Intravenous Neoadjuvant Chemotherapy Research Articles

Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis

ObjectiveThe objective of this systematic review was to evaluate the effect of different types of neoadjuvant chemotherapy regimens, in terms of optimal pathological response and oncological outcomes, in patients with...

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

ObjectiveThe objective of this systematic review was to assess the oncologic and fertility outcomes of patients with cervix-confined cancer >4 cm who underwent neo-adjuvant chemotherapy followed by fertility-sparing surgery.MethodsThis study...

The Safety and Efficacy of Intra-Arterial versus Intravenous Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer: A Meta-Analysis.

Objective The aim of this study was to evaluate the safety and efficacy of intra-arterial versus intravenous neoadjuvant chemotherapy for the management of patients with locally advanced cervical cancer. Methods The PubMed, EMBASE, PMC, Web of Science, and Cochrane databases were searched to identify correlational studies published in English. Prospective controlled studies that evaluated the treatment effect of intra-arterial neoadjuvant chemotherapy or intravenous neoadjuvant chemotherapy in patients with locally advanced cervical cancer were pooled for a meta-analysis. Results A total of three eligible studies with 112 patients with locally advanced cervical cancer were eventually included in this analysis. The baseline regimen of neoadjuvant chemotherapy was platinum-based chemotherapy. The total clinical response rate was 71.4%, and the overall pathological complete response (CR) rate was 11.5%. The grade 3/4 toxicity rate was 27.2%. In the intra-arterial group, the response rate was 83.1% (CR, 22.0%; partial response (PR), 61.0%), which was significantly higher than 58.5% (CR, 11.3%; PR, 47.2%) in the intravenous group (P=0.01). The pathological CR rate was 15.5% in the intra-arterial group, which was higher than 6.5% in the intravenous group. The grade 3/4 toxicity rate was 17.2% in the intra-arterial group, which was higher than the rate of 13.8% in the intravenous group. Conclusion Platinum-based neoadjuvant chemotherapy was well tolerated in patients with locally advanced cervical cancer and showed moderate response activity. Compared to intravenous neoadjuvant chemotherapy, intra-arterial neoadjuvant chemotherapy had an evident advantage in terms of the clinical response while maintaining a similar toxicity rate. The clinical efficacy of intra-arterial neoadjuvant chemotherapy deserves further evaluation.

1354 The Safety and Efficacy Of Intra-Arterial Versus Intra-Venous Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer: A Meta-Analysis

Study Objective The aim of this study was to evaluate the safety and efficacy of intra-arterial (NCIA) versus intravenous (NCIV) neoadjuvant chemotherapy in managing patients with locally advanced cervical cancer (LACC). Design The PubMed, EMBASE, PMC, Web of Science and Cochrane databases were searched to identify correlational studies published in English. Prospective controlled studies that evaluated the treatment effect of NCIA or NCIV in patients with LACC were pooled for a meta-analysis. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results A total of three eligible studies with 112 LACC patients were eventually included in this analysis. The baseline regimen of neoadjuvant chemotherapy (NACT) was platinum-based chemotherapy. The total clinical response rate (RR) was 71.4%, and the pathological complete response (PCR) was 11.5% overall. The grade 3/ 4 toxicity rate was 27.2%. In the NCIA group, the RR was 83.1% (complete response [CR], 22.0%; partial response [PR], 61.0%), which was significantly higher than the 58.5% RR (CR, 11.3%; PR, 47.2%) in the NCIV group (P=0.005). The PCR was 15.5% in the NCIA group, which was slightly higher than 6.5% PCR in the NCIV group (P=0.43). The grade 3/4 toxicity rate was 17.2% in the NCIA group, which was slightly higher than the 13.8% toxicity rate in the NCIV group (P=0.38). Conclusion Platinum-based NACT was well tolerated in patients with LACC and showed moderate response activity. Compared to NCIV, NCIA showed an evident advantage in the clinical response with a similar toxicity rate. The clinical efficacy of NCIA deserves further evaluation.

