直肠癌新辅助放化疗后病理完全缓解的临床因素分析

目的 评估影响直肠癌新辅助放化疗后pCR的临床因素。方法 回顾分析2009—2012年间接受新辅助放化疗随后行根治性手术的116例直肠癌患者临床资料。所有患者术前接受盆腔调强放疗50 Gy分25次,同期氟尿嘧啶为基础化疗,完成治疗休息4~8周后行根治性手术。应用 Logistic法分析影响pCR和非pCR的临床因素。结果 共20例患者经新辅助放化疗后达pCR,pCR率为17.2%。单因素分析表明肿瘤侵犯直肠管腔周径范围达75%以上(全周肿瘤)、治疗前血清CEA水平、T分期、N分期、肛缘距离、分化程度、肿瘤最大直径与直肠癌新辅助放化疗后肿瘤pCR水平相关。多因素分析结果显示全周肿瘤、治疗前血清CEA水平和T分期是影响放化疗后肿瘤pCR预测因素。结论 非全周肿瘤、低CEA水平和早T分期等治疗前临床因素可能是获得pCR的重要决定因素。     

功能成像技术对局部晚期直肠癌新辅助治疗预测与评估价值

对于局部晚期直肠癌,新辅助放化疗后行手术切除,再行术后辅助化疗,已发展为标准治疗模式。新辅助治疗可使肿瘤病灶发生不同程度的退缩,部分患者术后病理证实达到完全缓解,有助于增加直肠癌患者根治性手术概率,并降低复发率,改善患者的远期预后。近年来,新辅助治疗疗效的预测和评估,成为临床医生关注的焦点。在影像学方面,常规的形态成像技术,不能够准确反映新辅助放化疗后肿瘤治疗效果,而DWI-MRI、DCE-MRI、PET-CT等功能成像技术不仅能够反映肿瘤退缩程度,还可以反映治疗前后肿瘤功能代谢方面的变化,因而更为准确。现对直肠癌新辅助放化疗影像学疗效评价方法的应用现状进行综述。     

直肠癌术前放化疗完全缓解后的临床策略分析

  目的  探讨直肠癌经新辅助放化疗后获得完全缓解病例的处理办法。  方法  回顾性分析河南大学淮河医院2010年1月至2014年8月收治的直肠癌术前进行新辅助放化疗的84例患者临床资料。  结果  经过新辅助放化疗,33例（39.3%）患者获得临完全床缓解（clinical complete response,cCR）;经术后病理检查,6例患者获得病理完全缓解（pathological complete response,pCR）,占cCR病例的18.2%（6/33）,术后随访12~36个月均未出现肿瘤转移复发情况。  结论  新辅助放化疗能明显降低肿瘤分期,并能使部分患者获得cCR。对于cCR病例,不建议非手术治疗。      

Significance of tumor‐infiltrating lymphocytes before and after neoadjuvant therapy for rectal cancer

Neoadjuvant therapy for locally advanced rectal cancer is becoming increasingly common. However, biomarkers predicting the response to neoadjuvant therapy have not been established. Tumor‐infiltrating lymphocytes (TILs) have a crucial effect on tumor progression and survival outcome as the primary host immune response, and an antitumor immune effect has been reported to contribute to the response to radiotherapy and chemotherapy. We investigated the significance of TILs before and after neoadjuvant treatment and the change in the density of those TILs. Sixty‐four patients who underwent radical resection after neoadjuvant treatment for locally advanced rectal cancer were enrolled. The number of TIL subsets was examined using immunohistochemical staining of pretreatment biopsy samples and post‐treatment resected specimens. In both the neoadjuvant chemotherapy cohort and the neoadjuvant chemoradiotherapy cohort, a low density of CD8⁺ TILs in pretreatment biopsy samples was associated with a poor response, and a low density of CD8⁺ TILs in post‐treatment resected specimens was similarly associated with a poor response. In the neoadjuvant chemoradiotherapy cohort, the density of CD8⁺ TILs in post‐treatment resected specimens was significantly increased compared with that in pretreatment biopsy samples. We concluded that T lymphocyte‐mediated immune reactions play an important role in tumor response to neoadjuvant treatment for rectal cancer, and the evaluation of TILs in pretreatment biopsy samples might be a predictor of the clinical effectiveness of neoadjuvant treatment. Furthermore, neoadjuvant therapy, especially chemoradiotherapy, could induce the activation of the local immune status.     

