• Title/Summary/Keyword: Neoadjuvant chemotherapy

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BRCA 유전자 변형 환자의 양측 삼중음성 유방암의 선행화학요법에 대한 상이한 반응 (Bilateral Triple Negative Invasive Ductal Breast Carcinoma in a BRCA1 Mutation Carrier with Discrepant Pathologic Response to Neoadjuvant Chemotherapy)

  • 신기원;박영미;김태현;이안복;박하영;윤혜경;허영진;백진욱;이유진
    • 대한영상의학회지
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    • 제81권2호
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    • pp.428-435
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    • 2020
  • 저자들은 BRCA 유전자 변형 환자의 양측 삼중음성 유방암의 선행화학요법에 대한 상이한 반응에 대한 증례를 보고한다. 우측은 T1cN0M0, 좌측은 T4dN3aM0으로 각각 진단되었다. 환자는 Adriamycin, cyclophosphamide 항암요법 4차, docetaxel 4차를 시행 받았다. 양측 유방암은 첫 번째 항암요법 4차 이후에 부분 관해를 보였다. Docetaxel 항암요법 중 양측 유방암은 상이한 반응을 보였다. 우측 유방암은 지속적인 관해를 보였으나, 좌측 유방암은 진행되는 양상을 보였다. 전절제술 결과, 우측 유방암은 0.3 cm, 좌측은 12 cm로 측정되었다. 동일한 삼중음성 유방암에서도 항암요법에 대하여 좌우가 상이한 반응을 보일 수 있으므로, 면밀한 추적 관찰이 고려되어야 할 것이다.

골육종에서 수술 전 항암 약물치료가 생존에 미치는 영향 (Effect of Preoperative Chemotherapy on Survival in High-grade Localized Osteosarcoma of the Extremity)

  • 최은석;한일규;조환성;김한수
    • 대한골관절종양학회지
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    • 제18권2호
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    • pp.59-65
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    • 2012
  • 목적: 본 연구는 수술 전 항암 약물 치료가 전이가 없는 골육종 환자의 생존율과 전이에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 1984년부터 2010년까지 사지에 발생한, 전이가 없는 원발성 골육종으로 수술적 절제술과 수술 후 항암 약물 치료를 시행한 30세 미만의 환자 225명을 후향적으로 분석하였다. 평균 연령은 14.4세, 평균 추시기간은 9.1년이었다. 수술 후에만 항암 약물 치료를 시행한 군과 수술 전, 후 약물 치료를 시행했던 두군의 임상적 특성과 생존율을 비교하였다. 결과: 전체 225예 중 수술 후 약물 치료 군은 32예, 수술 전후 약물 치료 군은 193예였다. 수술 후 약물 치료 군은 절단 수술과(p<0.001), 전이의 빈도가 유의하게(p=0.004) 높았으며, 전이 발생시기도 빨랐다. 수술 후 약물 치료 군에서는 5년 생존율 51%로 수술 전후 약물 치료 군의 84%보다 낮았다(p=0.001). 국소재발은 유의한 차이가 없었다. 결론: 사지에 발생한 골육종 환자에서 수술 전 항암 약물 치료는 전이의 억제와 생존율 향상에 도움이 된다.

구인두암의 방사선 치료 성적 (Results of Conventional Radiotherapy in Oropharyngeal Cancer)

