四肢Ⅱ期骨肉瘤的化疗效果评价

目的 对四肢骨肉瘤患者实施化疗的效果以及与生存率的关系进行总结.方法 1997年7月至2007年7月采用新辅助化疗及手术治疗ⅡB期骨肉瘤患者296例,其中男性184例,女性112例,年龄7～65岁.其中股骨近端10例,股骨干部7例,股骨远端148例,胫骨近端80例,胫骨远端5例,腓骨11例,肱骨33例,桡骨远端2例.外科分期(Enneking分期):6例为ⅡA期,290例为ⅡB期.对所有病例进行术前化疗反应评估,72例进行肿瘤坏死率分析.结果 296例患者平均随访时间47个月,出现远处转移98例,占33.1%.对术前化疗反应明显有效的103例患者中,15.5%出现转移;部分有效的145例患者中,31.0%出现转移;术前化疗无效的48例患者77.1%出现转移.在坏死率分析研究中,化疗后肿瘤体积明显缩小、肿瘤边界变清晰的病例,肿瘤坏死率明显升高.结论 骨肉瘤一旦诊断明确,应尽早给予化疗,化疗效果良好的患者,全身转移的可能性减小,无瘤生存率高.     

Effect of Wilms tumor histology on response to neoadjuvant chemotherapy

Purpose

To evaluate the association between Wilms tumor histology at diagnosis and the change in Wilms' tumor volume during preoperative chemotherapy.

Breast conservation after neoadjuvant chemotherapy for stage II carcinoma of the breast

BACKGROUND: Neoadjuvant chemotherapy has become the standard treatment for stage III breast cancer. Gratifying results in these patients prompted this prospective, nonrandomized study of neoadjuvant chemotherapy in stage II breast cancer. This study presents our experience with neoadjuvant chemotherapy in 127 patients with stage II carcinoma of the breast. STUDY DESIGN: Patients with stages IIA (T > 3.0 cm) and IIB carcinoma were considered for this study and underwent treatment with cyclic chemotherapy until a plateau of response was achieved. Responders underwent breast conservation or mastectomy according to conventional assessment. Chemotherapy was continued in the adjuvant setting. Survival data were compared with historic controls. RESULTS: Between 1981 and 2001, 127 women between the ages of 22 and 80 years (mean age 52, median age 50), with stage II breast cancer were enrolled, with median followup of 60 months. One hundred twenty-two patients (96.1%) responded to chemotherapy. Of this group, 35 (29.2%) experienced complete pathologic responses or had only microscopic foci of disease after treatment. Sixty-two patients (52.5%) had negative lymph nodes at the time of the operation; 28 of these patients were previously considered N-1 clinically. Seventy-six patients (62%) underwent breast conservation. Overall survivals at 5 years for stage IIA and IIB disease were 94.7% and 88%, respectively. Disease-free survival at 5 years was 85.2% for stage IIA patients and 69.1% for stage IIB patients. CONCLUSIONS: Neoadjuvant chemotherapy can be effectively applied to patients with stage II disease, and breast conservation becomes feasible in the majority of patients. When compared with historic controls, the current study suggests a statistically significant overall survival advantage (p < 0.007) at 5 years.     

Surgical conservation planning after neoadjuvant chemotherapy for stage II and operable stage III breast carcinoma

BACKGROUND: This study was performed to investigate the extent of tumor downstaging achieved in women with operable breast cancer treated with neoadjuvant chemotherapy and breast-conservation surgery, develop recommendations for effective surgical planning, and report local-regional recurrence rates with this approach. METHODS: One hundred nine patients with stage II or III (T3N1) breast cancer were treated in three prospective trials utilizing four cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC, n = 72) or paclitaxel (n = 37) followed by segmental resection (n = 109) and axillary node dissection (n = 94). Postoperatively, patients received 4 additional cycles of FAC followed by irradiation of the breast. The median follow-up was 53 months. RESULTS: The median tumor size was 4 cm (range 1.1 to 9 cm) at presentation and only 1 cm (range 0 to 4.5 cm) after four cycles of chemotherapy. The primary tumor could not be palpated after chemotherapy in 55% of 104 patients presenting with a palpable mass and therefore required needle localization or ultrasound guidance for surgical resection. Of the 34 patients clinically deemed to have no residual carcinoma in the breast after chemotherapy and before surgery, only 50% of these patients were found to have no residual carcinoma on pathologic examination after surgery. Patients with primary tumors < or =2 cm were significantly more likely than patients with larger tumors to have complete eradication of the primary tumor prior to surgery (P <0.001). The 5-year local-regional recurrence rate was 5%. CONCLUSIONS: Tumor downstaging is marked in patients with operable breast cancer and requires close monitoring during chemotherapy. We recommend placement of metallic tumor markers when the primary tumor is < or =2 cm to facilitate adequate resection and pathologic processing. Resection of the tumor bed remains necessary in women deemed to have a complete clinical response to ensure low rates of recurrence.     

