Neoadjuvant Chemotherapy In Cases Research Articles

Evaluation of the effects of neoadjuvant chemotherapy on probably benign breast lesions with MRI: Report of two cases

In cases with breast cancer, probably benign lesions can also be seen in the other areas of the breast. It is known that neoadjuvant chemotherapy causes morphological changes in the normal breast tissue and the benign lesions, in addition to effects on malignant mass. In cases with complete response with neoadjuvant chemotherapy, probably benign lesions without tissue diagnosis cause a dilemma in the breast conserving surgery plan, when they shrink or disappear at the end of the treatment. We aimed to demonstrate the effects of neoadjuvant chemotherapy in cases with probably benign breast lesions via dynamic contrast enhanced breast MRI.

Possibility of avoiding axillary lymph node dissection by immune microenvironment monitoring in preoperative chemotherapy for breast cancer

BackgroundThe diagnosis of metastasis by sentinel lymph node biopsy (SLNB) in early breast cancer surgery provides an accurate view of the state of metastases to the axillary lymph nodes, and it has now become the standard procedure. In the present study, whether omission of axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC) is possible by evaluation of tumor-infiltrating lymphocytes (TILs) before NAC in cases without metastasis on diagnostic imaging, but with metastasis on SLNB, was retrospectively investigated.MethodsA total of 91 patients with resectable, early-stage breast cancer, diagnosed as cT1–2, N0, M0, underwent SLNB and were treated with NAC. A semi-quantitative evaluation of lymphocytes infiltrating the peritumoral stroma as TILs in biopsy specimens of primary tumors prior to treatment was conducted.ResultsIn cases with a low number of TILs, estrogen receptor expression was significantly higher (p = 0.044), and human epidermal growth factor receptor 2 (HER2) expression was significantly lower than in other cases (p = 0.019). The number of TILs was significantly lower in cases in which the intrinsic subtype was hormone receptor-positive breast cancer (HRBC) (p = 0.044). Metastasis to axillary lymph nodes was significantly more common in HER2-negative cases and cases with a low number of TILs (p = 0.019, p = 0.005, respectively).ConclusionsEven if macrometastases are found on SLNB in cN0 patients, it appears that ALND could be avoided after NAC in cases with a good immune tumor microenvironment of the primary tumor.

Modern Possibilities of Organ-Preserving Treatment in Children with Intraocular Retinoblastoma

Retinoblastoma is one of highly curable diseases; today the total 5-year survival rate in patients with retinoblastoma exceeds 95%. The article summarizes the current world experience on treatment of patients with intraocular retinoblastoma. The treating skills of intraocular malignant tumor in children are a balance between the patient’s life and the preservation of an eye and its visual functions. The complex and challenging task is the treatment of common intraocular retinoblastoma groups «C», «D», «E» when the large size or localization of the tumor does not allow performing the local (focal) destruction of the tumor. As a rule, in such cases neoadjuvant chemotherapy (CT) is performed at the first stage in order to reduce the size of the tumor for further focal therapy. However, the analysed data on the effectiveness of neoadjuvant CT in combination with focal or radiotherapy demonstrated the limited possibilities of the proposed therapy. Local drug delivery in cancer therapy became a real breakthrough in the organ-preserving treatment of children with large intraocular retinoblastoma. The most widely used current methods of local drug delivery are intravitreal (IVitC) and selective intra-arterial chemotherapy (SIAC) as monotherapy or in combination with neoadjuvant CT and focal therapy which significantly increased the percentage of preserved eyes without radiotherapy administration or damage to the patient survival. The review discusses the different IVitC and SIAC techniques, chemotherapy schemes, dosages of chemotherapy, immediate and long-term complications of treatment.

The impact of staging laparoscopy on treatment strategy in advanced ovarian cancer

Introduction: Complete primary cytoreductive surgery (PCS) is the most important prognostic factor for progression free survival (PFS) and overall survival (OS) in patients with advanced (FIGO stage III) ovarian cancer (AOC). In patients with poor general conditions or with heavy disease burden, complete PCS is difficult to achieve. Various patterns of abdominal disease spread represent biological aggressiveness affect prognosis and demands visual evaluation before planning treatment strategy. Beside imaging methods, laparoscopic pretreatment evaluation of resectability was proposed to more accurately identify those patients that can not be completely resected. In such cases neoadjuvant chemotherapy (NACT), followed with interval debulking surgery (IDS) is proposed. We present the preliminary results of treatment with NACT and IDS in patients selected according to laparoscopic evaluation of resectability. Methods: 2 years retrospective analysis (2011–2013) of 41 patients with clinical signs of AOC, where according to gyn-oncology consultative team, laparoscopy was proposed as a diagnostic and staging procedure. After evaluation of respectability, PCS by laparotomy was performed. Metastatic process of intestinal mesenterium and/or serosa was considered unresectable and NACT was started followed by IDS. Evaluation of laparoscopic procedures and impact on treatment strategy is presented through PFS analysis between the subgroup that had PCS and those started with NACT, followed with IDS. Results: Ascites together with elevated tumor markers, with or without pelvic mass were the most common clinical sign in population studied. 32 patients presented in Stage IIIC and 9 in stage IV. Laparoscopic staging included evaluation of omental infiltration, peritoneal and diaphragmatic carcinosis, intestinal mesenteric or serosal involvement, bowel infiltration, and liver superficial metastasis as well as amount of pelvic disease. In all stage IV patients only laparoscopy was performed. According to laparoscopic staging in stage III patients, conversion to laparotomy for PCS and adjuvant chemotherapy was performed in 21 patients; while in 12 neodjuvant chemotherapy was started. Laparoscopic procedures were: unilateral or bilateral adnexectomy (N = 18); omental biopsy (N = 21), peritoneal biopsy (N = 21); and cytology specimen (N = 15). Average start of chemotherapy was 10 days (7–14) after surgery No major intraoperative complications were registered. In 2 patients laparotomy was performed because of obstructive ileum on day 3 and 5 after laparoscopy. During the mean follow up of 21 (8–33) months 3/21 patients died in PCS subgroup and 5/12 in NACT subgroup; all in the first 8 months after surgery. PFS were 27.80 (19.41–36.19) months for complete PCS; 13.62 (8.54–18.7) months for suboptimal PCS and 15.80 (8.6–22.99) months for NACT with IDS. Estimated OS were 35.6 (30.09–41.26) months for complete PCS, 31.85 (26.35–37.35) months for suboptimal PCS and 31.33 (25.48–37.18) months for NACT with IDS. Conclusions: According to our results, laparoscopy as a staging procedure have a certain impact on treatment strategy in AOC by selecting patients where tumor biology disables complete PCS and making them candidates for NACT. Our preliminary analysis of PFS and estimated OS in this selected group demonstrates that this strategy is not inferior towards suboptimal PCS and adjuvant chemotherapy, but more cases should be analyzed for more definitive conclusions.