Patients In Neoadjuvant Chemotherapy Group Research Articles

The effect of neoadjuvant treatment on postoperative morbidity in upper rectal cancer

Background. The need of neoadjuvant treatment for upper rectal cancer remains the object of discussion, which makes further study of this topic important.Аim. To estimate the postoperative complications rate depending on the type of neoajuvant treatment.Materials and methods. A retrospective cohort multicenter study, that analyzed data of medical records of patients with upper rectal cancer from the archive of N.N. Blokhin Cancer Research Center of the ministry of Health of Russia, Ryzhikh national medical Research Center of Coloproctology of the ministry of Health of Russia and Stavropol Regional Clinical Oncology Center for 2007–2020. Patients were devided into 3 groups: the group of radiotherapy (5*5 gy), the group of neoadjuvant chemotherapy (4 courses of XELOX before surgery) and the group of surgery. The main endpoint was the study of anastomotic leak rate. Also we estimated the postoperative complications rate III–Iv degree (Clavien– Dindo), the sphincter-preserving surgery rate, the stoma creation rate, the postoperative mortality.Results. we included 110 patients in radiotherapy group, 188 patients in neoadjuvant chemotherapy group, 103 patients in surgery group. Study groups were comparable by sex, ASA status and histological grade. Postoperative grade III– Iv complications (in all cases were associated with anastomotic leak) developed in 8 (6.8 %) patients in neoadjuvant chemotherapy group versus 11 (10.0 %) patients in radiotherapy group (p = 0.379) and 12 (11.7 %) patients in surgery group (p = 0.208). There weren»t any significant differences in this parameter between the radiotherapy and the surgery group (p = 0.698). R0-resection was performed in 117 (99.2 %) patients in neoadjuvant chemotherapy group versus 107 (97.3 %) patients in radiotherapy group (p = 0.280) and 103 patients (100 %) in surgery group (p = 0.349). Radiotherapy and surgery groups didn’t differ significantly in R0-resection rate (p = 0.091). 1 patient (0.84 %) in neoadjuvant chemotherapy died before surgery, in other groups there weren’t any lethal outcomes (p = 0.283). Only the male sex, had a statistically significant effect on the anastomotic leak rate (risk ratio (HR) 2.875; 95 % confidence interval (CI) 1.24–6.63; p = 0.003).Conclusions. A study of these case histories of patients with cancer of the upper ampullary rectum, conducted by us, showed that neoadjuvant treatment didn»t affect the postoperative complications rate.

Clinical significance of neoadjuvant chemotherapy for locally advanced colorectal cancer patients with deficient mismatch repair: possibly residual value in the era of immunotherapy.

Deficient mismatch repair (dMMR) or microsatellite instability is one of the well-established molecular biomarkers in colorectal cancer (CRC). The efficiency of neoadjuvant chemotherapy (NAC) in locally advanced colorectal cancer (LACC) patients with dMMR is unclear. We assessed the tumor response and clinical outcome in LACC patients with dMMR received NAC. Retrospective, single-center analysis. From 2013 to 2018, a total of 577 LACC patients with dMMR who underwent radical surgery were identified. Among them, 109 patients who received adjuvant chemotherapy were further screened out for analysis. According to whether receiving NAC or not, 109 patients were divided into two groups with the purpose of retrospectively analyzing their characteristics, treatment, and survival results, especially the 5-year disease-free survival (DFS) and 5-year overall survival. Baseline characteristics were matched between the two groups. One of 40 patients in NAC group recurred, while 13 of 69 patients in non-NAC group recurred. Univariate and multivariate analyses showed that NAC (hazard ratio: 0.115; 95% confidence interval: 0.015-0.897; p = 0.039) was independent influence factor for DFS. In NAC group, there were 13/40 (32.5%) patients for tumor regression grade 1 and 27/40 (67.5%) patients converted clinical positive N-stage into negative N-stage. In this study, NAC was associated with better tumor downstaging and longer 5-year DFS in LACC patients with dMMR. Consequently, NAC might be an additional treatment choice when it comes to such patients in the future.

Neoadjuvant chemotherapy followed by radical trachelectomy versus upfront abdominal radical trachelectomy for patients with FIGO 2018 stage IB2 cervical cancer