  • 남택근;안성자;정웅기;나병식
    • Radiation Oncology Journal
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    • 제14권1호
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    • pp.1-8
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    • 1996
  • 목적 : 통상적인 외부 방사선 단독 치료 또는 유도 화학 병용요법으로 치료한 구인두암 환자들을 대상으로 생존율과 예후 인자를 후향적으로 분석하여 이들 치료방법의 역할을 평가하고자 하였다. 대상 및 방법 : 1985년 11월부터 1993년 4월까지 구인두암으로 근치적 방사선 치료를 시행한 47명의 환자들 중, 26명은 통상적인 외부 방사선 치료만을, 나머지 21명은 유도 화학요법을 시행하였고 화학요법의 약제는 대부분 Cisplatin과 Pepleomycin으로 2회 시행하였으며, 방사선 단독 치료군과 유도 화학 병용요법군간의 환자 특성은 대체로 유사하였다. 방사선 치료는 6MV-LINAC으로 1일 선량 1.8-2.0 Gy씩 원발병소에는 54.0-79.2 Gy까지, 경부 임파절 병소에는 병소의 크기에 따라 55.8-90.0 Gy까지 조사하였다. 추적 기간은 3개월에서 102개월로 중앙값은 20개월이었고, 연령 분포는 33세에서 79세로 중앙값은 58세였다. 결과 : 전체 환자의 3년 생존율은 $39\%$였고, AJCC에 의한 병기별 3년 생존율은 I기 (n=5), II기 (n=11), III기 (n=12), IV기 (n=19)에서 각각 60, 55, 33, $32\%$이었다. 원발병소와 경부 임파절 병소의 병기별 3년 생존율은 T1+2, T3+4와 No, N+에서 각각 55, $18\%$ (p=0.005)와 43, $36\%$ (p>0.1)이었다. 방사선 단독 치료군과 유도 화학 병용요법군의 3년 생존율은 각각 38, $43\%$이었으나 통계적인 유의한 차이는 없었다(p>0.1). 원발병소 부위별 3년 생존율은 편도암(n=32), 설근암(n=8), 연구개 및 구개수암(n=6), 인두벽암(n=1)에서 각각 36, 38, 67, $0=%$이었으나 통계적인 유의한 차이는 없었다(p>0.1). 편도암 환자 32명 중, 22명은 주위 조직으로 침습이 있었고 그렇지 않은 군(10명)과의 3년 생존을은 24 대 $60\%$로 낮은 경향을 보였다 (p=0.08). 전체 환자에 대하여 원발병소 부위, 원발병소의 병기, 경부 임파절 병소의 병기, 방사선 치료 기간, 나이, 유도 화학요법 사용 유무 등에 대한 다요인 분석에서 원발병소의 병기만이 유의한 예후 인자였다. 결론 : 통상적인 외부 방사선 단독 치료군과 유도 화학 병용요법군간의 3년 생존율의 유의한 차이는 없었고, 이와 같은 치료방법으로 구인두암의 조기 병변, 특히 연구개암과 구개수암, 또는 주위 조직으로 침습이 없는 편도암에서 근치적 효과를 볼 수 있었다. 그러나 대부분의 진행된 병기의 생존율을 높이기 위해서는 통상적인 방사선 치료나 유도 화학요법 대신 다분할 조사 또는 가능한 수술적 방법의 추가나 동시적 화학 방사선 병용요법 등 보다 적극적이고 다면적인 치료가 필요할 것으로 사료된다.

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Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy

  • Wee, Chan Woo;Keam, Bhumsuk;Heo, Dae Seog;Sung, Myung-Whun;Won, Tae-Bin;Wu, Hong-Gyun
    • Radiation Oncology Journal
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    • 제33권2호
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    • pp.98-108
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    • 2015
  • Purpose: The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. Materials and Methods: Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. Results: With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. Conclusion: CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

Locally Advanced Breast Cancer in Jamaica: Prevalence, Disease Characteristics and Response to Preoperative Therapy

  • Chin, Sheray Nicole;Green, Cheryl May Antoinette;Gordon-Strachan, Georgiana Marie;Wharfe, Gilian Helen Frances
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권7호
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    • pp.3323-3326
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    • 2014
  • Breast cancer is the most common cancer in Jamaican women. Locally advanced breast cancer (LABC) is associated with aggressive biology and poor prognosis, and has a predilection for African-American women. In this retrospective review, we assessed the prevalence of LABC as a breast cancer presentation in a population of mainly Afro-centric ethnicity, and determined disease characteristics and response to pre-operative chemotherapy. LABC was prevalent (20%), and had a low pathological response rate to pre-operative chemotherapy, with a high risk of disease recurrence. Increased utilization of breast cancer screening may help detect cancer at less advanced stages, and optimizing pre-operative chemotherapy is recommended to improve response rates and ultimately survival.

Neoadjuvant chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: Meta-analysis and trial sequential analysis of randomized controlled trials

  • Shahab Hajibandeh;Shahin Hajibandeh;Christina Intrator;Karim Hassan;Mantej Sehmbhi;Jigar Shah;Eshan Mazumdar;Ambareen Kausar;Thomas Satyadas
    • 한국간담췌외과학회지
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    • 제27권1호
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    • pp.28-39
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    • 2023
  • We aimed to compare resection and survival outcomes of neoadjuvant chemoradiotherapy (CRT) and immediate surgery in patients with resectable pancreatic cancer (RPC) or borderline resectable pancreatic cancer (BRPC). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards, a systematic review of randomized controlled trials (RCTs) was conducted. Random effects modeling was applied to calculate pooled outcome data. Likelihood of type 1 or 2 errors in the meta-analysis model was assessed by trial sequential analysis. A total of 400 patients from four RCTs were included. When RPC and BRPC were analyzed together, neoadjuvant CRT resulted in a higher R0 resection rate (risk ratio [RR]: 1.55, p = 0.004), longer overall survival (mean difference [MD]: 3.75 years, p = 0.009) but lower overall resection rate (RR: 0.83, p = 0.008) compared with immediate surgery. When RPC and BRPC were analyzed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, p = 0.004) and overall survival (MD: 6.64, p = 0.004) of patients with BRPC. However, it did not improve R0 resection rate (RR: 1.18, p = 0.13) or overall survival (MD: 0.94, p = 0.57) of patients with RPC. Neoadjuvant CRT might be beneficial for patients with BRPC, but not for patients with RPC. Nevertheless, the best available evidence does not include contemporary chemotherapy regimens. Patients with RPC and those with BRPC should not be combined in the same cohort in future studies.