直肠癌新辅助放化疗临床效果的评估

直肠癌是常见的恶性肿瘤，直肠癌发病率近年有上升趋势。全直肠系膜切除术（total mesorectal excision ，TME ）是直肠癌的最主要治疗手段，但局部进展期直肠癌患者术后局部复发率高、保肛率低，新辅助放化疗成为局部晚期直肠癌的优选治疗手段。直肠癌新辅助治疗后的临床效果是临床医生关注的焦点。直肠癌新辅助治疗效果的预测及评估关系到后续治疗方案的选择，影响患者的生存期及生活质量。      

Predictive Factors for Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Background: An accurate assessment of potential pathologic complete response(pCR) following neoadjuvant chemoradiotherapy(NCRT) is important for the appropriate treatment of rectal cancer. However, the factors that predict the response to neoadjuvant chemoradiotherapy have not been well defined. Therefore, this study analyzed the predictive factors on the development of pCR after neoadjuvant chemoradiation for rectal cancer. Methods: From January 2008 to January 2018, a total of 432 consecutive patients from a single institution patients who underwent a long-course neoadjuvant chemoradiotherapy were reviewed in this study. The clinicopathological features were analyzed to identify predictive factors for pathologic complete response in rectal cancer after neoadjuvant chemoradiation. Results: The rate of pathologic complete response in rectal cancer after neoadjuvant chemoradiation was 20.8%, patients were divided into the pCR and non-pCR groups. The two groups were well balanced in terms of age, gender, body mass index, ASA score, tumor stage, tumor differentiation, tumor location, surgical procedure, chemotherapy regimen and radiation dose. The multivariate analysis revealed that a pretreatment carcinoembryonic antigen (CEA) level of ≤5 ng/mL and an interval of ≥8 weeks between the completion of chemoradiation and surgical resection were independent risk factors of an increased rate of pCR. Conclusions: Pretreatment carcinoembryonic antigen (CEA) level of ≤5 ng/mL and an interval of ≥8 weeks between the completion of chemoradiation and surgical resection are predictive factors for pathologic complete response in rectal cancer after neoadjuvant chemoradiation. Using these predictive factors, we can predict the prognosis of patients and develop adaptive treatment strategies. A wait-and-see policy might be possible in highly selective cases.     

Clinical and biochemical predictors of tumor response after neoadjuvant therapy in rectal cancer

Background

Patients who have a good clinical and/or pathologic response to neoadjuvant chemoradiotherapy (nCRT) for rectal cancer have better long-term outcomes and can potentially be spared morbid surgery. This study aimed to identify pretreatment clinical and biochemical predictors of response to neoadjuvant treatment for rectal cancer.

Methods

Patients undergoing neoadjuvant therapy for rectal cancer between 2007 and 2022 were retrospectively included. Those patients who achieved a complete clinical response were offered a nonoperative management strategy and the remaining patients underwent surgical resection. The primary endpoint was tumor regression grade (TRG) based on radiological imaging (mrTRG) or pathology (pTRG). Patient response was classified as good (mrTRG 1–2 or pTRG 0–1) versus poor (mrTRG 3–4 or pTRG 2–3). Logistic regression was performed to determine predictors of TRG.

Results

A total of 984 patients with rectal cancer were identified of which 274 met the inclusion criteria. Of 274 patients, 228 (83%) underwent surgical resection. A good TRG response was observed in 119 (41%) patients, and a complete response was achieved in 53 (17%) patients. On univariable and multivariable logistic regression, clinical T2 stage and body mass index of ≥25 kg/m² were significant predictors of a good TRG. Clinical T2 stage and a personalised total neoadjuvant therapy regimen were significant predictors of complete response.

Conclusion

Clinical T2 stage and a BMI≥25 kg/m² were predictors of good response to neoadjuvant therapy for rectal cancer. Future prospective studies are required to confirm these findings and evaluate their potential use in better targeting of nCRT.     

