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Presentar el caso de una paciente con cáncer de cérvix en estadio IB1 mayor de dos centímetros, a quien se le administró quimioterapia neoadyuvante seguida de traquelectomía radical con linfadenectomía pélvica por laparoscopia, con el fin de preservar su fertilidad; hacer una revisión de los casos reportados en la literatura con énfasis en los resultados obstétricos y oncológicos.Materiales y métodos: presentación del caso y bésqueda en Medline vía PubMed de los artículos publicados en inglés, francés y español desde enero de 2000 hasta agosto de 2014, sobre la administración de quimioterapia neoadyuvante y cirugía conservadora de la fertilidad en pacientes con cáncer de cérvix en estadio IB.Resultados: se seleccionaron 12 artículos pertinentes, para un total de 55 pacientes. Con un seguimiento entre 14 y 69 meses, se reportaron 4 recaídas y solo una muerte por enfermedad. Resultados obstétricos: 30 embarazos, 24 nacimientos, 3 abortos, 1 embarazo ectópico y 2 embarazos en curso.Conclusión: la quimioterapia neoadyuvante, seguida de cirugía conservadora de la fertilidad, puede considerarse como una alternativa de manejo en pacientes seleccionadas con cáncer de cérvix en estadio IB, con tumores voluminosos, que deseen preservar su fertilidad...
To present the case of a patient with stage IB1 cervical cancer larger than 2 centimetres who received neo-adjuvant chemotherapy followed by laparoscopic radical cervicectomy and pelvic lymphadenectomy for fertility preservation; and to review the literature for case reports emphasizing obstetric and oncologic outcomes.Materials and methods: Case presentation and search of the literature in Medline through PubMed of articles published in English, French and Spanish between January 2000 and August 2014 on the topic of neo-adjuvant chemotherapy and fertility preservation surgery in patients with stage IB cervical cancer.Results: Overall, 12 relevant articles were selected totalling 55 patients. Over follow-up period ranging between 14 and 69 months there were 4 relapses and only one death attributable to the disease. Obstetric outcomes included 30 pregnancies, 24 births, 3 miscarriages, 1 ectopic pregnancy, and 2 on going pregnancies.Conclusion: Neo-adjuvant chemotherapy followed by conservative, fertility preservation surgery may be an option for the management of selected patients with stage IB cervical cancer involving large tumours sizes, who wish to preserve their fertility...
Subject(s)
Adult , Female , Drug Therapy , Fertility Preservation , Laparoscopy , Neoadjuvant Therapy , Uterine Cervical NeoplasmsABSTRACT
Objective:This work presents the therapeutic advantage of induction therapy in patients withⅢA-N2 non-small cell lung cancer (ⅢA-N2 NSCLC). Methods:ⅢA-N2 NSCLC patients with ipsilateral mediastinal lymph node metastasis (>1 cm as shown by CT scan) who were admitted in our hospital between January 2008 and July 2013 were retrospectively analyzed. The response rates and survival outcomes of patients were presented and the prognostic factors were analyzed. Results:The 3-and 5-year overall survival (OS) rates were 57.7%and 34.2%, respectively, and the 3-and 5-year disease-free survival (DFS) rates were 37.9%and 30.5%, respec-tively. No significant differences in OS and DFS were observed between R0 and R1 resections (P=0.118; P=0.369), between groups who received neo-adjuvant chemo-radiotherapy and chemotherapy (P=0.771; P=0.953), between cases with and without clinical re-sponse (P=0.865;P=0.862), and among groups of different histological subtypes (P=0.685;P=0.208). However, patients with standard lobectomy or pathological nodal downstaging exhibited better OS (P=0.023 and P=0.024, respectively) and DFS (P=0.036 and P=0.025, respectively) than those who had extensive resections or persistent N2. Univariate analysis predicted better OS and DFS for both standard lobectomy and pathological nodal donwstaging. In addition, Cox multivariate analysis revealed that only pathological nodal downstaging could be considered as a favorable prognostic factor for DFS, while non-smoking and standard lobectomy are the corre-sponding variables for OS. Conclusion:Neo-adjuvant therapy with platinum-based doublet is feasible and useful in tumor and patho-logical nodal downstaging, which potentially improved resectability and survival rates in patients withⅢA-N2 NSCLC. Performing lo-bectomy or pathological nodal downstaging following induction therapy improved the patients' survival rate.
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Objective To explore the expression of Ki 67 in 72 cases of breast cancer and to analyze the correlation of Ki67 expression with clinicopathological factors and efficacy of neo-adjuvant chemotherapy .To as-sess the prediction value of Ki 67 in selecting neo-adjuvant chemotherapy .Methods Ki67 expression in tumor tissues of 72 cases of breast cancer was detected before and after neo-adjuvant chemotherapy .Tumor tissues are a-chieved by core needle biopsy .Results Ki67 overexpression was found in those with axillary lymph node ( ALN) metastasis, in pathological stage III and tumor diameter >2 cm(P＜0.05).Ki67 expression was not significantly associated with age(P>0.05).Objective response(OR)rate of neo-adjuvant chemotherapy was 84.2%(61/72). Patients with Ki67 over-expression were more sensitive than those with lower-expression(P>0.05).Positive ex-pression rate of Ki67 was reduced significantly by neo-adjuvant chemotherapy(P＜0.05).Positive expression rate of Ki67 was reduced significantly in pathological complete response ( PCR ) group, clinical complete remission (CCR)group and partial response(PR)group.Conclusion The expression of Ki67 may be a potential predictive biomarker for neo-adjuvant therapy response in patients of breast cancer and can provide the basis for individual therapy for breast cancer .