新辅助化疗对低位直肠癌化疗疗效及手术效果的影响

目的探讨规范化新辅助化疗(NC)治疗低位直肠癌的化疗疗效及对手术效果的影响。 方法选取2016年10月至2018年10月接受治疗的96例低位直肠癌患者为研究对象,按照随机数表分为两组,开腹组行开腹手术治疗,NC组术前添加规范化NC,治疗后行开腹手术,各48例。采用SPSS23.0软件对数据进行统计学分析。术中术后指标采用( ±s)描述,采用独立t检验;术后并发症发生率比较采用χ²检验,P<0.05为差异有统计学意义。 结果NC组淋巴结清扫数目、远切端长度显著高于开腹组淋巴结清扫数目、远切端长度(P<0.05)。两组患者手术时间、术中出血量差异无统计学意义(P>0.05);NC组术后排气时间、术后进食时间显著优于开腹组(P<0.05)。NC组术后并发症总发生率为12.5%,显著低于开腹组术后并发症总发生率29.2%,差异有统计学意义(P<0.05)。 结论规范化新辅助化疗联合常规开腹手术治疗能够增加淋巴结清扫数目、远切端长度,改善患者术后排气时间和进食时间,降低术后并发症发生率,适合临床推广应用。     

新辅助化疗后肿瘤坏死率及碱性磷酸酶同工酶变化与预后的相关性研究

目的探讨骨肉瘤患者新辅助化疗后的肿瘤坏死率（TCNR）及碱性磷酸酶骨同工酶（BALP）变化与预后的关系。方法选取2003年1月至2007年3月初诊经活检病理诊断为骨肉瘤且排除转移的58例患者,术前常规新辅助化疗,根据对手术切除肿瘤标本的TCNR测定将患者分为两组（TCNR≥90％和〈90％）,分别随访两组患者的术后肺转移率和5年生存率并进行比较。同时检测患者在化疗前后及随访期间血清中BALP,并对检测结果进行分析。结果58例骨肉瘤患者中TCNR≥90％组为36例,〈90％组为22例,两组的术后肺转移率分别为16．7％和81．8％（x^2=12．156,P〈0．01）,5年生存率分别为72．2％和22．7％（x^2=8．125,P〈0．01）。化疗后BALP的下降比值与TCNR的升高呈正相关（r=0．735,P〈0．01）。随访期间肿瘤复发转移组与无瘤生存组BALP水平上差异有统计学意义（P〈0．01）。结论TCNR测定是评价骨肉瘤新辅助化疗反应较可靠方法,TCNR≥90％患者的远期转移率和生存时间明显优于TCNR〈90％患者。BALP是骨肉瘤血清学检查的高灵敏度指标,在骨肉瘤的治疗监测和预后的判断上有很高价值。TCNR和BALP两者同时检测可以提高预后精确性。     

Effect of a local surgical procedure on the incidence of metastases following neoadjuvant chemotherapy of osteosarcoma

