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Neoadjuvant Regimens (neoadjuvant + regimen)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

International survey on esophageal cancer: part II staging and neoadjuvant therapy

DISEASES OF THE ESOPHAGUS, Issue 3 2009
J. Boone
SUMMARY The outcome of esophagectomy could be improved by optimal diagnostic strategies leading to adequate preoperative patient selection. Neoadjuvant therapy could improve outcome by increasing the number of radical resections and by controlling metastatic disease. The purposes of this study were to gain insight into the current worldwide practice of staging modalities and neoadjuvant therapy in esophageal cancer, and to detect intercontinental differences. Surgeons with particular interest in esophageal surgery, including members of the International Society for Diseases of the Esophagus, the European Society of Esophagology , Group d'Etude Européen des Maladies de l'Oesophage, and the OESO, were invited to participate in an online questionnaire. Questions were asked regarding staging modalities, neoadjuvant therapy, and response evaluation applied in esophageal cancer patients. Of 567 invited surgeons, 269 participated resulting in a response rate of 47%. The responders currently performing esophagectomies (n= 250; 44%) represented 41 countries across the six continents. Esophagogastroscopy with biopsy and computed tomography (CT) scanning were routinely performed by 98% of responders for diagnosing and staging esophageal cancer, while endoscopic ultrasound (EUS) and barium esophagography were routinely applied by 58% and 51%, respectively. Neoadjuvant therapy is routinely administered by 33% and occasionally by 63% of responders. Of the responders that administer identical neoadjuvant regimens to esophageal adenocarcinoma (AC) and squamous cell carcinoma, 54% favor chemoradiotherapy. For AC, chemotherapy is preferred by 31% of the responders that administer neoadjuvant therapy, whereas for squamous cell carcinoma, the majority of responders (38%) prefer chemoradiotherapy. Response to neoadjuvant therapy is predominantly assessed by CT scanning of the chest and abdomen (86%). Barium esophagography, EUS, and combined CT/PET scan are requested for response monitoring in equal frequency (25%). Substantial differences in applied staging modalities and neoadjuvant regimens were detected between surgeons from different continents. In conclusion, currently the most commonly applied diagnostic modalities for staging and restaging esophageal cancer are CT scanning of the chest and abdomen, gastroscopy, barium esophagography and EUS. Neoadjuvant therapy is routinely applied by one third of the responders. Intercontinental differences have been detected in the diagnostic modalities applied in esophageal cancer staging and in the administration of neoadjuvant therapy. The results of this survey provide baseline data for future research and for the development of international guidelines. [source]

Nasopharygeal carcinoma in Queensland, Australia: A review of 10 years experience

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007
CH-K Wong
Summary The purpose of this study was to compare the treatment outcomes of patients with nasopharyngeal carcinoma in Queensland in a 10-year period during which synchronous chemoradiotherapy has come into use and to compare characteristics of patients of different racial origins and their prognostic factors. Eighty-one patients treated between 1991 and 2001 at the Queensland Radium Institute, Brisbane, Queensland for histologically confirmed nasopharyngeal carcinoma were included. Seventeen patients were treated using the Intergroup protocol, 32 patients with miscellaneous synchronized chemoradiotherapy, 6 patients with neoadjuvant regimens and 26 patients with radiotherapy only. Asian patients were found to present earlier than White Australian patients (P < 0.02). No significant difference was identified in the histological presentation between the two ethnic groups. Asian patients were more likely to have a relapse and poor loco-regional control. Overall survival, however, was not different. Patients treated according to the Intergroup protocol had better disease-specific survival and relapse-free survival than the other groups. The median follow up was 36 months. Twenty-five patients (30%) developed recurrent disease. The 5-year salvage survival or survival after relapse was 15%. Our experience with the Intergroup protocol in our population is similar to other studies, with likelihood of improved results. [source]

A delay in radical nephroureterectomy can lead to upstaging

BJU INTERNATIONAL, Issue 6 2010
Matthias Waldert
Study Type , Prognosis (case series) Level of Evidence 4 OBJECTIVE To examine the association between the delay from diagnosis of upper-tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU), and the pathological features and outcomes, as the decision to proceed to RNU for an individual patient is complex. PATIENTS AND METHODS The records of 187 patients who had RNU were reviewed; the interval from diagnosis to RNU was analysed as both a continuous (months) and categorical variable (<3 vs ,3 months). Logistic regression and survival analyses were used to evaluate the association between time from diagnosis to RNU with pathological characteristics and clinical outcomes. RESULTS The median time from diagnosis to RNU was 45 days (interquartile range 68). A delay from diagnosis to RNU analysed as a continuous variable was associated with advanced stage, higher grade, previous endoscopic procedure, tumour necrosis, infiltrative tumour architecture, and lymphovascular invasion (P = 0.034), but not disease recurrence or cancer-specific mortality. In the subgroup of patients (90, 48.1%) who had muscle-invasive disease (,pT2) a longer delay from diagnosis to RNU as a continuous variable was associated with advanced stage (P = 0.030), higher grade (P = 0.014), infiltrative tumour architecture (P = 0.044), lymphovascular invasion (P = 0.034), disease recurrence (P = 0.02), and cancer-specific mortality (P = 0.03). CONCLUSIONS Our data suggest that a delay in the interval from diagnosis to RNU is associated with more advanced disease stage. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Timely consideration of definitive treatment for patients with high-risk UTUC is of high importance. Further studies are necessary to validate these hypothesis-generating findings. [source]