OBJECTIVES

The influence of weight change on the response to neoadjuvant chemotherapy (NAC) among adult Filipino patients with breast cancer remains unclear. Currently, there has been increasing evidence that weight gain during NAC is associated with increased recurrence risk and decreased survival. This study aimed to investigate this relationship and identify significant predictors of pathologic complete response (pCR), overall survival (OS) and disease-free survival (DFS).

This is a retrospective study using data from 52 female patients who received NAC for stage II or III breast cancer and had complete records of weight before and after NAC. Significant predictors of pCR such as host factors and tumor characteristics and associations between weight change and pCR, OS and DFS were examined using univariate and multivariable logistic regression analyses.

The average weight of all patients before NAC was 57.0 kg while the average weight of all patients after NAC was 59.5 kg. The average BMI of all patients before NAC was 25.8 kg/m2. In total, 29 patients (55.8%) were classified in the overweight/obese (OW/OB) group, and the rest were classified in the normal weight/underweight (NW/UW) group. The pCR rate was 51.3% in the OW/OB group versus 48.7% in the NW/UW group (p = 0.11). Initial BMI was a significant factor for achieving pCR (hazard ratio, 3.85; 95% confidence interval [CI], 1.72-8.60, p = 0.001), suggesting that a higher initial BMI was associated with an increased likelihood of achieving pCR. Initial BMI was also an independent prognostic factor for OS (p = 0.0006) and DFS (p = 0.0005). On the other hand, no significant correlation was seen between pCR rates as well as OFS and DFS (p = 0.0551) among patients whose weight changed during the course of treatment.

These findings suggest that while initial weight may significantly predict pCR rates and affect DFS and OS, weight change during treatment may not be as influential. Further research is needed to validate these findings in more diverse and larger patient populations.

In recent years, the treatment strategy of locally advanced gastric cancer (LAGC) has changed from surgery alone to multidisciplinary comprehensive treatment (MDT) based on surgery. Many evidences have shown that perioperative therapy can improve the survival of most patients with late-stage LAGC compared to surgery combined with postoperative adjuvant chemotherapy. However, there is still a lack of standards and guidelines for precise preoperative staging, indications of perioperative neoadjuvant and adjuvant therapy, and regimen selection. Based on relevant literature and clinical practice, Chinese Journal of Gastrointestinal Surgery combined with Gastric Cancer Association, China Anti-Cancer Association took the lead and organized multidisciplinary experts to discuss, and finally formulate this expert consensus. This consensus aims to improve surgeons' and physicians' cognition on the MDT of LAGC, especially for doctors in primary hospitals; to clarify the preoperative staging, the indication and regimen selection of perioperative neoadjuvant and adjuvant therapy; so as to improve the diagnosis and treatment level of gastric cancer and the prognosis of LAGC in China. The level of evidence and recommendation of this consensus is determined by the criteria of Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Adjuvant ; China ; Consensus ; Gastrectomy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Stomach Neoplasms/surgery*

Humans ; Stomach Neoplasms/pathology* ; Neoadjuvant Therapy ; Chemotherapy, Adjuvant ; Gastrectomy ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Neoplasm Staging

The incidence of horseshoe kidney is about 1 in 400 cases. The presence of Wilms' tumor with a horseshoe kidney is unusual, and the occurrence of Wilms' tumor in a horseshoe kidney is estimated at 0.4 to 0.9% of all Wilms' tumors. We report the case of a 5-year-old boy who presented with a stage IV Wilms' tumor in a horseshoe kidney. The patient was treated with preoperative chemotherapy followed by surgical resection and adjuvant chemotherapy. This case illustrates the role of preoperative chemotherapy for preserving renal function and aims to highlight the multimodality treatment of Wilms' tumor.
Chemotherapy, Adjuvant ; Humans ; Incidence ; Kidney ; Neoadjuvant Therapy ; Preschool Child ; Wilms Tumor

Breast Neoplasms ; diagnosis ; therapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Humans ; Neoadjuvant Therapy