Following preoperative chemotherapy of 9-18 weeks duration limb salvage procedures were performed instead of ablative surgery in about 1/2 of the patients (pts). Overall continuous disease-free survival rate is 69% (80/115) at 37 (21-51) months. 5 pts died from therapy related complications, 4 developed a local failure (2 following amputation and 2 following limb salvage each) and 26 pts developed pulmonary metastases. The incidence of pulmonary metastases after en bloc resection, but not after shank rotation plasty, was found to be significantly increased over that after ablative surgery (83% vs 60% metastases free survival (MFS) at 40 months, p less than 0.05). The outcome was most unfavourable following en bloc resection of large tumors (36% MFS) and of tumors poorly responding to preoperative chemotherapy. Delaying surgery for preoperative chemotherapy in itself did not influence MFS-rate but it enabled a thorough planing and preparation of surgical procedures. Chemotherapy has very much improved the prognosis of osteosarcoma, trials on limb salvage surgery are indicated therefore. However, these procedures appear to be hazardous by increasing the rate of pulmonary metastases. Until the underlying mechanisms are not uncovered and preventive strategies worked out, limb salvage surgery in osteosarcoma has to be regarded and handled as an experimental procedure.     

Telangiectatic osteosarcoma of the extremity: neoadjuvant chemotherapy in 24 cases

Between April 1990 and December 1994, we treated 24 patients with telangiectatic osteosarcoma (TO) of the extremities with neoadjuvant chemotherapy using 2 protocols. Surgery consisted of limb salvage in 21 patients and amputation or rotation plasty in 3. The histologic response to chemotherapy was good (90% or more tumor necrosis) in 23 patients, of whom 12 had total necrosis. With a mean follow-up of 74 (60-96) months, 20 patients remained continuously free of disease and 4 relapsed with lung metastases. There were no local recurrences. Comparing these results to the ones achieved in 269 contemporary patients with conventional osteosarcoma of the extremities using the same protocols for chemotherapy, we found a significantly better histologic response to chemotherapy (96% vs 68% of good histologic response; p = 0.004) and disease-free survival (83% vs 55%; p = 0.01) in the TO group. We conclude that TO, once considered a lethal tumor, seems to be even more sensitive to chemotherapy than conventional osteosarcoma, and that most of these patients may be cured without amputation.     

The differences in the histological types of breast cancer and the response to neoadjuvant chemotherapy: the relationship between the outcome and the clinicopathological characteristics

Although effective regimens have been established for invasive ductal carcinoma-not otherwise specified (IDC), the efficacy and prognosis of other minor types of breast cancer are unknown because of their rareness. The clinicopathological features and prognosis of other minor types concerning the response to neoadjuvant chemotherapy (NAC) were evaluated in this study.A total of 562 patients were classified according to the Japanese and the World Health Organization (WHO) classifications, and the number of IDC and other special types (SP) was 500 and 62. The SP patients had a significantly poorer clinicopathological response to NAC and less breast-conservative therapy than those with IDC. According to the WHO classification, mucinous carcinoma, metaplastic carcinomas and apocrine carcinoma also responded poorly, and patients with metaplastic carcinomas and invasive lobular carcinoma had a significantly poorer prognosis. Despite the poor response to chemotherapy, patients with mucinous carcinoma and apocrine carcinoma had a good prognosis.The response to NAC and the prognosis vary for each histological type. For some types, the prognosis was not related to the clinicopathological response to NAC.BackgroundIn the treatment of breast cancer, neoadjuvant chemotherapy (NAC) has become the standard treatment modality for downstaging purposes. Although effective regimens have been established for the treatment of invasive ductal carcinoma-not otherwise specified (IDC), the data about the efficacy and prognosis for patients with other minor types of breast cancer are insufficient because of the rareness of these tumors. Defining the relationship between each histological type and the clinicopathological response to NAC is essential to optimizing individualized treatment.MethodsWe retrospectively evaluated the clinicopathological features and classification of the histological types based on the Japanese and the World Health Organization (WHO) classifications before and after NAC in 562 patients with primary breast cancer who underwent curative treatment after NAC between 1998 and 2008. The prognosis was estimated for each histological type.ResultsOf the 562 patients, the number of cases of IDC and other special types (SP) was 500 and 62. In the SP group, the clinicopathological response to NAC was significantly poorer, and the patients underwent breast-conservative therapy less frequently than did the IDC patients. According to the WHO classification, mucinous carcinoma, metaplastic carcinomas and apocrine carcinoma responded poorly to NAC. The disease-free survival and overall survival were significantly worse for patients with metaplastic carcinomas (p < 0.001 and p < 0.001) and with invasive lobular carcinoma (p = 0.03 and p < 0.001) than other cancers. Despite their poor response to treatment, patients with mucinous carcinoma and apocrine carcinoma had a good prognosis.ConclusionsThe response to standardized NAC and prognosis varies for each histological type. For some types, the prognosis was not associated with the clinicopathological response to NAC. Innovative regimens should therefore be investigated for each histological type to achieve the best response.     