Detection of circulating tumor cells and circulating tumor DNA before and after mammographic breast compression in a cohort of breast cancer patients scheduled for neoadjuvant treatment

PurposeIt is not known if mammographic breast compression of a primary tumor causes shedding of tumor cells into the circulatory system. Little is known about how the detection of circulating biomarkers such as circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) is affected by breast compression intervention.MethodsCTCs and ctDNA were analyzed in blood samples collected before and after breast compression in 31 patients with primary breast cancer scheduled for neoadjuvant therapy. All patients had a central venous access to allow administration of intravenous neoadjuvant chemotherapy, which enabled blood collection from superior vena cava, draining the breasts, in addition to sampling from a peripheral vein.ResultsCTC and ctDNA positivity was seen in 26% and 65% of the patients, respectively. There was a significant increase of ctDNA after breast compression in central blood (p = 0.01), not observed in peripheral testing. No increase related with breast compression was observed for CTC. ctDNA positivity was associated with older age (p = 0.05), and ctDNA increase after breast compression was associated with high Ki67 proliferating tumors (p = 0.04). CTCs were more abundant in central compared to peripheral blood samples (p = 0.04).ConclusionsThere was no significant release of CTCs after mammographic breast compression but more CTCs were present in central compared to peripheral blood. No significant difference between central and peripheral levels of ctDNA was observed. The small average increase in ctDNA after breast compression is unlikely to be clinically relevant. The results give support for mammography as a safe procedure from the point of view of CTC and ctDNA shedding to the blood circulation. The results may have implications for the standardization of sampling procedures for circulating tumor markers.

Application of combined intraperitoneal and intravenous neoadjuvant chemotherapy in senile patients with advanced ovarian cancer and massive ascites.

The aim of this study was to explore the effects of neoadjuvant chemotherapy in senile patients with advanced ovarian can- cer and ascites. One hundred eight senile patients with advanced ovarian cancer and ascites were randomly di- vided into two groups: experimental and control groups. Patients in the experimental group were treated with two courses of intraperitoneal combined with intravenous neoadjuvant chemotherapy, followed by cytoreductive surgery, and six courses of intravenous chemotherapy, while the patients in the control group only received cytoreductive surgery and six to eight courses of intravenous chemotherapy. The operation duration, blood loss, ideal success rate of cytoreductive surgery, and prognosis of the two groups were then compared. Thirty-eight patients in the experimental group successfully received cytoreductive surgery, accounting for 74.14%, while only 23 patients in the control group received cytoreductive surgery successfully, accounting for 46%, showing signifinificantly less than those in the control group (p < 0.001). However, the median survival and the median progression-free survival showed no statistical difference between the two groups (p > 0.05). Neoadjuvant chemotherapy can obviously shorten the operation duration, reduce the intraoperative blood loss, and improve the ideal success rate of cytoreductive surgery, but does not obviously improve the prognosis.

Neoadjuvant intra‐arterial chemotherapy in advanced laryngeal and hypopharyngeal cancer

To investigate whether neoadjuvant intra-arterial chemotherapy down-stages the tumors and predicts ultimate outcome in patients with advanced laryngeal and hypopharyngeal cancer. Fifteen patients with stage III and IV cancers received two cycles of intra-arterial cisplatin (40 mg/m(2)) at days 1 and 15, infused super-selectively into superior thyroid artery. Interim evaluation using RECIST 1.1 and volumetry was done in all patients at day 25. Subsequently, the patients received concurrent chemoradiotherapy or surgery with radiotherapy. Final evaluation was done in 10 patients. At interim evaluation, five patients qualified as responders. Partial response, stable disease and progressive disease rates were 40, 33 and 27%, respectively. At final evaluation, complete response was noted in all patients. At interim evaluation, the response rates were lower compared to intravenous neoadjuvant chemotherapy and response to intra-arterial chemotherapy did not predict the ultimate outcome. Thus neoadjuvant intra-arterial chemotherapy offers no advantage over concurrent chemoradiotherapy.

