Preoperative Adjuvant Treatment Research Articles

Preoperative chemotherapy of chemoradiotherapy for the treatment of adenocarcinoma of the pancreas and ampulla of Vater.

Much has been written about preoperative strategies in the treatment of pancreatic adenocarcinoma, yet there has been very little comment concerning other periampullary malignancies. This review discusses current issues relevant to the further development of preoperative adjuvant treatment of pancreatic adenocarcinoma. A small series of patients with ampullary adenocarcinomas treated with preoperative adjuvant chemoradiotherapy is also described.

The Role of Preoperative Adjuvant Treatment in the Management of Esthesioneuroblastoma: The University of Virginia Experience

The Role of Preoperative Adjuvant Treatment in the Management of Esthesioneuroblastoma: The University of Virginia Experience

The Role of Preoperative Adjuvant Treatment in the Management of Esthesioneuroblastoma: The University of Virginia Experience

The Role of Preoperative Adjuvant Treatment in the Management of Esthesioneuroblastoma: The University of Virginia Experience

The Role of Preoperative Adjuvant Treatment in the Management of Esthesioneuroblastoma: The University of Virginia Experience

The Role of Preoperative Adjuvant Treatment in the Management of Esthesioneuroblastoma: The University of Virginia Experience

The role of preoperative adjuvant treatment in the management of esthesioneuroblastoma: the University of Virginia experience.

Multidisciplinary management of esthesioneuroblastoma has effected markedly increased survival during the past 20 years. The potential for radical craniofacial surgery for complete en bloc resection, the availability of advanced neuroimaging modalities, and the incorporation of neoadjuvant therapy into treatment strategies for tumor remission have all contributed to this accomplishment. However, a standard protocol for the management of these lesions has not been accepted; preoperative radiation and chemotherapy have been advocated, but neither radiographic nor clinical response has been quantified. Thirty-four consecutive patients with biopsy-proven esthesioneuroblastoma treated at one institution from 1976 to 1994 were reviewed to determine the effects of preoperative radiation therapy, with or without chemotherapy, on tumor size and long-term survival. In a multivariate regression analysis, advanced age was predictive of decreased disease-free survival (P=0.008), whereas advanced Kadish stage was associated with a borderline higher rate of disease-related mortality (P=0.056). Two-thirds of the patients showed a significant reduction in tumor burden with adjuvant therapy. Patients with response to neoadjuvant therapy demonstrated a significantly lower rate of disease-related mortality (P=0.050). In this series, the overall 5- and 10-year survival rates were 81.0 and 54.5%, respectively. Preoperative neoadjuvant therapy provides a valuable complement to radical craniofacial resection, leading to reduction in tumor burden. Patients experiencing reduction in tumor volume by neoadjuvant therapy demonstrate an improved prognosis.

330 Surgery of lung metastases

Background A retrospective analysis was performed of the results of surgical excision of lung metastases in children to identify prognostic factors. Methods From 1970 to 1992 139 thoracotomies were performed in 91 patients aged between 1 and 19 years with metastases of osteogenic sarcoma (40), nephroblastoma (24), Ewing sarcoma (12) and various other tumours (15). Results There were no perioperative deaths, and only one serious complication: chylothorax necessitating re-operation. Twenty-three patients are currently alive (26%), two with residual disease. Twelve pa (50%) with nephroblastoma aler alive; 7 patients with osteogenic sarcoma (18%) and 4 with other tumours (27%). Negative prognostic factors were: incomplete excision, primary tumour not controlled, or metastases developing during treatment. Not of significant influence on the outcome were: the number of metastases developing during treatment. Not of significant influence on outcome were: the number of metastases, the disease free interval, unilateral versus bilateral metastases, pre-operative and postoperative adjuvant treatment of the number of thoracotomies performed. Conclusion The most important prognostic factor is the type of primary tumour. Excision of lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major operation, should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand. A retrospective analysis was performed of the results of surgical excision of lung metastases in children to identify prognostic factors. From 1970 to 1992 139 thoracotomies were performed in 91 patients aged between 1 and 19 years with metastases of osteogenic sarcoma (40), nephroblastoma (24), Ewing sarcoma (12) and various other tumours (15). There were no perioperative deaths, and only one serious complication: chylothorax necessitating re-operation. Twenty-three patients are currently alive (26%), two with residual disease. Twelve pa (50%) with nephroblastoma aler alive; 7 patients with osteogenic sarcoma (18%) and 4 with other tumours (27%). Negative prognostic factors were: incomplete excision, primary tumour not controlled, or metastases developing during treatment. Not of significant influence on the outcome were: the number of metastases developing during treatment. Not of significant influence on outcome were: the number of metastases, the disease free interval, unilateral versus bilateral metastases, pre-operative and postoperative adjuvant treatment of the number of thoracotomies performed. The most important prognostic factor is the type of primary tumour. Excision of lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major operation, should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand.

悪性骨腫よう，局所再発症例の臨床的検討

We investigated the clinical factors associated with local recurrences in 24 patients with malignant bone tumors, who had undergone tumor resection with a wide surgical margin. Local recurrences occurred in 3 patients with osteosarcoma and one patient with Ewing's sarcoma.Recurrence was thought to be due to an inadequate surgical margin, and this was probably caused by the following: (1) Reduction of surgical margin after shrinkage of the tumor following preoperative adjuvant treatment, (2) usual wide surgical margin but skip metastases or tumor thrombi suggested by CT scan and MR imaging, and (3) needle biopsy scattering tumor cells into the surrounding soft tissue.

ＭＲＩによる悪性骨腫ようの術前補助的治療効果の判定

We studied the useful MRI findings to evaluate the histological anti-tumor effect of preoperative adjuvant treatment in 9 cases with malignant bone tumors. The decrease of tumor volume, measured using digitizer system on MRI, was the most valuable finding indicating the good and fair anti-tumor effect. The region with the deficit of gadolinium enhancement and high T2 signal intensity showed histologically complete tumor necrosis with cyst formation or myxoid stromal change. Narrow black rim around the tumor which consisted of fibrous membrane was seen partially in cases with the good and fair anti-tumor effect.From the above findings, however, it was impossible to decide the degree of the effect of preoperative adjuvant treatment for malignant bone tumors.

術前補助的治療による骨原発悪性腫よう周囲の反応層の変化

We observed microscopically the effects of preoperative adjuvant treatment on the reactive zone surrounding the neoplasmas in 14 cases of osteosarcoma, 3 cases of Ewing's sarcoma and 2 cases of MFH of bone. The reactive zone of biopsied specimens, which showed peritumoral edema and perivascular lymphocytic infiltration, was transformed into a thick membranous capsule in resected specimens after the treatment. The extramedullary component invading the periosteal soft tissues was completely covered with a thick membranous capsule. Invading foci within skeletal muscles were nearly covered with not a thick membranous capsule but a scar tissue mixed with striated muscle fibers. However, no capsular structures were seen around the intramedullary component.These findings might indicate that preoperative adjuvant treatment is of use to reduce the safety margin near the extramedullary component of the neoplasmas in the limb sparing surgery.

Treatment of Head and Neck Cancer with Combined Modalities

Patients with advanced epidermoid carcinoma of the head and neck are often treated with combinations of radiation therapy and surgery. Patients with more advanced malignancies may also receive adjuvant chemotherapy. Prospective randomized protocols provide the most effective means of determining the value of combined modalities versus a single modality only. Preoperative assessment includes direct visualization, palpation, endoscopy and, in selected incidents, CT or MRI scanning. CT scan may provide objective evidence of tumor response when preoperative adjuvant treatment, either as radiation or chemotherapy, is given.