Neoadjuvant treatment

Landry JC, Harris W Yang GY, et al. Neoadjuvant treatment with GEM, cisplatin, 5-FU and accelerated hyperfractionated radiation therapy in advanced GI malignancy. Radiology 2000 217 147. 

Fowler WC, Langer CJ, Curran WJ, et al. Postoperative complications after combined neoadjuvant treatment of lung cancer. Ann Thorac Surg 1993 55 986-989. 

Preoperative/neoadjuvant treatment is the conventional approach, allowing for a reliable pathological quantification of response to therapy. 

Kandioler-Eckersberger D, Ludwig C, Rudas M, et al. T P53 mutation and p53 overexpression for prediction of response to neoadjuvant treatment in breast cancer patients. Clin Cancer Res 2000 6 50-56. 

Symmans W, Volm M, Shapiro R, et al. Paclitaxel-induced apoptosis and mitotic arrest assessed by serial needle aspiration implications for early prediction of breast cancer response to neoadjuvant treatment. Clin Cancer Res 2000 6 4610-4617. 

Cortesi E. Neoadjuvant treatment for locally advanced bladder cancer a randomized prospective clinical trial. Proc Am Soc Clin Oncol 1995 14 237. 

Neoadjuvant treatment of breast cancer has traditionally been used in inflammatory breast cancer, mainly in those patients not amenable to radical surgery and radiotherapy. The aim of the treatment is a downstaging of the disease. However, this approach can also be applied to tumors that are not initially suitable for conservative surgery but may become so post-chemotherapy. The overall survival outcomes are similar for the pre- and post-surgery approaches. 

Chemotherapy is presently used in three main clinical settings (1) primary induction treatment for advanced disease or for cancers for which there are no other effective treatment approaches, (2) neoadjuvant treatment for patients who present with localized disease, for whom local forms of therapy such as surgery or radiation, or both, are inadequate by themselves, (3) adjuvant treatment to local methods of treatment, including surgery or radiation therapy, or both. 

Zangos S, Eichler K, Balzer JO, Straub R, Hammerstingl R, Herzog C et al (2007) Large-sized hepatocellular carcinoma (HCC) a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT). Eur Radiol 17(2) 553-563... 

Subsequently we present our results of a combined neoadjuvant treatment protocol and review the current status of combined interventional therapies for unresectable liver tumors. 

Kovacs AF (2005) Chemoembolization using Cisplatin crystals as neoadjuvant treatment of oral cancer. Cancer Biother Radiopharm 20 267-279... 

Table 26.10. Colorectal liver metastases surgery neoadjuvant treatment of nonresectable isolated liver metastases, downstaging and resection...

Wein A, Riedel C, Bruckl W, et al (2003) Neoadjuvant treatment with weekly high-dose 5-fluorouracil as 24-hour infusion, folinic acid and oxaliplatin in patients with primary resectable liver metastases of colorectal cancer. Oncology 64 131-138... 

Nelson s syndrome A condition characterized by the aggressive growth of a pituitary tumor and hyperpigmentation of the skin. Neoadjuvant therapy Therapy given prior to the primary treatment. In cancer, it is usually given prior to surgery to make the surgical... 

Neoadjuvant or primary chemotherapy is the initial treatment of choice. Benefits include rendering inoperable tumors resectable and increasing the rate of BCT. 

El Sayed and Nelson reviewed 42 trials between 1963 and 1993 including six trials prior to 1965 and one trial using razoxane, a nonstandard chemotherapy agent (73). A drawback to the El Sayed analysis is the inclusion of a single trial that had been accounted for twice because of its publication in two different journals. The addition of chemotherapy to locoregional treatment added an absolute benefit of 4.0% absolute benefits of concomitant chemotherapy were 8% (neoadjuvant and adjuvant chemotherapy were not assessed). 

Taylor SG, Murthy AK, Vannetzel JM, et al. Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 1994 12 385-395. 

Vanderbilt University Medical Center has recently completed accruing patients to a Phase II study of neoadjuvant chemoradiation, which consists of preoperative paclitaxel (175 mg/m2,3-h infusion) followed by cisplatin 75 mg/m2 d 1 and 21. Concurrent radiation was given to a total dose of 3000 cGy, in 200 cGy/fraction. Patients who are resectable go on to surgery 4 wk after completion of chemoradiation, whereas those who are unresectable (i.e., cervical esophageal cancer) continue to a total dose of 60 Gy without treatment interruptions. One month following surgery, patients receive two cycles (q 21-28 d) of postoperative chemotherapy, which consists of paclitaxel 175 mg/m2 over 3 h d 1,5-FU 350 mg/m2, d 1-3, and leucovorin 300 mg d 1-3. Preliminary analysis of this... 

Morrell LE, Lee YJ, Hurley J, et al. A Phase II trial of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin in the treatment of patients with locally advanced breast carcinoma. Cancer 1998 82 503-511. 

Eltahir A, Heys SD, Hutcheon AW, et al. Treatment of large and locally advanced breast cancers using neoadjuvant chemotherapy. Am J Surg 1998 175 127-132. 

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