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新辅助治疗在乳腺癌应用的临床意义
乳腺癌新辅助治疗(neoadjuvant therapy)也称为新辅助全身性治疗(neoadjuvant systemic therapy,NST)、初始全身性治疗(primary systemic therapy,PST)或术前治疗(preoperative therapy),是指在手术切除乳腺原发病灶之前所采用的伞身性的药物治疗.随着术后辅助治疗中疗效的确认,继化疗药物后,目前内分泌药物和分子靶向药物也应用于乳腺癌的NST.NST现已成为局部晚期乳腺癌的标准治疗方案,并给可手术的早期乳腺癌的治疗方案提供了一种新的选择,成为乳腺癌多学科综合治疗的重要组成[1-2].
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Surgery following neoadjuvant chemoradiotherapy (NCRT) is a common multidisciplinary treatment for resectable esophageal cancer (EC). Atfer analyzing 12 randomized controlled trials (RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma (SCC) and adenocarcinoma (AC), and most chemotherapy regimens are based on cisplatin, lfuorouracil (FU), or both (CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was signiifcantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identiifcation of optimum regimens and selection of patients who are most likely to beneift from speciifc treatment options.
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胃癌新辅助治疗存在的问题和发展趋势
胃癌发病和死亡虽然在发达国家呈逐年递减的趋势,但仍然是全球发病第4位、死亡第2位的恶性肿瘤[1].美国外科协会(AJCC)对13 295例胃癌患者的资料总结中显示,胃癌R0切除率只有23%;在获得R0切除的情况下,也有超过50%的患者已经出现淋巴结转移,N2、N1、T3N0的患者5年生存率分别为10%、20%和47%[2].术后辅助化疗可以消灭腹腔内的残存微小转移灶.理论上能获得生存优势.