Ku70 和端粒酶及端粒酶逆转录酶预测直肠癌新辅助放化疗的疗效

目的 研究Ku70、端粒酶（telomerase）及端粒酶逆转录酶（hTERT） 3种蛋白预测Ⅱ期和Ⅲ期直肠癌放疗联合XELOX方案化疗的疗效。方法 根据新辅助放化疗前后影像学检查的疗效评价,将入组患者分为有效组27例和无效组18例;采用免疫组化SP法检测两组患者新辅助放化疗前后Ku70、端粒酶及hTERT 蛋白的表达情况,并分析其与疗效的关系。结果 有效组患者hTERT蛋白的表达水平比无效组低,差异具有统计学意义（P〈0.05）。Ku70、端粒酶蛋白在有效组与无效组患者中的表达水平差异无统计学意义（P〉0.05）。Ku70、 端粒酶及hTERT蛋白的表达水平在放化疗前后的差异有统计学意义（P〈0.05）。直肠癌患者新辅助放化疗的疗效与患者KPS评分、性别、年龄和病理类型等无关（P〉0.05）。结论 hTERT蛋白的表达可以反映Ⅱ期和Ⅲ期直肠癌患者予放疗联合XELOX方案化疗的新辅助放化疗的疗效。     

A Panel of Tumor Biomarkers to Predict Complete Pathological Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer

Pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients is related to a favorable prognosis. The identification of early biomarkers predictive of pathological complete response would help optimize the multimodality management of the patients. A panel of 11 tumor-related proteins was investigated by immunohistochemistry in the pretreatment biopsy of a group of locally advanced rectal cancer patients to identify early biomarkers of pathological complete response to neoadjuvant chemoradiotherapy. A mono-institutional retrospective cohort of 95 stage II/III locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy and surgery was selected based on clinical–pathological characteristics and the availability of a pretreatment tumor biopsy. Eleven selected protein marker expression (MLH1, GLUT1, Ki67, CA-IX, CXCR4, COX2, CXCL12, HIF1a, VEGF, CD44, and RAD51) was investigated. The optimal cutoff values were calculated by receiver operating characteristic curve analysis. Classification and regression tree analysis was performed to investigate the biomarker interaction. Patients presenting either Ki-67 or HIF1a or RAD51 below the cutoff value, or CXCR4 or COX2 above the cutoff value, were more likely to get a pathological complete response. Classification and regression tree analysis identified three groups of patients resulting from the combination of Ki-67 and CXCR4 expression. Patients with high expression of Ki-67 had the lowest chance to get a pathological complete response (18%), as compared to patients with low expression of both Ki-67 and CXCR4 (29%), and patients with low Ki-67 and high CXCR4 expression (70%). Pretreatment Ki-67, CXCR4, COX2, HIF1a, and RAD51 in tumor biopsies are associated with pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. A combined evaluation of Ki-67 and CXCR4 would increase their predictive potential. If validated, their optimal cutoff could be used to select patients for a tailored multimodality treatment.     

Serum Cytokeratin 18 as a Potential Early Marker for Chemotherapy Response in Breast Cancer Patients: A Prospective Study

Background: Currently, it is well recognized that response to neoadjuvant chemotherapy is an important predictive factor for survival in breast cancer patients. However, it is still an area of research about which patient would respond to the neoadjuvant chemotherapy. Methods: Serum CK18 levels were measured using ELISA from 52 newly diagnosed breast cancer patients, at presentation and after first cycle of neo-adjuvant chemotherapy. Pre- and post-treatment CK-18 levels were correlated with several clinical and pathological parameters. At the end of neoadjuvant treatment, changes in serum CK18 levels were correlated with tumors’ response to therapy. Results: Significant elevation of pre-chemotherapy CK18 level was observed in patients who had progressive disease compared to those who had complete or partial response to therapy (P=0.006 and P<0.001, respectively). Significantly higher CK18 levels were observed post-chemotherapy in complete and partial responders, in contrast to patients with stable or progressive disease (P=0.012% and P=0.001%, respectively). The percent of change was significantly higher in complete responders compared to patients who had stable or progressive disease (P=0.043% and P=0.045%, respectively). Conclusion: Our results suggest that patients with increasing CK18 level following chemotherapy are potential responders to their neoadjuvant protocol. Thus, the measurement of serum CK18 early in the treatment course could be a simple, noninvasive way to predict tumor response to neoadjuvant chemotherapy.     