Clinico-immunological response to intratumoral versus intravenous neoadjuvant chemotherapy in advanced pediatric solid malignancies

Background:There is minimal literature on the use of intralesional chemotherapy in the pediatric age group. We undertook this present study to evaluate the two modalities (intratumoral and intravenous) of giving chemotherapy in terms of toxicity of chemotherapy, hematological parameters, efficacy of chemotherapy in reduction in volume of the tumor as well as resectability of tumor with special emphasis on immunological parameters.Materials and Methods:Advanced cases of Wilms’ tumor and Neuroblastoma were included in the study. Intratumoral chemotherapy was given through 25 G spinal needle under aseptic precautions and ultrasound guidance in the same dose as in systemic chemotherapy. Intravenous group was given chemotherapy in the usual way. Reassessment was carried out after every course of chemotherapy.Results:Group A included 16 cases of Wilms’ tumor and 6 cases of neuroblastoma. In group B, there were 14 cases of Wilms’ tumor and 8 of neuroblastoma. Vomiting, diarrhea, mucositis, and thrombophlebitis were more common in the intravenous group (P<0.05). The fall in Immunoglobulin A, Immunogloblulin G, Immunoglobulin M, and T-cell rosetting was more common in the intravenous group (P<0.05). Seventy percent of patients had completely resectable tumor at the end of 6 doses of intratumoral chemotherapy as compared to 50% resectability in the intravenous group (P<0.05).Conclusion:Intratumoral chemotherapy, besides causing less of the adverse effects and increasing the resecability rate, also causes less suppression of the immune system. This may be offered as an alternative safe and effective modality of treatment for advanced solid tumors.

Comparative Study of Grade 3/4 Toxicity Associated With Intraperitoneal Chemotherapy Administered After Primary Versus Interval Surgical Debulking in Ovarian Cancer

To determine the prevalence of grade 3 or 4 toxicity associated with intraperitoneal (IP) chemotherapy subsequent to primary surgical debulking compared to post-neoadjuvant chemotherapy and interval debulking in advanced ovarian cancer. Patients receiving IP chemotherapy from 2006 to 2010 were reviewed. Study cohort was stratified by initial treatment (upfront surgery vs neoadjuvant chemotherapy). The National Cancer Institute toxicity grading scale was used to assess treatment-related toxicities immediately before each cycle. The χ² test was used to check for association between categorical variables. Thirty-three patients received IP chemotherapy after optimal debulking. Sixteen patients had upfront surgery. The total number of IP chemotherapy cycles administered was 134. Significantly, more patients treated with IP chemotherapy after intravenous neoadjuvant chemotherapy experienced fatigue (P=0.038) compared to those treated after upfront surgery. During the course of IP regimen, the patients having upfront surgery tended to experience more grade 3/4 hematologic toxicities (P=0.06) and abdominal pain (P=0.08). Twenty-four (73%) of 33 patients completed all prescribed IP chemotherapy cycles. There was no significant difference between the 2 groups in need for dose reduction or delays, use of paclitaxel on day 8, neurologic/gastrointestinal/metabolic toxicities, and IP port complications. Intraperitoneal chemotherapy can be given after optimal primary surgery or interval surgery after neoadjuvant chemotherapy with similar toxicity profile. Toxicity data can be used to plan for optimal IP chemotherapy delivery, patient counseling, and ongoing supportive care.