Imatinib is the key medication for adjuvant therapy in gastrointestinal stromal tumors(GIST) and the first line therapy for patients with metastatic or recurrent GIST. Preoperative treatment with imatinib may improve R0 resection rate and provide the chance of metastasectomy for cytoreduction as well as prolonging patient's survival. We investigate the significance of neoadjuvant therapy of imatinib and the timing of surgery by reviewing clinical trials and consensus in recent years.
Antineoplastic Agents ; Chemotherapy, Adjuvant ; Gastrointestinal Neoplasms ; Gastrointestinal Stromal Tumors ; Humans ; Imatinib Mesylate ; Neoadjuvant Therapy

Esophageal squamous cell carcinoma (ESCC) is one of the commonest malignancies in China. Surgery is the main treatment for ESCC. However, the long-term survival is very poor by surgery alone. Perioperative multimodality treatment, including locally and systemically administrated, preoperatively and postoperatively, has been and will be the standard treatment in terms of improving long-term survival. Base on decades of practice and clinical trials, it is believed that preoperative treatment is better than postoperative treatment, and that chemotherapy plus radiotherapy preoperatively is better than either chemotherapy or radiotherapy alone. Therefore, preoperative radiochemotherapy followed by surgery is the standard treatment and future direction for locally advanced ESCC.
Chemotherapy, Adjuvant ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Humans ; Neoadjuvant Therapy ; Perioperative Care ; Radiotherapy, Adjuvant

As the most common metastasis in colorectal cancer, liver metastasis is the primary cause of treatment failure. Resection plays a dominant role in multidisciplinary treatment of colorectal liver metastases. However, this surgical field is still filled with disputes and challenges. Literature on liver metastasis of colorectal cancer were reviewed and clinical trials were collected. Different opinions were analyzed according to clinical evidence and personal experience. There are many disputes about surgical treatment of colorectal liver metastases, including incomplete staging system, inconsistent criteria of potential resectability, neoadjuvant chemotherapy for resectable liver metastases, adjuvant chemotherapy regimen after radical resection, and treatment of asymptomatic primary lesion in patients with unresectable liver metastasis.
Chemotherapy, Adjuvant ; Hepatectomy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; surgery ; Neoadjuvant Therapy

Several studies have demonstrated the benefit of perioperative chemotherapy in the treatment of advanced gastric cancers, especially the neoadjuvant chemotherapy (NAC). Many NAC trials in the United States, UK and Japan have proved that NAC can shrink the tumor and metastatic lymph nodes, downstage the T and N staging, achieve more curative (R0) resection for the unresectable cases, and even improve survival. Various neoadjuvant chemotherapy regimens have different effects on the body, therefore the timing selection of surgery, surgical programs and goals are different accordingly. Optimal surgery after neoadjuvant chemotherapy should be based on full comprehension of the pharmacology and pharmacokinetics. Strict surgical quality control is necessary.
Chemotherapy, Adjuvant ; Gastrectomy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Stomach Neoplasms ; drug therapy ; surgery

Recently, treatment strategy optimization for neoadjuvant therapy of rectal cancer includes two aspects: (1) Increasing treatment intensity may improve pathological complete response rate, including increasing radiation dose or concurrent chemotherapy intensity, or shifting adjuvant chemotherapy; (2) Short-course radiotherapy or neoadjuvant chemotherapy which can promise treatment efficacy will decrease toxicity and lead to better tolerance. Long-course chemoradiotherapy is the recent treatment standard for locally advanced rectal cancer. NCCN guidelines do not recommend combined chemotherapy in the radiotherapy period. However, it is important for individualized treatment of rectal cancer if appropriate patients who may benefit from the combined concurrent chemotherapy can be selected. Short-course radiotherapy is defined as 5 Gy × 5. It is recommended for T3 or N+ rectal cancer in NCCN guidelines, but not for T4 patients. In ESMO guidelines, stratified patients of intermediate risk by MRI can be treated with either short-course or long-course radiotherapy, but short-course radiotherapy is not recommended for T4 or positive mesorectum fascia (MRF+) patients with high risk. Neoadjuvant chemotherapy incorporated in the neoadjuvant part has been a therapeutic choice in NCCN guidelines. However, It is still unclear whether chemotherapy upfront as a component of neoadjuvant treatment or even completion of chemotherapy before surgery can improve treatment outcome or not. There are phase II( studies focused on this issue and final results are pending.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms ; radiotherapy ; Treatment Outcome