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Neoadjuvant therapy

24 Saturday Dec 2011

Posted by medicalsurgeryindia in Neoadjuvant therapy

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EAdjunctive or adjuvant therapy given prior to the primary therapy. Example: Sometimes chemotherapy is given to shrink the tumor so that surgery can be effective on tumors that were inoperable before the chemotherapy.

Introduction

Neoadjuvant therapy, an adjunctive therapy given before a definitive treatment, is an essential component of modern multidisciplinary cancer therapy. Although neoadjuvant or induction therapy does not contribute the most to the treatment outcome, it may improve the result substantially. For example, neoadjuvant therapy allows patients with large breast cancer to undergo breast-conserving surgery. It enables patients with locally advanced laryngeal cancer to have their vocal function preserved. Many patients with rectal cancer can avoid permanent colostomy after undergoing this approach. In addition, in certain cancers, neoadjuvant therapy may improve long-term survival. Recent years have seen an increase in the popularity of this treatment technique. The number of clinical trials on this topic published from 2000 to 2003 exceeded the number published during the entire previous decade.

This review summarizes the outcomes of neoadjuvant therapy for common malignant solid tumors. Since many patients rely on non-oncologists for guidance and support during cancer treatment, understanding the rationale and benefit of neoadjuvant therapy may aid primary care physicians in providing support and encouragement to their patients, ultimately improving care and treatment outcomes. The effect of neoadjuvant therapy can be delineated by comparing it with main therapy alone, or in some cancers, with main therapy plus adjuvant therapy, an adjunctive therapy given after the main treatment modality. This review, organized by organ of primary cancer, puts emphasis on long-term survival and organ preservation based on large phase III randomized, controlled trials.

Neoadjuvant therapy has its downside. Many neoadjuvant therapy regimens are cumbersome, requiring a highly motivated patient. For instance, one neoadjuvant therapy regimen for rectal cancer calls for weekly 2-hour infusional chemotherapy for 6 weeks, followed by a pause of 2 weeks.[1] The regimen goes on with daily 5-day intravenous chemotherapy at the beginning of daily 5-week radiation therapy, and another 5-day chemotherapy during the last week of radiation. There is a mandatory pause of up to 8 weeks before surgery, the definitive therapy, to allow maximal tumor shrinkage. The duration of neoadjuvant therapy in this regimen adds up to about 6 months. Unlike an immediate removal of the tumor, prolonged neoadjuvant therapy for resectable cancer can be physically, socially, and emotionally difficult for patients, especially those with gynecologic malignancy.[2] In addition, ineffective neoadjuvant therapy simply means a delay of the definitive treatment and an increase in treatment-related toxicities.

Given these uncertain data, the historical justification for neoadjuvant therapy besides the proven decrease of mastectomies, while it cannot be dismissed, cannot be considered convincing. Happily, a new and sound rationale for the neoadjuvant approach is available.

Molecular biologists have now provided the clinical oncologist with an extraordinarily rich and powerful range of new tools with which to improve our understanding of breast cancer and enhance its treatment. The promise is that in the near future it will be possible to tailor therapy to the particular characteristics of an individual tumor, so bringing an end to the era in which a particular therapy was administered blindly to all comers.

The work of Colleoni et al. stands as an example of how the importance of biological determinants can be established [9, 10]. Prospectively derived data suggest that response to either AC chemotherapy or the 5-fluorouracil/leucovorin/vinorelbine combination is predicted by factors such as p53 and c-erbB-2 positivity and a high or decreasing Mib1/Ki67 percentage in the tumor sample. According to these data, relative resistance to the chemotherapy regimens cited is predicted by ER and progesterone receptor (PgR) positivity.The neoadjuvant approach has been criticized in some quarters since it is held to prevent use of lymph node status as a guide to prognosis. It is argued that eradication of tumor from lymph nodes that were positive before neoadjuvant therapy might lead certain patients to receive insufficiently intensive adjuvant treatment. However, surgeons experienced in the field may be able to use sentinel lymph node biopsy to determine whether nodes were initially positive. The issue is being investigated in the European Organization for Research and Treatment of Cancer-AMAROS study. This trial should enable biological data from the tumor sample to be correlated with primary clinical and lymph node response.