Values of Three Different Preoperative Regimens in Comprehensive Treatment For Young Patients with Stage Ib2 Cervical Cancer

  • Zhao, Yi-Bing;Wang, Jin-Hua;Chen, Xiao-Xiang;Wu, Yu-Zhong;Wu, Qiang
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권4호
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    • pp.1487-1489
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    • 2012
  • Objective: To compare the clinical efficacy of concurrent chemoradiotherapy, neoadjuvant chemotherapy, and intracavity brachytherapy in comprehensive treatment for young patients with stage Ib2 cervical cancer. Methods: One hundred and twelve young patients with stage Ib2 cervical cancer were enrolled retrospectively in our hospital from January 2003 to June 2005. They were categorized into three groups according to preoperative regimens, including the concurrent chemoradiotherapy group (Group 1, n=38), the neoadjuvant chemotherapy (Group 2, n=49), and the intracavity brachytherapy group (Group 3, n=25). Radical hysterectomy was performed following these regimens. Chemotherapy and radiotherapy were given according to pelvic lymph node metastasis, deep cervical stromal invasion, intravascular cancer emboli, histological grading, vaginal stump and positive surgical margin. Results: The cancer disappearance and superficial muscle invasion rates were statistically significantly better in the concurrent chemoradiotherapy group than in the other two groups (P<0.01). No statistically significant difference was noted in the deep muscle invasion rate, surgical time and intraoperative blood loss among three groups, but significantly more postoperative complications occurred in the concurrent chemoradiotherapy group. The 2-year pelvic recurrence was statistically significantly lower in the concurrent chemoradiotherapy group compared to other two groups, while the 5-year survival was higher. Conclusion: Concurrent chemoradiotherapy is efficacious for young patients with stage Ib2 cervical cancer.

Predictive Role of GSTs on the Prognosis of Breast Cancer Patients with Neoadjuvant Chemotherapy

  • Bai, Yun-Lu;Zhou, Bing;Jing, Xiao-Yue;Zhang, Bin;Huo, Xiao-Qing;Ma, Chao;He, Jian-Miao
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권10호
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    • pp.5019-5022
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    • 2012
  • Objective: To evaluate the predictive value of GST gene polymorphisms with regard to prognosis of breast cancer patients receiving neoadjuvant chemotherapy. Methods: A total of 159 patients were included in our study between January 2005 and January 2007. All the patients were followed up until January 2012. Genotyping was based upon the duplex polymerase-chain-reaction with the PCR-CTPP method. Results: Patients with null GSTM1 and GSTP1 Val/Val genotypes had significantly had better response rates to chemotherapy when compared with non-null GSTM1 and GSTP1 Ile/Ile genotypes (OR=1.96 and OR=2.14, respectively). Patients with the GSTM1 null genotype had a longer average survival time and significantly lower risk of death than did those with non-null genotypes (HR=0.66). Similarly, those carrying the GSTP1 Val/Val genotype had 0.54-fold the risk of death of those with GSTP1 Ile/Ile (HR=0.54). Conclusion: A significant association was found between GSTM1 and GSTP1 gene polymorphisms and clinical outcomes in breast cancer cases.

췌장암 항암화학요법의 최신 지견 (Updates of Chemotherapy for Pancreatic Cancer)

  • 성민제
    • Journal of Digestive Cancer Research
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    • 제11권3호
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    • pp.147-156
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    • 2023
  • Pancreatic cancer is one of the most aggressive cancers, and it is expected to become the second-leading cause of cancer-related death in the United States by 2030. Its 5-year survival rate is <10% and approximately 15% of cases are eligible for surgical treatment during diagnosis. Furthermore, the risk of recurrence within 1 year postoperative is as high as 50%. Therefore, chemotherapy plays a crucial role in pancreatic cancer treatment. Survival rates are speculated to have improved since the introduction of FOLFIRINOX and gemcitabine/nab-paclitaxel combination therapy for metastatic pancreatic cancer in the 2010s. Additionally, the implementation of both neoadjuvant and adjuvant treatments in resectable and borderline resectable pancreatic cancer caused better outcomes compared to upfront surgery. Recently, not only have these medications advanced in development, but so have PARP inhibitors and KRAS inhibitors, contributing to the treatment landscape. This study aimed to explore the latest insights into chemotherapy for pancreatic cancer.