A Panel of Tumor Biomarkers to Predict Complete Pathological Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer

Pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients is related to a favorable prognosis. The identification of early biomarkers predictive of pathological complete response would help optimize the multimodality management of the patients. A panel of 11 tumor-related proteins was investigated by immunohistochemistry in the pretreatment biopsy of a group of locally advanced rectal cancer patients to identify early biomarkers of pathological complete response to neoadjuvant chemoradiotherapy. A mono-institutional retrospective cohort of 95 stage II/III locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy and surgery was selected based on clinical–pathological characteristics and the availability of a pretreatment tumor biopsy. Eleven selected protein marker expression (MLH1, GLUT1, Ki67, CA-IX, CXCR4, COX2, CXCL12, HIF1α, VEGF, CD44, and RAD51) was investigated. The optimal cutoff values were calculated by receiver operating characteristic curve analysis. Classification and regression tree analysis was performed to investigate the biomarker interaction. Patients presenting either Ki-67 or HIF1α or RAD51 below the cutoff value, or CXCR4 or COX2 above the cutoff value, were more likely to get a pathological complete response. Classification and regression tree analysis identified three groups of patients resulting from the combination of Ki-67 and CXCR4 expression. Patients with high expression of Ki-67 had the lowest chance to get a pathological complete response (18%), as compared to patients with low expression of both Ki-67 and CXCR4 (29%), and patients with low Ki-67 and high CXCR4 expression (70%). Pretreatment Ki-67, CXCR4, COX2, HIF1α, and RAD51 in tumor biopsies are associated with pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. A combined evaluation of Ki-67 and CXCR4 would increase their predictive potential. If validated, their optimal cutoff could be used to select patients for a tailored multimodality treatment.Key words: Rectal cancer, Neoadjuvant chemoradiotherapy (nCRT), Pathological complete response (pCR), Predictive biomarkers, Immunohistochemistry (IHC)     

进展期胃癌新辅助治疗后病理完全缓解相关因素分析及风险预测模型建立

  目的  探讨局部进展期胃癌新辅助治疗后病理完全缓解（pathological complete response，pCR）的临床相关因素。  方法  回顾性分析2011年6月至2018年3月河北医科大学第四医院收治的452例局部进展期胃癌患者cT3~4N+~M0新辅助治疗及手术的临床资料，采用单因素分析及Logistic多因素回归分析法研究pCR的临床相关因素。  结果  452例患者全部完成新辅助治疗及根治性手术，其中44例（9.7%）患者达到pCR。治疗前T分期为T3期、肿瘤最长径 < 4 cm、治疗前CA199≤30 U/mL、治疗结束与手术时间间隔≥6周、同步放化疗或联合靶向治疗方案与进展期胃癌新辅助治疗后高pCR率有关（均P < 0.05）。治疗前T分期为T3期、CA199≤30 U/mL、肿瘤最长径 < 4 cm、新辅助同步放化疗或联合靶向治疗是影响进展期胃癌新辅助治疗后出现pCR的独立因素（均P < 0.05）。以上每项指标出现pCR的预测评分均为1分。评分>2分患者出现pCR的概率为34.48%，评分≤2分患者出现pCR的概率为6.09%。  结论  治疗前临床分期、CA199水平、肿瘤最长径及治疗模式是进展期胃癌新辅助治疗后达到pCR的影响因素，通过预测评分模型能有效识别其发生率。      