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List of Cancers

22 Thursday Dec 2011

Posted by medicalsurgeryindia in A to Z List of Cancers

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Affordable Oncology Hospital Bangalore, Affordable Oncology Hospital Mumbai, Ahmedabad, Cancer Surgery Chennai, Chennai, Cost Cancer Hospital Delhi, Cost Cancer Surgery, Cost Cancer Surgery Mumbai, Cost Oncosurgery Ahmedabad, Cost Oncosurgery Mumbai, Delhi, Delhi-India, Hyderabad, Low Cost Cancer Surgery Hyderabad, Low Cost Oncology Delhi India, Low Cost Oncosurgery Hospital, Oncology Hospital Pune, Oncology Mumbai Hospital, Oncology Surgery India, Oncosurgery Hospital Delhi, Oncosurgery India, Pune


A

Acute Lymphoblastic Leukemia, Adult
Acute Lymphoblastic Leukemia, Childhood
Acute Myeloid Leukemia, Adult
Acute Myeloid Leukemia, Childhood
Adrenocortical Carcinoma
Adrenocortical Carcinoma, Childhood
AIDS-Related Cancers
AIDS-Related Lymphoma
Anal Cancer
Appendix Cancer
Astrocytoma, Childhood Cerebellar
Astrocytoma, Childhood Cerebral

B

Basal Cell Carcinoma, see Skin Cancer (non-Melanoma)
Bile Duct Cancer, Extrahepatic
Bladder Cancer
Bladder Cancer, Childhood
Bone Cancer, Osteosarcoma/Malignant Fibrous Histiocytoma
Brain Stem Glioma, Childhood
Brain Tumor, Adult
Brain Tumor, Brain Stem Glioma, Childhood
Brain Tumor, Cerebellar Astrocytoma, Childhood
Brain Tumor, Cerebral Astrocytoma/Malignant Glioma, Childhood
Brain Tumor, Ependymoma, Childhood
Brain Tumor, Medulloblastoma, Childhood
Brain Tumor, Supratentorial Primitive Neuroectodermal Tumors, Childhood
Brain Tumor, Visual Pathway and Hypothalamic Glioma, Childhood
Brain Tumor, Childhood (Other)
Breast Cancer
Breast Cancer and Pregnancy
Breast Cancer, Childhood
Breast Cancer, Male
Bronchial Adenomas/Carcinoids, Childhood
Burkitt’s Lymphoma

C

Carcinoid Tumor, Childhood
Carcinoid Tumor,Gastrointestinal
Carcinoma of Unknown Primary
Central Nervous System Lymphoma, Primary
Cerebellar Astrocytoma, Childhood
Cerebral Astrocytoma/Malignant Glioma, Childhood
Cervical Cancer
Childhood Cancers
Chronic Lymphocytic Leukemia
Chronic Myelogenous Leukemia
Chronic Myeloproliferative Disorders
Colon Cancer
Colorectal Cancer, Childhood
Cutaneous T-Cell Lymphoma, see Mycosis Fungoides and Sézary Syndrome


D

[No Entries]

E

Endometrial Cancer
Ependymoma, Childhood
Esophageal Cancer
Esophageal Cancer, Childhood
Ewing’s Family of Tumors
Extracranial Germ Cell Tumor, Childhood
Extragonadal Germ Cell Tumor
Extrahepatic Bile Duct Cancer
Eye Cancer, Intraocular Melanoma
Eye Cancer, Retinoblastoma


F

[No Entries]

G

Gallbladder Cancer
Gastric (Stomach) Cancer
Gastric (Stomach) Cancer, Childhood
Gastrointestinal Carcinoid Tumor
Gastrointestinal Stromal Tumor (GIST)
Germ Cell Tumor, Extracranial, Childhood
Germ Cell Tumor, Extragonadal
Germ Cell Tumor, Ovarian
Gestational Trophoblastic Tumor
Glioma, Adult
Glioma, Childhood Brain Stem
Glioma, Childhood Cerebral Astrocytoma
Glioma, Childhood Visual Pathway and Hypothalamic


H

Hairy Cell Leukemia
Head and Neck Cancer
Hepatocellular (Liver) Cancer, Adult (Primary)
Hepatocellular (Liver) Cancer, Childhood (Primary)
Hodgkin’s Lymphoma, Adult
Hodgkin’s Lymphoma, Childhood
Hodgkin’s Lymphoma During Pregnancy
Hypopharyngeal Cancer
Hypothalamic and Visual Pathway Glioma, Childhood


I

Intraocular Melanoma
Islet Cell Carcinoma (Endocrine Pancreas)


J

[No Entries]

K

Kaposi’s Sarcoma
Kidney (Renal Cell) Cancer
Kidney Cancer, Childhood


L

Laryngeal Cancer
Laryngeal Cancer, Childhood
Leukemia, Acute Lymphoblastic, Adult
Leukemia, Acute Lymphoblastic, Childhood
Leukemia, Acute Myeloid, Adult
Leukemia, Acute Myeloid, Childhood
Leukemia, Chronic Lymphocytic
Leukemia, Chronic Myelogenous
Leukemia, Hairy Cell
Lip and Oral Cavity Cancer
Liver Cancer, Adult (Primary)
Liver Cancer, Childhood (Primary)
Lung Cancer, Non-Small Cell
Lung Cancer, Small Cell
Lymphoma, AIDS-Related
Lymphoma, Burkitt’s
Lymphoma, Cutaneous T-Cell, see Mycosis Fungoides and Sézary Syndrome
Lymphoma, Hodgkin’s, Adult
Lymphoma, Hodgkin’s, Childhood
Lymphoma, Hodgkin’s During Pregnancy
Lymphoma, Non-Hodgkin’s, Adult
Lymphoma, Non-Hodgkin’s, Childhood
Lymphoma, Non-Hodgkin’s During Pregnancy
Lymphoma, Primary Central Nervous System


