Adjuvant therapy in primary breast cancer

This article considers the role of adjuvant therapy in primary breast cancer, utilizing data from randomized prospective clinical trials as illustrative examples. The ongoing efforts targeted toward addressing some of the unresolved issues are underscored.     

Adjuvant therapy of lung cancer

This article reviews the basic principles and the results with modern adjuvant therapies in resected non-small cell lung cancer, the role of preoperative chemotherapy in locally advanced, inoperable non-small cell lung cancer and the value of surgical resection as an adjuvant to radiotherapy and chemotherapy in the treatment of small cell lung cancer. At the time being these therapies are experimental and should not be used outside clinical research.     

Adjuvant therapy for pancreatic cancer

Although the morbidity and mortality of pancreatic resection for cancer has been remarkably reduced during the last 20 years, there has been little change in long-term survival. Based on experience in the treatment of locally unresectable but nonmetastatic pancreatic cancer, adjuvant therapies have been devised that do have an impact on survival. The number of pancreatic resections remains low, however. To increase the number of pancreatic resections that might be performed, phase II neoadjuvant trials are under way in several centers. Even if successful, they will have little effect on the proportion of patients with pancreatic cancer who are cured. New, innovative treatments must be explored.

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Resumen Aunque la mortalidad y morbilidad de la resección por cáncer pancreático se ha reducido en forma notoria en los últimos 20 años, apenas se registra un mínimo cambio en la sobrevida a largo plazo. Con base en la experiencia con el tratamiento del cáncer pancreático localmente no resecable pero libre de metástasis, se han diseñado terapias coadyuvantes que demuestran impacto sobre las tasas de sobrevida. Sin embargo, el número de resecciones pancreáticas continúa siendo bajo. Con miras a incrementar el número de resecciones pancreáticas que teóricamente pudieran ser realizadas, actualmente se desarrollan ensayos clínicos de terapia neoadyuvante en fase II en diversos centros médicos. Aún si se encuentra que son exitosos, éstos tendrán muy pequeño impacto sobre la proporción de los pacientes con cáncer pancreático que lleguen a ser curados. Es evidente que deben explorarse modalidades innovadoras de tratamiento.

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Résumé Bien que la morbidité et la mortalité après résection pour cancer du pancréas aient considérablement diminué depuis 20 ans, la survie à long terme n'a guère changé. Basé sur l'expérience du traitement des cancers non résécables mais non métastatiques, il existe des modalités thérapeutiques qui influencent positivement la survie. Le nombre de résections pancréatiques reste bas, cependant. Pour augmenter le nombre potentiel de résections, on a proposé plusieurs essais de traitement néoadjuvant phase II qui sont en cours dans plusieurs centres. Même s'ils sont efficaces, cependant, ils auront probablement peu d'effet sur la proportion de patients qui seront guéris. D'autres modalités thérapeutiques, entièrement innovatrices, sont nécessaires.

     

Adjuvant therapy of breast cancer

About 180,000 American women will be diagnosed with early stage breast cancer during 1993. In many of these patients breast cancer is a systemic disease at diagnosis and thus not curable by local treatment alone. The development of optimal forms of systemic adjuvant therapy has been a major area of research for more than 30 years. The two most widely employed types of adjuvant therapy, cytotoxic chemotherapy and tamoxifen, have been shown to improve relapse-free and overall survival in certain patient subsets. This review highlights recent advances in adjuvant therapy of early stage breast cancer and discusses current treatment guidelines.

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Resumen En alrededor de 150.000 mujeres norteamericanas se hará el diagnóstico de cáncer mamario temprano en el año 1993; en muchas de ellas el cáncer será una enfermedad sistémica en el momento del diagnóstico y, por consiguiente, no susceptible de sólo tratamiento local. El desarrollo de modalidades óptimas de terapia sistémica coadyuvante ha sido un área principal de investigación por más de 30 años. Los dos tipos de terapia coadyuvante más ampliamente utilizados, la quimioterapia citotóxica y el tamoxifén, han demostrado mejorar la tasa de sobrevida libre de recurrencia y de sobrevida global en ciertos subgrupos de pacientes. En la presente revisión se destacan los avances recientes en terapia coadyuvante del cáncer mamario temprano y se discuten las directrices terapéuticas que prevalecen en la actualidad.

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Résumé Environ 150000 femmes américaines auront un cancer du sein au début en 1993. Chez quelques unes, la maladie sera déjà généralisée au moment du diagnostic initial et ainsi, non curable par le seul traitement local. Le développement des régimes optimaux de chimiothérapie adjuvante systémiques est un sujet majeur de recherche depuis plus de 30 ans. Les deux types de thérapie adjuvante les plus employés, soit la chimiothérapie cytotoxique et le tamoxifène, ont été démontrés efficaces pour améliorer la survie sans récidive et la survie globale chez certains sous-groupes de patientes. Cet article souligne les progrès les plus récents du traitement adjuvant des cancers du début et présente des recommandations thérapeutiques possibles.

