modified radical mastectomy. Both groups were compared for disease free survival, overall survival and post‑operative complications. Tumor response to chemotherapy in neo adjuvant group was also studied. STATISTICAL ANALYSIS: All continuous variables were analyzed using student’s’ test and categorical variable by Fischer exact test. RESULTS: Thirty one patients were enrolled, of these 16 patients received neo adjuvant chemotherapy. Clinical complete response was observed in two patients (12.5%). Clinical partial response was found in 12 patients (75%) and no response was seen in two patients (12.5%). Disease free survival and overall survival was 82% in neo adjuvant group while in adjuvant group disease free survival was 75% and overall survival was 83%. Post operative complications were similar in both groups. CONCLUSION: Neo adjuvant chemotherapy helps in down staging LABC and offers opportunity in vivo to assess the effect of chemotherapy on individual basis. There was no significant difference in disease free survival, overall survival and post operative complication in between two groups.

Survival analysis of 256 patients with oral cancer / 中国肿瘤临床

Objective:To analyze survival in patients with advanced oral cancer from prospective clinical trials. Methods:From 2008 to 2010, 256 patients with oral cancer at clinical stage III/IVA were randomly categorized into two groups. Patients in the experi-mental group received neo-adjuvant chemotherapy, surgery, and post-operative radiation, and patients in the control group underwent surgery and post-operative radiation. All patients were routinely followed-up after treatments. Survival was analyzed using Kaplan–Meier method and log-rank test, and differences were considered statistically significant at P value lower than 0.05. Results: Each group was composed of 128 patients. With the median follow-up period of 60 months, the 5-year overall survival rate was 61.7%and the disease-free survival rate was 53.9%. The overall survival rate (P=0.350) and the disease-free survival rate (P=0.160) were not sig-nificantly different between the experimental and control groups. Patients with positive pathological response to neo-adjuvant chemo-therapy exhibited significantly improved overall survival (P＜0.05). Conclusion:Radical surgery should be emphasized to improve the prognosis of oral cancer. Functional reconstruction could also improve the quality of life and survival of patients. Despite that neo-adju-vant chemotherapy could not improve the survival of patients with advanced oral cancer in entirety, it could benefit patients exhibiting positive treatment responses.

An analysis of response to neo‑adjuvant chemotherapy in patients with locally advanced breast cancer with emphasis on pathological complete response.

CONTEXT: In India, most breast cancer women present at a locally advanced stage. Routine practice in majority of the cancer centers is to administer neo‑adjuvant chemotherapy (NACT) followed by loco‑regional treatment. Surgery is scheduled after 3 or 4 cycles. The patients who achieve pathological complete response (pCR) are expected do well. AIMS: The present study was conducted to analyze our results with NACT, to know pCR rate, to compare pCR rates among various subgroups and to determine the factors which predict pCR. SETTINGS AND DESIGN: The study was conducted in a tertiary care university affiliated cancer hospital in South India. SUBJECTS AND METHODS: All patients with non‑metastatic locally advanced breast cancer and agreed by the hospital tumor board to receive NACT were included. At each visit, response was assessed according to RECIST criteria. Re‑staging work up and mammography was done prior to surgery. STATISTICAL ANALYSIS USED: Chi square test was used to analyze categorical variables and uni and multivariate analysis were performed to determine the factors predicting pCR rates. RESULTS: A total of 84 patients received NACT. Median age was 46 years (ranged from 28 to 66), 46 patients were premenopausal. Totally 72 patients completed the full course before surgery. Clinical response was complete in 26, partial in 52 and 3 had local progression, one stable and two patient developed distant metastasis. Forty‑eight patients underwent modified radical mastectomy and breast could be conserved in 34 patients, pCR rate was 36%. CONCLUSIONS: Compared with historical controls particularly from India, we could achieve higher pCR rates.

