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Objective TodiscusstheevaluationeffectivenessofADCofMR DWIinneoadjuvantchemotherapy (NAC).Methods ThirtyGninepatientswithlocallyadvancedbreastcancerwereenrolledinthisstudy.Allthesepatientswerediagnosedbypuncture biopsyandtreatedwithNAC.DWIwasperformedbeforechemotherapyandafter4cyclesofchemotherapyrespectively.Radicalresectionof breastcancerwasperformedwithinoneweekaftertheendof4cyclesofNAC.Accordingtotheclinicalefficacyorpathologicalresponse,the changesoftumorvolumeandtumorcelldensitybeforeandafterchemotherapyweremeasured.Theresponseoftumorwasdividedas clinicallyeffective,completeremission (CR)+partialremission(PR)andclinicalineffectiveness,stabilizationdisease(SD)+progression disease(PD)ormajorhistologicalresponse (MHR)andnonGmajorhistologicalresponse (NMHR),respectively.Toevaluatethe practicalutilityofneoadjuvantchemotherapy,theADCvaluesweremeasuredinallgroupsandanalyzedstatistically.Results Before NAC,therewasnosignificantdifferenceinADCvaluebetweenCR+PR (0.96±0.22)andSD+PD (0.93±0.14)orMHR (1.05±0.22), NMHR (0.99±0.14).TheratiosofCR+PRand MHR were56.4%and66.7%respectivelyattheendoftreatment,andtheADC valuesinallpatientswerehigherthanthatbeforechemotherapy.However,Therewasnosignificantdifferencebeforeandafterchemotherapy intheSD+PD (1.02±0.19)andNMHR (1.08±0.20)groups (P＞0.05),whileCR+PR (1.47±0.16)and MHR (1.62+0.13) groupsweresignificantlydifferentbeforeandafterchemotherapy(P＜0.05).Therateoftumorvolumechangewaspositivelycorrelated withΔADC (r＝0.539,P＜0.05).Conclusion TheADCvalue canbeusedtoevaluatethevolumeandpathologicalgradeof tumorafterNACbasedon MRIplainscananddynamicscan, whichishelpfulfortimelyandeffectivepredictiveevaluationof chemotherapyeffect.ADCvaluecanbeusedasearlyevaluationofNACforbreastcancerandprognosticindicators.
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Objective ToinvestigatethevalueoftheADCandtherelativeADC(rADC)ofDWIparameterstopredictthefinal pathologicalresponseintheearlystageofneoadjuvantchemotherapy(NAC)fordifferentmolecularsubtypesofbreastcancer.Methods TheresultsoftwoDWI(beforeNACandwithinoneweekaftersecondcycleofNAC)in116patientsenrolledinthestudywere retrospectivelyanalyzed.Theminimum ADCandrADCofthelesionsweremeasuredandrecorded,andtheirratesofchangeaftersecond cycle(ADC%、rADC%)werecalculated.Molecularsubtypeswererecordedaccordingtotheresultsofpreoperativeimmunohistochemistry, andpatientsweredividedintomajorhistologicalresponse(MHR)groupandnon-majorhistologicalresponse(NMHR)groupaccording topostoperativepathologicalgradingcriteriaofMiller&Payne.Results TherewasnocorrelationbetweentheADCbeforeNACand thefinalpathologicalresponseofeachsubtype.AftersecondcycleofNAC,exceptforLuminalA,ADCandADC%hadtheabilityof predictingfinalpathologicalresponsesfortheremainingsubtypes,especiallyinthehighestefficacyofADC%forthetriple-negative. BeforeNAC,rADChadpredictiveefficacyforLuminlBandHER2-enrichedsubtypes;aftersecondcycleofNAC,therADCdiffered onlybetweenthedifferentpathologicalresponsegroupsofHER2-enrichedandthetriple-negative,andthediagnosticefficacy was limited.TherADC%hadpredictiveefficacyonlyinthetriple-negativegroup.Conclusion ADChasnopredictiveefficacyforeach subtypebeforeNAC;WhiletherADCbeforeNAC,everyDWIparametersafter2ndcycleofNAC,andtheirchangeshavecertainvalues toevaluatethefinalpathologicalresponseofthecorrespondingpartialsubtypesofbreastcancer.
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La supervivencia global a 5 años de los pacientes conosteosarcoma no-metastásico es del 60-70%, mientrasque la misma se reduce a 10-30% en los pacientes con enfermedad diseminada. El objetivo de nuestro estudiofue determinar supervivencia y factores pronósticos enun grupo de pacientes con metástasis pulmonares porosteosarcoma tratados quirúrgicamente. Se realizó unabúsqueda retrospectiva en nuestra base de datos oncológicaentre 1992-2006, y 38 pacientes fueron incluidos enel estudio. La edad media al momento del diagnóstico fuede 18 ± 9.4 años (3-45) y el seguimiento promedio de 57± 53.8 meses (12-231). Todos fueron tratados con quimioterapia, resección oncológica del tumor primario y de lasmetástasis pulmonares. Se analizó la supervivencia a 5 y10 años de la serie y los siguientes factores pronósticos: edad, sexo, localización del tumor primario, metástasis de inicio, recidiva local, número de metástasis extirpadasy la respuesta al tratamiento de quimioterapia (necrosistumoral). La supervivencia global fue de 29% a los 5 años(IC95%:14.5-43.5) y de 26% a los 10 años (IC95%:12-40).Se encontró una diferencia estadísticamente significativa entre los buenos y malos respondedores a la quimioterapia:53% (IC95%: 28-78) vs. 8% (IC95%: 0-20) (p = 0.0008). Nose observó relación estadísticamente significativa entre losdemás factores pronósticos analizados. La supervivenciaa 5 y 10 años de los pacientes con osteosarcoma y metástasis pulmonares tratados con quimioterapia y resección quirúrgica continúa siendo pobre. Los pacientes con buena respuesta a la quimioterapia neoadyuvante presentan un mejor pronóstico oncológico.