     

Adjuvant therapy for breast cancer

The use of adjuvant therapies after surgery for breast cancer has made a significant difference to breast cancer survival. The regular production of meta-analyses by the Early Breast Cancer Trials Collaborative Group has highlighted the effects of adjuvant therapies. The important histological factors that need to be considered when deciding the adjuvant therapy are tumour size, histological grade, nodal status and oestrogen receptor status. The original treatments were based on the idea that many breast cancers are hormone-sensitive and ovarian ablation was one of the first methods. The discovery of oestrogen receptors and the drug tamoxifen reduced breast cancer mortality and recurrence rates in patients with oestrogen receptor-positive tumours. Polychemotherapy regimens are very effective in pre- and post-menopausal women and are well tolerated. Anthracycline regimens are now used routinely in most pre-menopausal women (unless they have a very good prognosis). The results of ongoing trials which incorporate taxanes with chemotherapy are awaited. Another exciting potential treatment is the use of herceptin (an antibody against the HER-2 receptor) in the adjuvant setting. Postoperative radiotherapy can also be considered as an adjuvant treatment which decreases the risk of local recurrence in the breast after conservation treatment or in the chest wall after a mastectomy.     

前列腺癌的辅助治疗

前列腺癌的辅助治疗是指早期患者在经过确切治疗后接受的后续补充治疗,目前主要包括辅助内分泌治疗、辅助放疗和辅助化疗。就目前的研究来看,对于低危或中危患者,不建议早期接受辅助治疗,特别是低危患者,辅助内分泌治疗不能提高生存率;对于高危患者,辅助治疗能减少疾病进展,延长无疾病生存,辅助内分泌治疗可以提高总体生存率,根治术后辅助放疗不能减少肿瘤转移,也不能提高总体生存率,辅助化疗的研究可能为以后前列腺癌的治疗开辟一条新的途径。     

Adjuvant therapy in lymphnode positive prostate cancer

Summary Few patients with prostate cancer metastatic to the lymphnodes can be cured by radiotherapy, radical prostataectomy or androgen deprivation. Inevitably serum PSA levels will rise after a few years whereas the clinical recurrence appears after 5 to 10 years. Prospective trials regarding adjuvant treatment of lymphnode positive prostate cancer do not exist. Retrospective studies involving adjuvant endocrine treatment reveal a prolonged disease free survival time. Scientific proof of the best treatment for prostate cancer with lymphnode metastasis does not exist. The decision how to treat is based on our personal experience and philosophy as well as on our knowledge and interpretation of the available lierature. The art of medicine is the feeling for the best treatment of each individual patient.      

乳腺癌辅助内分泌治疗概况

乳腺癌的内分泌治疗是激素依赖型乳腺癌患者重要的辅助治疗之一,分为手术治疗和非手术治疗,近年来手术及放射去势治疗逐渐被药物治疗替代。雌激素受体和／或孕激素受体阳性,是目前临床应用内分泌治疗的重要指标。绝经前后患者内分泌环境的生理差别决定了用药方式的不同。绝经前患者主要抑制卵巢产生雌激素,而绝经后患者主要抑制芳香化酶的功能。本文旨在对乳腺癌患者内分泌常用药物进行简要介绍,并就他莫西芬及芳香化酶抑制剂进行重点介绍。     

Adjuvant therapy for advanced gastric cancer

The importance of surgery (gastrectomy plus lymph node dissection) for the treatment of advanced gastric cancer is unquestionable, although there has been a disparity in methods used to achieve local control in Asia and the West. The superiority of D2 dissection has not been confirmed in a large multiinstitutional trial, and the long-term follow-up results of a Dutch trial revealed that the recurrence rate was lower in the D2 group. Thus, the European Society for Medical Oncology and the US National Comprehensive Cancer Network guidelines recommend D2 dissection, leading to a worldwide consensus. Meanwhile, the focus of oncology should be on multimodality treatment for cure, and numerous large, randomized clinical trials have established effective adjuvant treatment. In gastric cancer, different evidence emerged first in the USA, followed by Europe, and Japan/the Republic of Korea to become the standard for each: adjuvant chemoradiation, perioperative adjuvant chemotherapy, and postoperative chemotherapy, respectively. The Japanese standard has become adjuvant S-1 chemotherapy for 1 year after surgery, and the optimal regimen for stage III should be further investigated in consideration of other robust results. Other issues include the role of surgery in local control with regard to adjuvant treatment such as radiation and molecular-targeted treatment to establish a worldwide standard.     

Adjuvant therapy for high-risk renal cell carcinoma patients

For most cases of renal cell carcinoma (RCC), the standard of care is surgical resection as monotherapy or as part of a multimodal approach. In patients with early localized disease, radical nephrectomy is associated with a favorable prognosis, whereas patients with advanced disease are rarely cured. A significant number of patients undergoing surgery for localized RCC experience recurrence, suggesting that there are some individuals in whom surgical excision is necessary but insufficient. In these patients, the development of effective adjuvant strategies is imperative. In this article, we review the prognostic variables and comprehensive staging algorithms for identifying patients at high risk for disease recurrence. Additionally, we review data from completed adjuvant RCC trials and highlight relevant ongoing trials.