Correlation and clinical significance between the breast cancer MRI schedule of reinforcement and the pattern of tumorshrinkage after neo-adjuvant chemotherapy / 中国肿瘤临床

Objective:To investigate the correlation between the breast cancer MRI schedule of reinforcement and the shrinkage pattern of tumor after neo-adjuvant chemotherapy, and its clinical significance in the guidance of formulating operation plan. Methods:Dynamic contrast-enhanced MRI scan was performed before chemotherapy and before surgery after a whole-range N-Acety-L-Cysteine (NAC) treatment in 55 patients with loco-regionally advanced breast cancer who received the neo-adjuvant chemotherapy. MRI sched-ule of reinforcement and the shrinkage pattern of tumor after neo-adjuvant chemotherapy were obtained in the treatment, and the corre-lation between the two was analyzed. Results:Of the 55 patients, the unilateral breast mass was found in 54 and the bilateral lesion in 1. There were 56 neo-plastic foci in these patients. The mass-like enhanced image was seen in 24 of the total cases (43%), of which 23 presented with a centripetal shrinkage, 1 with an annular decline, (P0.05). There were 11 of the total cases with non-tu-mor-like enhancement (20%), in which 4 assumed a centripetal shrinkage and 7 a honeycombed multifocal shrinkage (P<0.01). Conclu-sion:The tumor shrinking pattern and its accurate radiological image evaluation are the keys to the selection of breast-conserving sur-gery and the control of local recurrence after treatment of NAC regimen. We can predict the shrinking pattern through the type of the le-sion on baseline before NAC, which is important for the patients and surgeon to get a reasonable expectation in the subsequent treat-ments.

Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma.

Objective: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients. Materials and Methods: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1) surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion) or (2) organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes). Results: The mean age of this population was 55 years. Most (83%) of the patients had pyriform sinus (PFS) involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33) and organ preservation protocol was planned after NACT in 73% (19/26) patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%), mucositis 5%, diarrhea 5%. The median progression free survival was 20 months. Conclusions: NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.

Evaluation of neoadjuvant chemotherapy efficacy by the expression of cyclin D1 in human breast cancer / 肿瘤研究与临床

Objective To evaluate the effect of neoadjuvant chemotherapy (NAC) by investigating the expression of cyclin D1 in human breast cancer before and after NAC.Methods Eighty-four cases of breast cancer were diagnosed by core biopsies.The expression level of cyclin D1 in cancer tissues was measured by immunohistochemical envision two-step method before and after NAC (pirarubicin and docetaxel regimen for 3-4 cycles).Results Complete remission (CR) occurred in 4 cases of 84 patients (4.76 ％) with 2 pathological complete response cases,partial response (PR) in 54 cases (64.29 ％),stability (SD) in 26 cases (30.95 ％) and no disease progression (PD) patients.The positive rate of cyclin D1 in cancer tissues [65.48 ％ (55/84)] was significantly decreased after NAC [39.29 ％ (33/84)] (x2 =11.55,P =0.001).In clinical level,the ease rate was significantly improved in patients whose cyclin D1 expression switched from positive [86.36 ％ (19/22)] to negative [45.45 ％ (15/33)] after NAC treatment (x2 =9.359,P =0.002).Conclusion NAC significantly decreases the expression of cyclin D1 in breast cancer tissues.Meanwhile,the ease rate is improved when cyclin D1 expression switched from positive to negative after NAC.Therefore,cyclin D1 expression can be used as an evaluation index for the efficiency of NAC.

The use of ultrasonically activated scalpel in modified radical mastectomy for breast cancer after neo-adjuvant chemotherapy / 中华内分泌外科杂志

ObjectiveTo discuss the clinical value of ultrasonically activated scalpel(UAS) in breast cancer patients who underwent 2-3 cycles of neo-adjuvant chemotherapy by comparing UAS and electric knives (EI) in modified radical mastectomy. MethodsFrom Jun.2009 to Aug.2011, 52 breast cancer patients taking 2-3 cycles of neo-adjuvant chemotherapy underwent modified radical mastectomy in our hospital. Among them, UAS group included 23 patients, and EI group included 29 patients.The 2 groups were compared in terms of the operation time, intraoperative blood loss, postoperative drainage tube duration, postoperative hospital stay, the number of lymph nodes retrieved, and the volume of subcutaneous hydrops.ResultsBetween the 2 groups, the difference of intraoperative blood loss and postoperative drainage tube duration had statistical significance(P ＜0.01 ).The difference of operation time, hospital stay, and subcutaneous hydrops had statistical significance ( P ＜ 0.05 ).The difference of the number of lymph nodes retrieved had no statistical significance ( P ＞ 0.05 ).ConclusionThere are good curative effects for breast cancer patients undergoing modified radical mastectomy by UAS and axillary lymph node dissection after neo-adjuvant chemotherapy, which is consistent with the conception of fast track surgery.

