Postoperative chemotherapy

For unresectable tumors, neoadjuvant (preoperative) 5-FU or capecitabine chemoradiation followed by surgery is recommended. All patients who receive preoperative chemotherapy should receive postoperative chemotherapy, with or without RT. 

Surgery and adjuvant (postoperative) chemotherapy (Table 63-1) are the treatments of choice for early-stage NSCLC (stage I or II) some patients benefit from postoperative radiation. 

Postoperative Radiation Therapy Postoperative Chemotherapy or Chemoradiation NeOADJUVANT THERAPY, In GENERAL Preoperative Radiation Therapy Preoperative Chemotherapy Preoperative Chemoradiation... 

There are very few studies evaluating the role of postoperative chemotherapy alone. In a randomized study of 205 patients with resected squamous cell cancer of the esopha-... 

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... 

Between 3/95 and 3/98,47 patients were enrolled. At restaging, prior to surgery, eight (17%) were found to have progressed, while seven patients had metastases documented at surgery. Complete resection was achieved in 33 (70%) patients. At the time of surgery there were 5/33 patients with complete pathologic, pCRs (15%), and 9 (27%) had only microscopic residual foci. Only 25 patients were able to complete the two cycles of postoperative chemotherapy. Median survival was found to be 15 mo,and at 46 mo 16.5% of patients were alive (62). 

The role of postoperative chemotherapy for gastric carcinoma is still not clearly defined. Numerous prospective, randomized trials have been conducted in the United States and Europe, producing conflicting results. For example, Hermans et al. (14), in a meta-analysis of 123 trials, 11 of which could be analyzed for crude mortality odds, showed no improvement in survival after adjuvant chemotherapy. However, at the 1998 American Society of Clinical Oncology (ASCO) meeting, Earle et al. (15) presented a reanalysis of the literature. Twelve trials met the criteria for inclusion in this metaanalysis. They found a small survival benefit in the group that received adjuvant chemotherapy. Currently, postoperative adjuvant chemotherapy is not recommended. 

The overall effect of interval debulking is influenced by several factors including initial response to chemotherapy, the amount of residual disease before and after second-look surgery, and the presence of microscopic residual disease. The results of recent trials suggest that secondary surgical cytoreduction does not prolong survival in patients who are treated with maximal primary cytoreductive surgery followed by appropriate postoperative chemotherapy. 

After resection of the cancer in his large intestine and completion of a conrse of postoperative chemotherapy with 5-fluorouracil (5-FU), Colin Tuma retnrned to his gastroenterologist for a routine follow-up colonoscopy. His colon was completely normal, with excellent healing at the site of the anastomosis. His physician expressed great optimism about a cure of Colin s previous mahgnancy but cautioned him about the need for regular colonoscopic examinations over the next few years. 

Breast carcinoma Postoperative chemotherapy commonly involves use of the CMF regimen (cyclophosphamide, methotrexate, and fluorouracil) with or without tamoxifen, or the CAP regimen in which doxorubicin (Adriamycin) replaces methotrexate. Tamoxifen (or toremifene) is added to such regimens for receptor-positive cancers, and trastuzumab may be included if tumors overexpress HER2 protein. 

Provisor AJ, Ettinger LJ, Nachman JB, Krailo MD, Makley JT, Yunis EJ et al. Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy a report from the Children s Cancer Group. J Clin Oncol 1997 15 76 4. 

Oztiirk E, Eroglu M, Ozdemir N, Denkbag EB (2004) Bioadhesive drug carriers for postoperative chemotherapy in bladder cancer. Adv Exp Med Biol 553 231-242... 

Eroglu M, Irmak S, Acar A, Denkba EB (2002) Design and evaluation of a mucoadhesive therapeutic agent delivery system for postoperative chemotherapy in superficial bladder cancer. Int J Pharm 235(l-2) 51-59... 

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