局部晚期直肠癌新辅助治疗pCR相关因素研究

目的 评价局部晚期直肠癌新辅助治疗后pCR的相关影响因素。方法 回顾分析2011—2013年间收治的265例AJCC分期Ⅱ、Ⅲ期直肠癌患者资料。所有患者均接受新辅助治疗±等待手术间期化疗, 而后手术。运用单因素和二元Logistic回归多因素分析影响pCR的预测因素, 并根据预测危险因素进行归类后分为无风险组(无因素)、低风险组(1个因素)、高风险组(2个因素)。建立临床风险评估模型。因素分析运用二元Logistic回归模型。结果 达pCR者50例(18.9%)。单因素分析中新辅助治疗前CEA、放化疗前T分期、同期放化疗结束至手术间隔时间和放化疗前肿瘤最大厚度对pCR有影响(P=0.017、0.001、0.000、0.040), 多因素分析显示新辅助治疗前CEA水平和同期放化疗结束至手术间隔时间是pCR影响因素(P=0.021、0.001), 进一步分层分析表明只有非吸烟组中新辅助治疗前低水平CEA对pCR有影响(P=0.044)。临床风险评估模型诊断pCR的敏感性为80.5%, 特异性为46.0%, AUC为0.690, 阳性预测值为35.49%, 阴性预测值为86.5%, 准确性为73.9%。结论 新辅助治疗能使部分局部晚期直肠癌患者达pCR。新辅助治疗前低水平CEA和更长的同期放化疗结束至手术间隔时间是局部晚期直肠癌新辅助治疗pCR的预测因素, 而新辅助治疗前低水平CEA对pCR预测只在非吸烟人群中有效。根据新辅助治疗前CEA>5 ng/ml和同期放化疗结束至手术间隔时间≤8周的危险因素建立的临床风险评估模型可用于预测局部晚期直肠癌新辅助治疗pCR率。     

A2aR在直肠癌组织中的表达及其与新辅助放化疗敏感性的关系

目的:探讨A2a型腺苷受体(adenosine 2a receptor,A2aR)在直肠癌组织中的表达丰度,并探讨其与直肠癌新辅助放化疗敏感性的关系.方法:收集56例2014年06月至2019年06月期间于我院行直肠癌新辅助放化疗治疗前活检石蜡标本,采用免疫组织化学染色法检测其中A2 aR蛋白的表达情况.采用直肠癌消退...     

Tumor infiltrating lymphocytes (TILs) before and after neoadjuvant chemoradiotherapy and its clinical utility for rectal cancer

Backgrounds: Radiotherapy (RT) and chemotherapy (CT) can potentiate systemic antitumor immune effect. However, immunomodulation during RT or CT and their clinical implications in rectal cancer have not been thoroughly investigated. Methods: We investigated alterations in the densities of tumor infiltrating lymphocytes (TILs) during chemoradiation and their clinical utilities in patients with rectal cancer. We analyzed 136 rectal cancer patients who underwent neoadjuvant RT, CT or chemoradiotherapy (CRT), followed by radical resection retrospectively. Pretreatment biopsy specimens and posttreatment resected specimens of all patients were immunostained for CD3 and CD8. The predictive value of TILs to neoadjuvant treatment and prognosis were examined. Results: Densities of CD3+ and CD8+TILs in posttreatment specimens after RT, CT or CRT were all significantly higher than those in pretreatment specimens. There were no significant differences between each two of these three groups. High pretreatment CD3+ and CD8+TILs were associated with good response (TRG ≥ 3) after neoadjuvant treatments (P = 0.033 and 0.021). High CD3+TILs and CD8+TILs in pretreatment biopsy specimens were significantly associated with favorable disease free survival (DFS) (P = 0.010 and P = 0.022) and overall survival (OS) (P = 0.019 and P = 0.003). Conclusions: We may, thus, conclude that chemoradiation can enhance local immune response by increased TILs. High TILs densities before treatment are associated with good response to neoadjuvant chemoradiotherapy and a favorable prognosis.     

直肠癌新辅助治疗进展

近年来新辅助治疗已成为局部晚期中低位直肠癌的标准治疗,目前常用的方案为长程同步放化疗与短程放疗。全新辅助治疗也是可行的新辅助治疗方案,临床完全缓解后等待观察的临床研究也在进行中。本文就直肠癌新辅助治疗的现状与研究进展进行综述。     