Five years overall survival in osteosarcoma patients isaround 70%, although in patients with metastatic diseaseit is only 10-30%. The objective of this study was to analyzeoverall survival and prognostic factors in a group of patientswith metastatic osteosarcoma treated with surgical removal of the lung metastases. A retrospective review from ouroncology data base revealed 38 patients treated between1992 and 2006. The mean age at diagnosis was 18 ± 9.4years (3-45) and mean follow-up was 57 ± 53.8 months(12-231). All patients were treated with chemotherapy and oncologic resection of the primary tumor and surgicalremoval of the lung metastases. We analyzed overallsurvival and prognostic factors: age, gender, site, time ofmetastasis, local recurrences, number of lung metastasisand chemotherapy response (necrosis). Overall survival of the entire series was 29% at 5 years (CI95%: 14.5-43.5)and 26% at 10 years (CI95%: 12-40). Significant differencein 5 year overall survival was found between good and badresponders to chemotherapy, 53% (IC95%: 28-78) vs. 8%(IC95%: 0-20) (p = 0.0008). No statistically significantrelationship between other prognostic factors analyzedwas observed. Five and ten years overall survival ratesin osteosarcoma patients with lung metastasis treatedwith chemotherapy and surgically resection is poor. Patientswith good response to chemotherapy have betterprognosis.
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Drug Therapy , Neoplasm Metastasis , Osteosarcoma , General Surgery , Prognosis , SurvivalABSTRACT
Background and purpose:Antracycline combined with paclitaxel is more widely applied in breast cancer as neoadjuvant chemotherapy.There are differences in applications of different paclita~els.In this research,the efficacy and toxicity of neoadjuvant chemotherapy with ET,ED regimen were compared for the patients with stageⅢbreast cancer.Methods:64 cases of stageⅢbreast cancer patients were divided in two groups.Before surgery,one group had received ET(EPI ivgtt 60 mg/m~2 d_1?21,PTX ivgtt 175 mg/m~2 d_2?21),the other group had received ED(EPI ivgtt 60 mg/m~2 d_2?21,DOC ivgtt 75 mg/m~2 d_2?21)neoadjuvant chemotherapy for three weeks. Curative effect and side effects were evaluated after 2-4 cycles.Results:Total effective rate was 87.5%.Effective rate in ED group was 92.9%,and effective rate in ET group was 83.5%.There was no significant difference(P=0.253).In pCR cases,8 cases in ED group achieved pathologically complete response compared to 3 cases in ET group(P=0.033). The number of patients in ED group(24 cases)hadⅣ-Ⅴgrade pathology evaluation after chemotherapy,it was higher than that in ET patients(21 cases).There was a significant difference(P=0.017).In both groups side effects including hair loss,nausea and vomiting,liver dysfunction were similar.Incidence rate of peripheral neurotoxicity in ET group was higher than that in ED group(P=0.002).Incidence rates of leukopenia,skin rash and phlebitis in ED group were higher than that in ET group.There was a significant difference between two groups in the leukopenia(P=0.034). Conclusions:For the patients with stageⅢbreast cancer patients,both two regimens could achieve better curative effect.ET and ED regimen have similar effect.But in ED regimen,the number ofpCR cases was obviously higher than in ET group.In both groups side effects were similar.There were significant differences in terms of leukopenia and peripheral neurotoxicity,but the side effects could be tolerated.
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Objective:To evaluate the therapeutic effect of neoadjuvent chemotherapy for grade Ⅲ and Ⅳ carcinoma in the digestive tracts,Methods: A total of 30 cases of carcinoma in the digestive tracts were collected;including 9 cases in grade Ⅲa,13 cases in grade Ⅲb,and 8 cases in grade Ⅳ admitted to our hospital.Through gastroscope、enteroscope and CT investigation after admission,20 cases had been determined as advanced carcinoma in the digestive tracts before operation.Then the cases underwent chemotherapy twice,were rechecked by CT,and finally accepted operation treatment.The changes of the cancer volume,labelling micovessel index CD105 and the content of the inhibitory protein of apoptosis survivin from excisional tumor tissue were compared after operation. Results: 1.The change of tumorvolumebeforeandafterchemotherapyshowedstatisticalsignificance(P0.05)between intervenient chemotherapy group and systematical chemotherapy group. None died from operation. Conclusion: Surgical therapy after neoadjuvent chemotherapy for advanced cancer in the digestive tracts can improve the rate of exairesis and therapic effect.