Neoadjuvant Intraperitoneal and Systemic Chemotherapy for Gastric Cancer Patients with Peritoneal Dissemination

The present study was designed to assess the feasibility and efficiency of intraperitoneal and intravenous neoadjuvant chemotherapy in gastric cancer patients with peritoneal dissemination. The study subjects were 25 treatment-naïve patients with gastric cancer. Patients with positive cytology or with peritoneal carcinomatosis received neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), comprising intraperitoneal (i.p.) mitomycin C (MMC) and cisplatin (CDDP), followed by two cycles of intravenous triplet chemotherapy of docetaxel, 5-fluorouracil (5-FU), and CDDP. Gastrectomy with lymph node dissection was performed after NIPS in patients free of peritoneal deposits, confirmed by staging laparoscopy. Seventeen patients had measurable lymph node metastases by the RECIST criteria. CT examination showed response to the treatment in ten (59%, 0 complete response, 10 partial response). Of the 25 patients, 14 (56%) showed negative results on peritoneal cytology with no macroscopic peritoneal metastasis, whereas the remaining 11 were cancer cell-positive on peritoneal cytology or macroscopic peritoneal metastasis even after NIPS. The median survival time for all 25 patients was 16.7 months. Prognosis was better in patients who showed negative cytology and disappearance of peritoneal cancer metastases after NIPS than in those with positive cytology or existing peritoneal deposits (P < 0.0001). The predominant toxicity was myelosuppression and grade 3-4 leukopenia and neutropenia occurred in 20 (80%) patients, which were manageable. No treatment-related mortality was observed during and after NIPS and surgery. The results of this prospective phase II study indicated that the newly designed NIPS was highly effective and well tolerated in patients with advanced gastric cancer and peritoneal dissemination.

Comparison of effectiveness between intra-arterial and intra-venous neoadjuvant chemotherapy in stage Ib2-IIb cervical carcinoma

To compare the effect between intra-arterial and intra-venous neoadjuvant chemotherapy (NACT) in stage Ib2-IIb cervical carcinoma. A retrospective analysis was done on 52 cases of intra-venous NACT and 95 cases of intra-arterial NACT for stage Ib2-IIb cervical carcinoma treated in Peking Union Medical College Hospital from 1999. The response rate of intra-venous NACT and intra-arterial NACT was 88% (46/52) and 79% (75/95), and the operative rate after NACT was 81% (42/52) and 72% (68/95) respectively (P > 0.05). There were no significant differences in surgery time, blood loss and post-operative morbidity between these two groups. Pathological parametrial positive rate after NACT in arterial group (6%) was significantly lower than that of venous group (50%, P > 0.05). The venous group had very similar recurrence rates (13% vs 17%) and death rates (9% vs 12%) when compared with the arterial group (P > 0.05). The intra-arterial and intra-venous NACT for stage Ib2-IIb cervical carcinoma show similar response rate, operative rate and surgical difficulties. Arterial NACT shows a better effect on parametrial infiltration.

Limb salvage and outcome of osteosarcoma. The University of Muenster experience.

One hundred thirty-six patients with non-metastatic high grade osteosarcoma treated from 1978 to 1994 in one institution with a multidisciplinary approach that included intravenous neoadjuvant chemotherapy were studied to evaluate which factors influence the outcome of modern orthopaedic therapy. Anatomic location, tumor volume, surgical margins, complications, and functional outcome were analyzed. Seventy-nine patients had a limb salvage procedure, 21 had a rotationplasty, and 33 had an amputation. Limb salvage consisted of 32 endoprostheses, 39 allograft replacements, six autograft replacements, and two shortening procedures. Three patients died during preoperative chemotherapy treatment. At a mean followup of 43 months, 81 patients continue to be disease free, three are alive after local recurrence, 17 are alive after having metastatic lesions, five are alive with metastatic lesions present, and 30 patients died of their disease. Forty-seven patients had pulmonary metastatic lesions, 14 had osseous metastatic lesions, three had abdominal metastatic lesions, two had lymphatic metastatic lesions, and eight patients had skip metastatic lesions. Prognosis correlated with chemotherapy response, surgical margins, and tumor volume. The minor complication rate for limb salvage was 4% and the major complication rate was 52%. Amputations had a 6% minor complication rate and 34% major complication rate. Rotationplasties had 10% minor and 48% major complication rates. The Musculoskeletal Tumor Society functional evaluation after limb salvage showed that 23 (38%) patients had more than 75% of the maximum functional score, 34 (56%) were from 50% to 75%, and three (5%) less than 50%. Of the rotationplasties, six (67%) were functionally better than 75% and three (33%) were functionally better than from 50% to 75%. In the group of amputations, 13 (56%) were from 50% to 75%, and 10 (44%) less than 50%. The extent of preoperative necrosis, surgical margins, and tumor volume are the most important prognostic factors. The increase in limb salvage procedures and the better long term survival of patients results in a higher rate of immediate and delayed complications. Functional outcome after rotationplasty is superior to limb salvage reconstruction and amputation.

