Preoperative (Neoadjuvant) Chemotherapy

Despite recent advances in adjuvant therapies of cancer, the regi mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re fined individual approaches to the planning of postoperative adju vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery.

Klappentext

Despite recent advances in adjuvant therapies of cancer, the regi­ mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre­ operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur­ gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor­ tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re­ fined individual approaches to the planning of postoperative adju­ vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery.

Inhalt
Clinical and Scientific Considerations in Preoperative (Neoadjuvant) Chemotherapy.- Experimental Adjuvant Chemotherapy: An Overview.- Theoretical Considerations Regarding the Early Use of Adjuvant Chemotherapy.- Experimental Preoperative Chemotherapy.- Implications of Certain Cell Kinetic and Biological Parameters for Preoperative Chemotherapy.- Adjuvant Therapy for Breast Cancer: A Brief Overview of the NSABP Experience and Some Thoughts on Neoadjuvant Chemotherapy.- Factors Affecting the Development of Permanent Drug Resistance and Its Impact upon Neoadjuvant Chemotherapy.- Impact of Preoperative Chemotherapy for the Surgeon.- Preoperative (Neoadjuvant) Chemotherapy for Breast Cancer: Outline of the British Columbia Trial.- Perioperative Adjuvant Chemotherapy of Breast Cancer: The Scandinavian Experience.- Perioperative and Conventionally Timed Chemotherapy in Operable Breast Cancer: The Ludwig Breast Cancer Study V.- Neoadjuvant Chemotherapy in the Conservative Management of Breast Cancer: Study of 143 Patients.- Preliminary Results of Preoperative Chemotherapy with a Combination of Platinum-Bleomycin Administered in 5-Day Cycles in Carcinoma of the Bronchus.- Impact of Primary Site of Stage III and IV Squamous Cell Carcinomas of the Head and Neck on 7-Year Survival Figures Following Initial Non-Cisplatin-Containing Combination Chemotherapy.- Chemotherapy with or Without Anticoagulation as Initial Management of Patients with Operable Colorectal Cancer: A Prospective Study with at Least 5Years Follow-up.- Preoperative Chemotherapy for Gastric Cancer: A Prospective Study with at Least 1 Year Follow-up.- Neoadjuvant Chemotherapy for Osteogenic Sarcoma: A Model for the Treatment of Other Highly Malignant Neoplasms.- Summary of Preoperative (Neoadjuvant) Chemotherapy.