M

Macroglobulinemia, Waldenström’s
Malignant Fibrous Histiocytoma of Bone/Osteosarcoma
Medulloblastoma, Childhood
Melanoma
Melanoma, Intraocular (Eye)
Merkel Cell Carcinoma
Mesothelioma, Adult Malignant
Mesothelioma, Childhood
Metastatic Squamous Neck Cancer with Occult Primary
Mouth Cancer
Multiple Endocrine Neoplasia Syndrome, Childhood
Multiple Myeloma/Plasma Cell Neoplasm
Mycosis Fungoides
Myelodysplastic Syndromes
Myelodysplastic/Myeloproliferative Diseases
Myelogenous Leukemia, Chronic
Myeloid Leukemia, Adult Acute
Myeloid Leukemia, Childhood Acute
Myeloma, Multiple
Myeloproliferative Disorders, Chronic


N

Nasal Cavity and Paranasal Sinus Cancer
Nasopharyngeal Cancer
Nasopharyngeal Cancer, Childhood
Neuroblastoma
Non-Hodgkin’s Lymphoma, Adult
Non-Hodgkin’s Lymphoma, Childhood
Non-Hodgkin’s Lymphoma During Pregnancy
Non-Small Cell Lung Cancer


O

Oral Cancer, Childhood
Oral Cavity Cancer, Lip and
Oropharyngeal Cancer
Osteosarcoma/Malignant Fibrous Histiocytoma of Bone
Ovarian Cancer, Childhood
Ovarian Epithelial Cancer
Ovarian Germ Cell Tumor
Ovarian Low Malignant Potential Tumor


P

Pancreatic Cancer
Pancreatic Cancer, Childhood
Pancreatic Cancer, Islet Cell
Paranasal Sinus and Nasal Cavity Cancer
Parathyroid Cancer
Penile Cancer
Pharyngeal Cancer
Pheochromocytoma
Pineoblastoma and Supratentorial Primitive Neuroectodermal Tumors, Childhood
Pituitary Tumor
Plasma Cell Neoplasm/Multiple Myeloma
Pleuropulmonary Blastoma
Pregnancy and Breast Cancer
Pregnancy and Hodgkin’s Lymphoma
Pregnancy and Non-Hodgkin’s Lymphoma
Primary Central Nervous System Lymphoma
Prostate Cancer


Q

[No Entries]

R

Rectal Cancer
Renal Cell (Kidney) Cancer
Renal Cell (Kidney) Cancer, Childhood
Renal Pelvis and Ureter, Transitional Cell Cancer
Retinoblastoma
Rhabdomyosarcoma, Childhood


S

Salivary Gland Cancer
Salivary Gland Cancer, Childhood
Sarcoma, Ewing’s Family of Tumors
Sarcoma, Kaposi’s
Sarcoma, Soft Tissue, Adult
Sarcoma, Soft Tissue, Childhood
Sarcoma, Uterine
Sézary Syndrome
Skin Cancer (non-Melanoma)
Skin Cancer, Childhood
Skin Cancer (Melanoma)
Skin Carcinoma, Merkel Cell
Small Cell Lung Cancer
Small Intestine Cancer
Soft Tissue Sarcoma, Adult
Soft Tissue Sarcoma, Childhood
Squamous Cell Carcinoma, see Skin Cancer (non-Melanoma)
Squamous Neck Cancer with Occult Primary, Metastatic
Stomach (Gastric) Cancer
Stomach (Gastric) Cancer, Childhood
Supratentorial Primitive Neuroectodermal Tumors, Childhood


T

T-Cell Lymphoma, Cutaneous, see Mycosis Fungoides and Sézary Syndrome
Testicular Cancer
Throat Cancer
Thymoma, Childhood
Thymoma and Thymic Carcinoma
Thyroid Cancer
Thyroid Cancer, Childhood
Transitional Cell Cancer of the Renal Pelvis and Ureter
Trophoblastic Tumor, Gestational


U

Unknown Primary Site, Carcinoma of, Adult
Unknown Primary Site, Cancer of, Childhood
Unusual Cancers of Childhood
Ureter and Renal Pelvis, Transitional Cell Cancer
Urethral Cancer
Uterine Cancer, Endometrial
Uterine Sarcoma


V

Vaginal Cancer
Visual Pathway and Hypothalamic Glioma, Childhood
Vulvar Cancer


W

Waldenström’s Macroglobulinemia
Wilms’ Tumor
Women’s Cancers

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