The role of endoscopic ultrasound in assessing tumor response and staging after neoadjuvant chemotherapy for esophageal cancer

Background  

Although the role of endoscopic ultrasound (EUS) in the initial staging of esophageal cancer is well established, its role in assessing tumor response and staging esophageal cancers after neoadjuvant chemotherapy (NAC) is controversial, and this study aimed to investigate this role.     

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目的　研究采用TEF +CF联合化疗方案的新辅助化疗对乳腺癌的细胞增殖、微血管密度和组织学分级的影响。方法　应用免疫组化S -P染色法分别检测 13例行新辅助化疗的病人和 13例对照组病人手术切除的乳腺癌标本的增殖细胞核抗原 (PCNA)标记指数以及肿瘤组织的微血管密度 (MVD) ,并且对两组病人的HE染色标本进行组织学分级。结果　新辅助化疗组对化疗的总反应率为 92 9%。两组病例的PCNA标记指数差异有显著性 (P <0 0 1) ,MVD和组织学分级差异均有显著性 (P <0 0 5 )。结论　采用TEF +CF新辅助化疗方案近期疗效明显 ,可以显著地抑制乳腺癌细胞的增殖 ,减少新生血管的生成 ,降低组织学的分级。     

The importance of clinical stage among patients with a complete pathologic response at radical cystectomy after neoadjuvant chemotherapy

Purpose

Patients without evidence of disease at radical cystectomy (RC) following neoadjuvant chemotherapy (NAC) have the greatest potential for survival in muscle-invasive bladder cancer. Historically, 15 % of such patients will experience disease recurrence and cancer-specific mortality. We sought to evaluate the effect of pre-treatment clinical factors on the risk of recurrence in patients who were ypT0N0 at RC.

Methods

We performed a multi-institutional review of patients treated with NAC + RC for muscle-invasive bladder cancer (≥cT2) without pathologic evidence of disease at surgery (ypT0N0). The association of pre-treatment clinicopathologic features with recurrence was evaluated using Cox proportional hazards.

Results

A total of 78 patients were identified with ypT0 disease at RC after NAC. Median postoperative follow-up was 32.4 months (IQR 16.8, 60.0), during which time 17 patients recurred at a median of 6.4 months after RC. Estimated 3-year recurrence-free survival (RFS) of this cohort was 74.8 %. In univariate analysis, cT4 disease (HR 3.12; p = 0.04) and time to RC (HR 1.17 for each month increase; p < 0.01) were associated with inferior RFS.

Conclusion

Patients without evidence of disease at the time of RC are still at risk of recurrence and death from bladder cancer. Higher clinical stage and increased time to RC were associated with an increased risk of recurrence and subsequent death. These data highlight the importance of timely RC and the continued risk of recurrence in higher clinically staged patients—underscoring the need for close monitoring and patient counseling.

     

Adjuvant chemotherapy of metastatic stage II nonseminomatous testis tumor.

In a prospective randomized trial, 225 patients with stage IIB nonseminomatous testis tumor after radical retroperitoneal lymph node dissection received 2 versus 4 courses (arms 1 and 2, respectively) of adjuvant chemotherapy with cis-platinum, vinblastine and bleomycin. With a median followup of 43 months, a total of 7 relapses occurred; 6 in arm 1 and 1 in arm 2. Three patients died: 2 during adjuvant chemotherapy and 1 of progressive disease. The difference in relapse rates between arms 1 and 2 is not statistically significant. Patient compliance differed: chemotherapy was administered according to protocol in 83% and 50% of the cases in arms 1 and 2, respectively. Most frequent side effects observed were nausea, vomiting and alopecia. No significant differences regarding these or other side effects were obtained. Patients with stage IIB nonseminomatous testis tumor after retroperitoneal lymph node dissection are treated sufficiently with 2 courses of adjuvant cis-platinum-containing chemotherapy.     

