Neoadjuvant and Adjuvant Surgical Interventions in Oncology: Optimizing Treatment Pathways

Aim The review aims to explore the evolution, current practices, and future directions of neoadjuvant and adjuvant therapies in surgical oncology. It emphasises the synergistic impact of integrating surgery with drug development, targeted therapies, and technological innovations to enhance cancer treatment outcomes. Method A systematic literature review was conducted following PRISMA guidelines, analysing historical developments, clinical trials, and recent advancements in multimodal cancer treatment. Data was collected from multiple reputable databases, including PubMed, Scopus, and Google Scholar, focusing on studies that highlight the integration of neoadjuvant and adjuvant therapies with surgical interventions. Keywords like "Neoadjuvant Therapy," "Adjuvant Surgical Intervention," and "Multimodal Cancer Treatment" guided the search. A total of 47 studies were included after applying specific inclusion criteria, ensuring relevance to the review's objectives. Results The analysis underscores the significant benefits of combining neoadjuvant therapies, which shrink tumours preoperatively to improve resectability, with adjuvant therapies, which target residual disease postoperatively to reduce recurrence risk. The review highlights the crucial role of personalized medicine, molecular profiling, and advancements in surgical technology. Clinical trials demonstrate improved survival rates with multimodal approaches, particularly in breast, rectal, and lung cancers. These strategies have enabled less invasive surgeries, better organ preservation, and enhanced patient's life quality. Conclusions Neoadjuvant and adjuvant surgical interventions represent a transformative approach in oncology, significantly enhancing patient outcomes. The integration of personalized medicine, innovative surgical techniques, and targeted therapies has optimised treatment pathways, reduced recurrence, and improved survival rates. The review calls for continuous optimization and individualisation of treatment sequencing to adapt to the evolving landscape of cancer care.

Therapeutic Advances in Pancreatic Cancer

The role of hormone therapy as a neoadjuvant to radical prostate radiotherapy.

Multidisciplinary considerations in the treatment of triple-negative breast cancer.

Does adjuvant therapy reduce postmetastatic survival?

Chemotherapy + PD-1/PD-L1 Blockade Should Be the Preferred Option in the Neoadjuvant Therapy of NSCLC

Original Articles: Bladder Cancer: Neoadjuvant Cisplatin Chemotherapy Before Radical Cystectomy in Invasive Transitional Cell Carcinoma of the Bladder: A Prospective Randomized Phase III Study

414 Background: Receipt of adjuvant therapy has become a standard of care for management of high risk localized renal cell carcinoma (RCC), with emerging literature demonstrating longer disease-free survival. Neoadjuvant approaches have been utilized investigationally to facilitate complete surgical resections in high risk and complex renal masses. We sought to evaluate outcomes of patients treated with neoadjuvant or adjuvant therapy in non-metastatic RCC utilizing a propensity score model. Methods: We queried the INMARC database for patients with localized surgically treated RCC who underwent systemic neoadjuvant or adjuvant therapy. Neoadjuvant therapy was defined as presurgical therapy given in the setting of localized disease and adjuvant therapy as systemic therapy given postoperatively in the absence of documented metastases. Patients with metastases at time of diagnosis were excluded from the analysis. A propensity score match (PSM) model in a 1:3 ratio was conducted within a caliper width of 0.1 including: age, sex, hypertension, Charlson Comorbidity Index, tumor size, tumor necrosis, stage, surgical margin, tumor grade and type of surgery [radical vs. partial nephrectomy]. Primary outcome was all-cause mortality (ACM), and secondary outcome was cancer-specific mortality (CSM). Multivariable analysis (MVA) via Cox regression was fitted for the outcomes of interest. Kaplan-Meier analysis (KMA) for overall (OS), cancer specific survival (CSS) was conducted for 5-year survival assessment. Results: After PSM 293 patients were analyzed [adjuvant n=203, (69.2%), 109 targeted therapy (TT) vs. 94 immunotherapy; neoadjuvant n=90, (30.7%), 59 TT vs. 31 immunotherapy]; median follow up was 50 (IQR 20-76) months from surgery . MVA revealed adjuvant vs. neoadjuvant (HR 1.98, p=0.007) and positive margin (HR 2.01, p=0.046) to be associated with increased risk of ACM; immunotherapy vs. TT (HR 0.47, p=0.001) was associated with a decreased risk. MVA for CSM revealed that adjuvant vs. neoadjuvant (HR 2.18, p=0.016) and positive margin (HR 2.41, p=0.028) were associated with increased risk of CSM, while immunotherapy vs. TT (HR 0.35, p<0.001) was associated with decreased risk. KMA comparing neoadjuvant vs. adjuvant 5-year OS was 80.4% vs. 64.8% (p=0.04), while CSS was 88.1% vs. 76.2% (p=0.03). Conclusions: In a comparison of patients with localized RCC who underwent adjuvant or neoadjuvant systemic therapy, receipt of neoadjuvant therapy was associated with superior survival outcomes. These findings are hypothesis generating and call for consideration for a clinical trial to compare outcomes of adjuvant vs. neoadjuvant therapy in high-risk localized RCC.

Pathological Downstaging and Survival Outcomes Associated with Neoadjuvant Chemotherapy for Variant Histology Muscle Invasive Bladder Cancer.

Gastric Adenocarcinoma in patients with Roux-en-Y Gastric bypass: A case series

Locally Advanced Rectal Cancer: What Does the Local Treatment Response Tell Us About the Global Picture?

The Efficacy of Neoadjuvant versus Adjuvant Therapy for Resectable Esophageal Cancer Patients: Direct and Indirect Comparisons <i>via</i> Meta-Analysis

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Muscle atrophy and strength decline are two of the most prominent characteristics in cancer patients undergoing cancer therapy, leading to decreased functional ability and reduced quality of life. Therefore, the aim is to systematically review research evidence of the effects of resistance exercise (RE) on lower-limb muscular strength, lean body mass (LBM), and body fat (BF) in cancer patients undertaking neoadjuvant or adjuvant therapy. This research was conducted using the following online database: Clinical Trial Register, Cochrane Trial Register, PubMed, SPORT Discus, and SciELO, from September 2014 until May 2015. We used the following keywords in various combinations with a systematic search: "Cancer therapy," "Wasting muscle," "Muscle loss," "Muscle function," "Neoadjuvant therapy," "Adjuvant thera-py," "Resistance Training," "Weight training," and "Exercise." After selection of 272 full-text articles, 14 publications were included in this meta-analysis. Resistance exercise (RE) during neoadjuvant or adjuvant therapy increased lower-limb muscular strength (mean: 26.22kg, 95% CI [16.01, 36.43], heterogeneity: P=<0.01, I 2=76%, P=0.00001) when compared to controls over time. Similarly, lean body mass (LBM) increased (mean 0.8kg, 95% CI [0.7, 0.9], heterogeneity: P=0.99, I 2=0%, P<0.00001), and decreased body fat (BF) (mean: -1.3kg, 95% CI [-1.5, 1.1], heterogeneity: P=0.93, I2=0%, P<0.00001) compared to controls over time. RE is effective to increase lower-limb muscular strength, increase LBM, and decrease BF in cancer patients undergoing neoadjuvant and adjuvant therapy regardless of the kind of treatment. RE increases muscle strength, maintains LBM, and reduces BF in cancer patients undergoing adjuvant and neoadjuvant therapies. Cancer patients and survivors should consider undertaking RE as an effective countermeasure for treatment-related adverse effects to the musculoskeletal system.

Systematic Review of Neoadjuvant Immunotherapy for Patients With Non–Small Cell Lung Cancer