ObjectiveTo explore the optimal fertility-sparing treatment for stage IB2 cervical cancer. We compared the outcomes of neoadjuvant chemotherapy (NACT) followed by radical trachelectomy (RT) with those of upfront abdominal RT (ART). MethodsThis is a retrospective study with prospectively collected data between August 2015 and July 2019. Patients with IB2 cervical cancer who desired fertility preservation underwent NACT followed by RT, or upfront ART, per their choice. ResultsThis study included 51 patients, of which, 16 patients underwent NACT followed by RT and 35 patients chose upfront ART. Fertility was preserved in 12 (75.0%) and 27 (77.1%) patients from the NACT and upfront ART groups, respectively. Incidence rates of intraoperative (0% versus 3.7%) and postoperative complications (25.0% versus 48.1%) of the NACT group were lower compared to the upfront ART group (P=NS). Eleven (91.7%) patients in NACT group and 17 (63.0%) patients in upfront ART groups received adjuvant chemotherapy after surgery. The median follow-up, and 5-year recurrence-free survival rates of the NACT-RT and upfront ART groups were 56 and 61 months, and 83.3% and 96.3%, respectively (P=NS). The recurrence rate was higher in patients with tumor reduction <50% after NACT than that in patients with tumor reduction >50% (66.7% versus 0%, P < 0.05). Tumor reduction <50% was the only independent predictor of recurrence in patients who underwent NACT before RT. ConclusionsNACT followed by RT could be a feasible fertility-sparing option for selected patients with 1B2 cervical cancer. The NACT group had a relatively higher recurrence rate and fewer complications compared to the upfront ART group, albeit without statistical significance. Patients with tumor regression >50% after NACT could be ideal candidates for RT after NACT.

278. SHORT- AND LONG-TERM OUTCOME AFTER UPFRONT SURGERY OR NEOADJUVANT CHEMOTHERAPY FOLLOWED BY SURGERY IN ELDERLY PATIENTS WITH RESECTABLE ESOPHAGEAL CANCER

Abstract In Japan, the standard therapeutic strategy for resectable advanced esophageal cancer (R-AEC) is neoadjuvant chemotherapy (NAC) followed by surgery. However, there is no strong evidence of the strategy for the elderly patients, thus the efficacy of NAC for the elderly patients with R-AEC remains controversial. Here we studied the efficacy of NAC for R-AEC in the patients aged 75 or older. This study included the patients aged 75 or older who diagnosed with R-AEC and underwent esophagectomy in our institution from 2005 to 2021. Among the total of 59 cases with R-AEC, the cases who received neoadjuvant chemoradiotherapy or who had poor follow-up were excluded, and the remaining 42 cases were enrolled in this cohort. Among 42 patients with R-AEC, 33 patients underwent UFS and 9 patients underwent NAC followed by surgery. The short- and long-term outcome was evaluated between upfront surgery (UFS) group and NAC group. There was a difference in historical background: patients in UFS group were more in 2012 or before, and patients in NAC group were more later than 2013. There was no significant differences in age, PS, Charlson comorbidity index and clinical characteristics such as TNM disease stage between two groups. The short-term outcome, the frequency of postoperative complications, curability, etc., was similar in two groups. In UFS group, only 5 cases (15.2%) underwent adjuvant chemotherapy. NAC improved 2-year RFS (UFS: 51.4% vs. NAC 76.2%, not significant), and 2-year OS (UFS 60.1% vs. NAC 71.1%, not significant). This study showed the likelihood of the benefits of NAC on the long-term outcomes without increasing the postoperative complications in patients with R-AEC aged 75 or older. There were some limitations in this study, single-institutional and retrospective study with small number of cases. The further study will be needed to clarify the efficacy of NAC in elderly patients with R-AEC.

Prognostic analysis of neoadjuvant chemotherapy for locally advanced gastric cancer with propensity score matching method

To compare the effects of neoadjuvant chemotherapy and adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer using propensity score matching method. Clinical data of patients with locally advanced gastric cancer undergoing open D2 radical gastrectomy between January 2012 and December 2014 at the Affiliated Tumor Hospital of Zhengzhou University were analyzed retrospectively. Sixty-five patients receiving neoadjuvant chemotherapy (NAC) were allocated into the NAC group and 1243 patients receiving postoperative adjuvant chemotherapy (AC) were allocated into the AC group. (1) age ranged from 18 to 75 years old, and biopsy specimen was confirmed as adenocarcinoma; (2) all the operative procedures were open D2 radical gastrectomy;(3)image examinations showed no distant metastasis or other unresectable factors. no open D2 radical gastrectomy, undergoing laparoscopic surgery, neoadjuvant chemotherapy course <2 cycles, without adjuvant chemotherapy, history of other malignancies, severe complications, incomplete data. SOX (tegafur-gimeracil-oteracil plus oxaliplatin) or XELOX (capecitabine plus oxaliplatin) was used as neoadjuvant and postoperative adjuvant chemotherapy regimen. One-to-two propensity score matching was performed to balance the covariance between two groups. Survival was analyzed using the Kaplan-Meier method. Differences between the curves were tested using log-rank test. After balancing the covariates including gender, age, tumor location, degree of differentiation, clinical stage, chemotherapy regimen, chemotherapy course and surgical approach, 195 patients were enrolled, including 65 patients of the NAC group and 130 patients of the AC group. The number of harvested lymph nodes in NAC and AC group was 22.3±4.6 and 22.6±5.1 respectively, without statistically significant difference(t=1.125, P=0.263). Pathological response assessment for NAC group showed TRG0 in 6 cases, TRG1 in 8 cases, TRG2 in 17 cases, TRG3 in 34 cases; sensitive (TRG 0 to 2) in 31 cases (47.7%), non-sensitive in 34 cases (52.3%). The 3-year progression-free survival rate of NAC and AC group was 73.6%(95%CI: 62.8-84.3) and 69.9%(95%CI:62.1-77.7) respectively, which was not significantly different(P=0.361). The 3-year overall survival rate of NAC and AC group was 80.0%(95%CI:70.2-89.8) and 74.6%(95%CI:67.2-82.0) respectively, which was not significantly different as well(P=0.387). Subgroup analysis revealed that the 3-year progression-free survival rate and 3-year overall survival rate of sensitive patients in NAC group were 83.3%(95%CI:70.0-96.6) and 87.1%(95%CI:75.3-98.9) respectively, which were significantly higher than 62.4%(95%CI:46.1-78.7, P=0.037) and 70.2%(95%CI:54.7-85.7, P=0.033) of non-sensitive patients in NAC group, and those in AC group(P=0.044 and P=0.040). Effects of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer are similar. Patients who are sensitive to neoadjuvant chemotherapy have better prognosis. It may be beneficial to improve prognosis that some appropriate patients with locally advanced gastric cancer are screened for neoadjuvant chemotherapy.