Survival, prognosis, and therapeutic response in osteogenic sarcoma. The memorial hospital experience

Two hundred seventy-nine consecutive patients with Stage II osteogenic sarcoma of the appendicular skeleton treated between 1976 and 1986 were studied to identify predictors of long-term survival. Survival was 77% and 73% at 5 and 10 years, respectively, with continuously disease-free survival being 70% and 69%. On univariate analysis, the most significant predictors of survival were the location of the primary lesion, local control of the tumor, and the degree of necrosis in the primary tumor after intravenous neoadjuvant chemotherapy (histologic response). On initial multivariate analysis, similarly, only location and histologic response to chemotherapy predicted disease-free outcome. After statistical control for local recurrence, only histologic response to chemotherapy was retained as an independent predictor, suggesting that in this data set, the location of primary lesion exerted its effect only secondarily through its association with the ability to provide local control. The risk of local recurrence was almost fivefold higher in tumors of the femur than in tumors of other locations (relative risk, 4.6) and, within the femur, was more than threefold higher in the proximal femur than in the distal femur (relative risk, 3.4). None of the other primary tumor or patient characteristics studied yielded independent predictive significance for survival. The rate of failure was almost fivefold as high in those with an incomplete response to chemotherapy compared with those with a complete response to chemotherapy (relative risk, 4.9; 95% confidence interval, 2.2 to 11). Even in those patients with minimal or no necrosis in the primary tumor, ultimately 62% and 54% were disease-free at 5 and 10 years, respectively.

Bone tumours

The Journal of PathologyVolume 163, Issue 2 p. 143-147 Selected SummariesFree Access Bone tumours Archie J. Malcolm, Archie J. Malcolm University Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, U.K.Search for more papers by this author Archie J. Malcolm, Archie J. Malcolm University Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, U.K.Search for more papers by this author First published: February 1991 https://doi.org/10.1002/path.1711630210AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Whang-Peng J, Triche TJ, Knutsen T, et al. Cytogenetic characterization of selected small round cell tumors of childhood. Cancer Genet Cytogenet 1986; 21: 185– 208. 2 Pinto A, Grant LH, Hayes FA, Schell MJ, Parham DM. Immunohisto-chemical expression of neuron-specific enolase and leu 7 in Ewing's sarcoma of bone. Cancer 1989; 64: 1266– 1273. 3 Nachman J, Simon MA, Dean L, Shermeta D, Dawson P, Vogelzang NJ. Disparate histologic responses in simultaneously resected primary and metastatic osteosarcoma following intravenous neoadjuvant chemotherapy. J Clin Oncol 1987; 5: 1185– 1190. Volume163, Issue2February 1991Pages 143-147 ReferencesRelatedInformation

Disparate histologic responses in simultaneously resected primary and metastatic osteosarcoma following intravenous neoadjuvant chemotherapy.

Seven patients with newly diagnosed metastatic osteosarcoma underwent simultaneous resection of the primary tumor and metastases following intravenous (IV) neoadjuvant chemotherapy. Histologic response was assessed in all tumor specimens. Disparate responses were noted between primary tumor and metastases and, in some cases, between two or more metastatic tumor deposits. The diverse histologic response to neoadjuvant chemotherapy suggests tumor cell heterogeneity. Changing postoperative therapy on the basis of the histologic response induced in the primary tumor may not be appropriate.