直肠癌新辅助放化疗前后LGR5基因表达的变化及其与疗效的关系

目的：探讨肿瘤干细胞标记基因LGR5在局部晚期直肠癌新辅助放化疗（放疗同时口服卡培他滨）前后表达的变化,及其对新辅助放化疗效果预测的作用。方法：收集2014年1月-2016年2月在新疆医科大学附属肿瘤医院接受新辅助放化疗并手术治疗的94例局部晚期直肠癌患者临床资料,对其新辅助放化疗前肠镜活检组织及新辅助放化疗后手术切除组织标本采用荧光定量PCR（qPCR）法检测LGR5 mRNA的表达,分析其在新辅助放化疗前后表达水平的变化及其与疗效的关系,采用Kaplan-Meier法进行生存分析,Log-rank法进行单因素预后分析和Cox回归进行多因素预后分析。结果：直肠癌患者接受新辅助放化疗后肿瘤病理退缩反应良好,肿瘤退缩有效率达87.2%,其中病理完全缓解率为18.1%。直肠癌癌组织中LGR5 mRNA的相对表达水平从新辅助放化疗前的14.396±9.924减少到手术后的8.847±6.664,总体表达水平显著下降（P < 0.05）。放化疗后LGR5 mRNA表达上调者27例,表达下调者67例,表达下调组肿瘤病理退缩程度（TRG）和1、2年生存率均明显优于表达上调组（P < 0.05）。单因素生存分析结果显示放化疗前血清CA19-9水平、临床分期、TRG分级和LGR5 mRNA表达差异为直肠癌预后的影响因素（P均 < 0.05）;多因素分析表明放化疗前CA19-9水平和放化疗前后LGR5 mRNA表达差异是直肠癌预后的影响因素（P分别为0.013和0.015）。结论：新辅助放化疗可以诱导LGR5 mRNA表达的改变,检测其表达对于判断直肠癌预后及指导治疗具有参考价值,新辅助放化疗前后LGR5 mRNA表达变化和放化疗前CA19-9水平有可能成为预测局部晚期直肠癌新辅助放化疗效果的参考指标。     

局部晚期直肠癌新辅助放化疗研究进展

直肠癌是最常见的恶性肿瘤之一,近年来发病率及死亡率日趋升高。患者确诊时大多为中晚期,新辅助放化疗可有效提高局部晚期直肠癌患者的局部控制率、保肛率及病理缓解率,进而改善患者预后。局部晚期直肠癌异质性明显,多项研究对新辅助治疗的具体方案进行探索,如何优化新辅助治疗模式是进一步研究的热点。文章对近年来局部晚期直肠癌新辅助放化疗的研究进展做一综述,为局部晚期直肠癌的精准化医疗提供了参考。     

CT findings of breast cancer with clinically complete response following neoadjuvant chemotherapy--histological correlation

In breast cancer patients, several regimens of neoadjuvant chemotherapy have been developed in order to achieve prognostic advantages for individual patients. Though some percentages of breast cancer patients show clinically complete response to neoadjuvant chemotherapy, the histopathological specimens of these patients demonstrate a considerably high frequency of the existence of residual disease. In this study, we aimed to evaluate the therapeutic effect of neoadjuvant chemotherapy for breast cancer patients showing clinically complete response (cCR) to neoadjuvant chemotherapy, using thin-section (5 mm) helical CT (prone position) with bolus injection of contrast agent. Between April 1994 and March 2002, 9 patients with breast cancer showing cCR to the neoadjuvant chemotherapy, who had undergone thin-section CT study both before and following neoadjuvant chemotherapy, enrolled in the study. The mean age of the patients was 46.2 years and all of them were female. The clinical stages were, 8 patients in stage II, and one in stage IIIA. In the CT evaluation, residual disease was visualized in 5 out of the 9 patients. Histopathological examination disclosed the existence of residual cancers in 6 out of the 9 patients, but only non-invasive cancer was revealed in 1 out of the 6. As patients having residual disease composed only of non-invasive cancer are classified into the pathologically complete response group according to the WHO classification, 4 out of these 9 patients showing clinically complete response to the neoadjuvant chemotherapy were classified into pCR (pathologically complete response) group, and another 5 were classified into the pPR (pathologically partial response) group. As a result, the diagnostic accuracy of the second CT study performed after neoadjuvant chemotherapy was evaluated as 77.8%, with a sensitivity of 80.0%, a specificity of 75.0%, a positive predictive value (PPV) of 80.0%, and a negative predictive value (NPV) of 75.0%. Therefore, for precise evaluation of the neoadjuvant chemotherapeutic effect for breast cancer, thin-section CT studies are considered to be essential.