Impact of ERCC1 expression in new neo-adjuvant chemotherapy containing platinum before operation in stage Ⅲ NSCLC / 中国综合临床

Objective We analyzed the curative effect of ERCC1 and RRM1 expression on the Neo-adjuvant Chemotherapy of stage Ⅲ NSCLC to investigate the guiding function of ERCC1 and RRM1 expression in chemotherapy regimen containing platinum.Methods Branch DNA-liquid phase chip methods were used to detect ERCC1 and RRM1 expressions before chemotherapy in 80 cases of stage Ⅲ NSCLC confirmed by pathology.All patients received 2 periods Neo-adjuvant Chemotherapy with GP regimen.According to WHO efficacy appraisal standard,the Enhanced Scan of CT showing reaching complete remission or partial remission was effective or stable,otherwise the progression was considered ineffective.Results For the 80 cases of stage Ⅲ NSCLC,the treatment for 20 of the 25 patients with low expressions of both ERCC1 and RRM1 were effective with an effective rate of 80.0％;The treatment for 14 of the 23 patients with low expressed ERCC1 and high expressed RRM1 were effective with an effective rate of 60.9％;The treatment for 10 of the 20 patients with high expressed ERCC1 and low expressed RRM1 were effective with an effective rate of 50.0％;and the treatment for 4 of the 12 patients with both high expression were effective with an effective rate of 33.3％.The difference of effective rates among the four groups had statistical significance ( x2=7.81,P＜0.05 ) with group A having significantly higher rate than the other three groups and group B and group C having significantly higher rate than group D ( P＜0.05 ).Conclusion ERCC1 detection has guiding significance on the regimen selection of NSCLC Neo-adjuvant Chemotherapy.It was worthwhile to use ERCC1 detection widely in the individualized treatment of the stage Ⅲ NSCLC before surgery.

Analysis of neo-adjuvant chemotherapy in the treatment of 32 cases of cervical cancer / 中国综合临床

Objective To evaluate the clinical efficacy of neo-adjuvant chemotherapy in the treatment of cervical cancer. Methods A total of 32 patients,of which 12 cases of Ⅰ b2,8 cases of Ⅱ a,5 case of Ⅱ b and 7 cases of Ⅲ, were all treated with 2 - 3 cycles of PF chemotherapy before treatment with cisplatin 100 mg/m2, d 1;5-fluorouracil 1000 mg/m2 ,d1-5. The chemotherapy was performed for 3 weeks followed by three weeks rest as one cycle. Results Short-term effect was 81.3% (26/32), with 3 cases of Ⅰ b2 and 1 cases of Ⅱ a had been completely relieved after 2 - 3 cycles of chemotherapies. Simultaneously, chemotherapy improved the removal rate of surgery. Among these 32 patients, there were 4 cases achieved complete response (CR) ,22 cases achieved partial response (PR) ,5 case of stable disease ( SD), 1 cases of progressive disease(PD). The overall response rate( CR +PR) was 81.3% (26/32) ,and the control rate ( CR + PR + SD) was 96. 9% (31/32). The main adverse events included myelosuppression and gastrointestinal response, which were all tolerable. Conclusions The neo-adjuvant chemotherapy reduced the size of cancer,which can improve removal rate of surgery and the quality of life.

Neo-adjuvant chemotherapy of megestrol acetate in bereast cancer: short-term clinical study / 国际外科学杂志

Objective To observe the role of short-term use of megestrol acetate in reducing the toxicity of chemotherapy in breast cancer and in improving the quality of life of patients, as well as its impact on neo-adjuvant chemotherapy effects. Methods The effection of adjuvant chemotherapy, toxicity, and the quality of life of 158 patients with breast cancer were investigated by a retrospective control study. The data were statistically analysized by X~2 test. Results There was no significant difference of neo-adjuvant chemotherapy effects between Megestrol acetate + CEF chemotherapy group and vitamin C + CEF chemotherapy group (Megestrol acetate + CEF chemotherapy group was 74. 84%, vitamin C + CEF chemotherapy group was 76.15) ; Megestrol acetate + CEF chemotherapy group had more modest bone marrow suppression and gas-trointestinal reactions and better food intake, weight, KPS score than vitamin C + CEF Chemotherapy group, all the differences being statistically significant (P < 0.05). Conclusion Short-term use of megestrol ace-tate can reduce the adverse effects derived from chemotherapy of breast cancer and improve the quality of life of patients with breast cancer and had no effects on the efficacy of the neo-adjuvant chemotherapy.