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Trastuzumab is a specific inhibitor against human epidermal growth factor receptor-2 (HER-2). Trastuzumab is widely used in the neo-adjuvant treatment of HER-2 breast cancer. Large-scale randomized and controlled clinical trials have demonstrated that pathologic complete response rates (pCRs) were significantly increased with neo-adjuvant trastuzumab therapy plus chemotherapy than with regular chemotherapy. The use of trastuzumab plus chemotherapy with lapatinib supplements could further improve pCR rates. An-thracycline and non-anthracycline drugs could both be used concurrently with trastuzumab. Endocrine therapy could be used as an alter-native for estrogen receptor-positive patients. pCR is a powerful predictor of long-term outcomes in HER-2 positive patients under neo-adjuvant therapy with trastuzumab. However, patient loss of HER-2 expression with residual disease after neo-adjuvant therapy with trastuzumab is a poor prognostic factor. This study paper will provide a review of related research.
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Based on special biological characteristics and prognosis, the incidence of gastroesophageal junction adenocarcinoma (GEJA) has rapidly increased over recent years, and its diagnosis and treatment remain controversial. Compared with simple surgery, neo-adjuvant and adjuvant therapies can improve the survival of patients with locally advanced GEJA. Under neo-adjuvant therapy, neo-adjuvant chemoradiation is superior to neo-adjuvant chemotherapy alone for improving the resectability, maintaining loco-regional control, and improving the quality of life of the patient. The combination of this therapy with targeted drugs may further increase the ef-ficacy of GEJA. Most data on GEJA-treated patients were obtained from randomized clinical studies on esophageal cancer or gastric cancer. Thus, prospective randomized controlled studies with a large sample size should be performed to optimize the strategy of neo-adjuvant and adjuvant therapies, and further improve the treatment outcome. In this article, studies on the comprehensive treatment of GEJA were reviewed.
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In order to explore the possibility to predict the risk factors for postoperative complications and survival time, the clinical data of 152 patients (including 116 males and 36 females) who had undergone neo-adjuvant therapy and surgery for stage Ilia and B non-small cell lung cancer (NSCLC) were retrospectively analyzed. Demographic data, preoperative functional parameters,staging, induction regimen (chemotherapy alone or associated with radiotherapy), associated disorders, and data about operation were collected. Chi-square test and multivariate analysis fitting the unconditional logistic regression model were performed to identify predictors of postoperative complications, while Kaplan-Meier and multivariate Cox proportional hazard model were employed to identify predictors of survival time, respectively. The univariate analysis demonstrated that forced expiratory volume in 1 second predicted percent (FEVI%, P=0.040) and associated disorders (P=0.020) were the predictive factors of complications, but multivariate analysis found no independence factors (P>0.05) of it. Univariate Kaplan-Meier analysis showed that stage (P=0.050) and pneumonectomy (P=0.018) affected the survival time. However, multivariate Cox proportional hazard model analysis demonstrated that only pneumonectomy (P=0.026) was associated with a decreased survival time, but no differences between right and left pneumonectomy were found. The results suggest that the risk factor for postoperative complications is acceptable, and pneumonectomy is associated with increased mortality, which should be performed only in stage Ⅲ NSCLC patients.
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Purpose:To evaluate the efficacy of bladder p re servation treatment by concurrent neoadjuvant intra-arterial chemotherapy, radi otherapy and transurethral resection for patients with bladder cancer with muscl e invasion. Methods:Thirteen patients who were unfit for or unwilling to re ceive radical cystectomy were enrolled in this study. All patients had muscle in vasive transitional cell carcinoma of bladder(T 2-T 3). Patients were treated with neoadjuvant intra-arterial chemotherapy, radiotherapy and transurethral r esection. The chemotherapy regimen consisted of cisplatin 80 mg, epirubicin 50 m g and fluorouracil 1 g/camptothecin 30 mg. The average dose of radiotherapy was 30-50 Gy. Results:At the end of neoadjuvant therapy, 1 patient (7.69%) sh owed a complete response and 12 patients (92.31%) showed partial response; tran surethral resection was performed for residual tumors. All patients completed th e treatment and showed good tolerance. With a median follow-up of 26.46 months, local recurrence or distant metastasis occurred in 5 patients (38.46%). Recurre nt tumors were treated with transurethral resection or systematic chemotherapy a nd radiotherapy. Conclusions:concurrent neoadjuvant intra-arterial chemotherapy , radiotherapy and transurethral resection is a feasible and promising treatment for patients with bladder cancer with muscle invasion.