Clinical effects of irinotecan hydrochloride in combination with cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer

Objective To evaluate the toxicity and efficacy of irinotecan plus cisplatin neoadjuvant chemotherapy (NACT) for cervical cancer. Methods A total of 120 cases with cervical cancer were divided into 2 groups and retrospectively reviewed: Sixty FIGO IB2-IIB patients in NACT group were treated with 2 cycles of irinotecan 60 mg/m 2 on days 1 and 8 plus cisplatin 60 mg/m 2 on day 1 followed by surgery. Sixty FIGO IB2-IIB patients in control group were treated directly with surgery. Results The 60 patients in NACT group received a total of 120 cycles. Grades III and IV neutropenia and diarrhea were seen in 15.8% and 11.7%, respectively, of all chemotherapy cycles. Six (10.0%) patients achieved complete remission, 33 (55.0%) achieved partial remission, 21 (35.0%) remained stable, and none had disease progression. Postoperatively the deep cervical stromal invasion and positivity of surgical margins were significantly fewer in the NACT group. The pelvic lymph node metastasis rate of responders to NACT was significantly lower than that of non-responders (12.8% vs 38.1%). With a median follow-up of 29 and 30 months, the intra-pelvic recurrence rate of the NACT group was significantly lower than that of the control group (3/60 vs 11/60, p = 0.023), the 2-year recurrence-free survival and the 2-year overall survival was 82.3% and 86.1% in the NACT group, and 86.3%, 87.9% in the control group with no significant difference. Multivariate analysis showed that response to NACT was the only factor associated with survival ( p = 0.036). Conclusion Irinotecan plus cisplatin NACT for cervical cancer has high efficacy and tolerable toxicity, and can significantly reduce the rates of deep cervical stromal invasion and positive surgical margins. Pelvic lymph node metastasis decreases significantly in responders compared with non-responders. The response to NACT can be considered as an independent prognostic factor.

Effect of neoadjuvant chemotherapy on survival in patients with gastric signet ring cell adenocarcinoma: A multicentric comparative study.

4036 Background: Perioperative chemotherapy is a standard treatment for gastric adenocarcinoma (GA). Signet ring cell GA (SRC) has been shown to be of poorer prognosis when compared to non-SRC. Although of major importance in this context, chemosensitivity of SRC remains hypothetical. The aim of this study was to evaluate the survival impact of neoadjuvant chemotherapy (NCT) in patients with gastric SRC through a large national comparative cohort. Methods: 1,054 patients were treated for SRC in 18 French centers from 1997 to 2009. Were included patients treated in a curative intent (n=924) with 171 patients who received NCT followed by surgery (NCT arm, 18.5%) compared in intention to treat to 753 patients treated by surgery alone (S arm, 81.5%). NCT, mainly based on a fluorouracil-platinum doublet or triplet, was proposed in some centers in accordance to national guidelines for GA treatment, whereas other centers favored primary surgery for SRC due to the suspected chemoresistance. Results: Both groups were comparable regarding usual prognostic variables such as age, gender, ASA score, malnutrition, tumoral location and TNM stage. Ten patients did not benefit from surgery because of a major tumoral progression meanwhile. At surgical examination, metastases were discovered in 4.8% of patients in NCT group and 8.1% in S group (p=0.130), with no tumoral resection in 50 patients. Among the 864 resected patients, R0 resection rates were 65.9% vs. 62.3%, respectively (p = 0.308). Significantly more patients received adjuvant chemotherapy in the NCT group than in the S group (62% vs. 31%, p<0.001). After a median follow-up of 31.5 months, overall survival was significantly shorter in the NCT group (8.6 vs. 12.7 months, p<0.001). In multivariate analysis, NCT was an independent predictor of poor survival (HR 1.4 95% CI 1.1-1.9, p=0.042). Conclusions: While perioperative chemotherapy is considered a standard treatment for GA regardless of histological subtype, we demonstrate for the first time that NCT provides no survival benefit in SRC. Registered on Clinicaltrial.gov website under identifier NCT01249859.