Adjuvant chemotherapy and neo-adjuvant treatment of gastric cancer / 肿瘤研究与临床

Gastric cancer is common in the world. Only 40 % of the patients can be treated by radical operation. Even for those patients who undergo radical resection, the rate of recurrence or distant metastasis is high. To increase the chance of curative surgery and improve survival for gastric cancer, combined-modality treatments have been investigated. There are different therapeutic modes, chemotherapeutic regimens and treatment results between Eastern countries and Western countries. The current status and advance on the adjuvant and neo-adjuvant treatment of gastric cancer were reported.

Localization of Breast Lesions Using Metal Spring Ring under the Guidance of Ultrasonography / 中国微创外科杂志

Objective To evaluate the value of metal spring ring for localization of breast lesions. Methods Thirteen cases of nonpalpable breast benign lesion and 41 cases of breast cancer that had been treated by neoadjuvant chemotherapy were enrolled in this study. The lesion was localized with the margin being marked under the guidance of ultrasonography. Metal spring rings with proper length was used according to the maximum diameter of the lesion; and then via a 18G puncture needle, the metal spring ring was place exactly to the two ends of the biggest cross-section of the lesion by using a guide wire. Afterwards, the lesions were resected with the spring ring. The 41 patients with breast cancer received 2-to 3-week chemotherapy after the operation. Results For the 13 cases of benign breast lesion, the mass was resected accurately and completely with the spring rings. In the 41 cases of breast cancer, no residual tumor cells were found in the tissues around the margin of resection. During the postoperative chemotherapy, ultrasonography showed that the mass was reduced in 39 of the cases, among which 9 had no clear margin of the tumor before the operation shown by ultrasonography. Off the 9 cases, postoperative pathological examination found no tumor cells in the successive sections. Conclusions Localization of breast lesions under the guidance of ultrasonography is a new method for diagnosis and treatment of nonpalpable breast lesions. It is valuable for follow-up by ultrasonography, evaluation of chemotherapy, and postoperative biopsy, especially for the breast cancer patients who have received preoperative chemotherapy.

Neoadjuvant chemotherapy and preoperative radiation for stage Ⅰb-Ⅱb cervical cancer / 中国癌症杂志

Purpose:To evaluate the effect of preoperativ e chemotherapy or brachtherapy and radical hysterectomy on stage Ⅰb-Ⅱb locally advanced cervical cancer with high risk factors. Methods:preoperative chemotherapy or radiotherapy followed by r adical hysterectomy compared to radical hysterectomy alone in stage Ⅰb-Ⅱb cer vical cancer with higher risk factors(bulky,lower grade,small cell cancer or ade nocarcinoma). Results:①Pelvic lymphnode metastases rate was significantly decreased in the neoadjuvant chemotherapy arm compared with surgery alone(P 0.05). Conclusions:Preoperative chemotherapy followed by surgery is e ffective and superior to surgery alone in stage Ⅰb-Ⅱb cervical cancer with high risk factors.It might be able to reduce tumor volume and eliminate effectiv ely disease in lymphnodes and possibly micrometastases.It may be beneficial in improving quality of life of patients by decreasing the need for postoperative r adiotherapy. Response to chemotherapy may be a prognostic factor.Preoperative br achytherapy showed no significant advantage in eliminating lymphnodes matastases as compared to surgery alone.

Change expressing of hTERT gene in breast cancer tissue before and after neo-adjuvant chemotherapy / 中国癌症杂志

Background and purpose:hTERT is indistinct in the effect of neo-adjuvant chemotherapy. Our aim was to detect both expression of hTERT mRNA and protein in breast cancer tissue and their changes after neoadjuvant chemotherapy. Methods:From Feb 2004 to Jun 2007, 53 cases with untreated advanced breast cancer were enrolled. All patients received CEF chemotherapy three cycles. The breast cancer tissue was collected before and after chemotherapy. hTERT mRNA and protein expression were detected by RT-PCR and immunohistochemistry techniques. Results:The positive hTERT mRNA and protein expression in breast cancer tissue before chemotherapy were 77.4% and 73.6% respectively, and after neo-adjuvant chemotherapy were 28.3%,22.6% respectively.The effective rate of the neo-adjuvant chemotherapy of the patients with positive of hTERT expression was higher than those with negative hTERT expression. Conclusion:The chemo-agents altered hTERT gene expression, improved negative rate of hTERT expression. Detecting expression of hTERT gene in breast cancer tissue would be an important index for predicting the effects of neo-adjuvant chemotherapy.