Prognostic significance of the tumor volume in radical prostatectomy specimens after neoadjuvant hormonal therapy

INTRODUCTION: The objective of this study was to determine whether the tumor volume in radical prostatectomy specimens of patients with prostate cancer who underwent neoadjuvant hormonal therapy (NHT) could be used as a prognostic predictor. PATIENTS AND METHODS: In this study, we included 96 patients who underwent NHT followed by radical prostatectomy between January 1995 and July 2003 in our institutions. Several clinicopathological factors of these patients were analyzed, focusing on the association between tumor volume in radical prostatectomy specimens and disease recurrence. RESULTS: The tumor volume in radical prostatectomy specimens after NHT was significantly associated with capsular penetration, seminal vesicle invasion, and lymph node metastases, among the factors examined in this study. The biochemical recurrence-free survival rates in patients with tumor volumes <1.0 cm(3) were significantly higher than in those having tumor volumes > or =1.0 cm(3). However, multivariate analysis showed that the tumor volume could not be used as an independent predictor for biochemical recurrence. CONCLUSIONS: In patients who received NHT prior to radical prostatectomy, the tumor volume was shown to correlate with other prognostic indicators. Furthermore, a higher probability of biochemical recurrence was noted, when there was a residual tumor volume > or =1.0 cm(3) after NHT. Thus, careful follow-up and, if necessary, additional treatment should be considered in cases demonstrating tumor volumes > or =1.0 cm(3) after NHT.     

新辅助化疗及保乳手术在Ⅱ|Ⅲ期乳腺癌中的治疗作用

目的探讨新辅助化疗及保乳手术在Ⅱ,Ⅲ期乳腺癌治疗中的作用。方法对观察组46例Ⅱ,Ⅲ期乳腺癌经新辅助化疗后接受保乳手术治疗的患者进行随访观察,并与59例患者对照研究。新辅助化疗方案为表阿霉素60 mg/m2第1天静脉注射,紫杉醇150 mg/m2。第2天持续3 h静脉滴注,21 d为1个疗程。保乳手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清除。对照组常规行根治性切除术。术后对乳房外形及局部复发、远处转移进行随访观察。结果新辅助化疗后,观察组术前肿瘤病灶临床完全缓解(CR)9例,部分缓解(PR)37例。术后病理学检查发现,观察组癌细胞均有不同程度的变性、坏死,细胞间质水肿,纤维增生,炎性细胞浸润;其中病理完全缓解(PCR)4例。对保乳综合治疗(放疗+化疗)结束后1年的31例患者进行外形评估,其中优19.4%(6/31),良58.1%(18/31),差22.6%(7/31)。观察组局部复发率为8.7%(4/46),对照组为6.8%(4/59),两组比较无统计学意义(P0.05);观察组远处转移率为6.5%(3/46),与对照组(15.3%,9/59)比较无统计学意义(P0.05)。结论新辅助化疗后行保乳手术治疗Ⅱ,Ⅲ期乳腺癌基本是安全的,可达到根治性手术的效果。新辅助化疗,规范化切除,术后放疗、化疗是保乳治疗成功的关键。     

Radical surgery after neoadjuvant intra-arterial chemotherapy in stage IIIb squamous cell carcinoma of the cervix.

We examined the efficacy and safety of neoadjuvant intra-arterial chemotherapy (NAC) followed by radical hysterectomy and/or radiotherapy in patients with stage IIIb cervical cancer. Treatment consisted of bilateral internal iliac artery infusion of cisplatin or carboplatin and peplomycin every 21 days for two courses. Patients who responded to NAC underwent radical surgery. Patients who did not respond to NAC were treated with pelvic radiotherapy. Complete response was achieved in 2 (7.1%) of 28 patients, while a partial response was observed in 17 (60.7%) and stable disease in 9 (32.1%) patients. Sixteen patients (57.2%) were able to undergo surgery. The median blood loss (674 ml) and operating time (232 min) for radical surgery in patients with stage IIIb disease was similar to that in patients with stages Ib to IIb disease. No intra-operative or immediate postoperative complications were observed. The 5-year disease-free survival (DFS) for patients who underwent surgery (81.3%) was higher than for patients who underwent radiotherapy after NAC (31.3%). Radical surgery after NAC for stage IIIb disease was safe, and a survival benefit followed by surgery with or without radiotherapy.