NEOADJUVANT THERAPY IN CANCER-TREATMENT

Neoadjuvant therapy has come to play an increasingly prominent role in the treatment of cancer. Originally defined as systemic therapy given before local treatment, the concept has been extended to include radi ation therapy given before surgery. Potential advantages include impro ved local and distant control, direct evaluation, and organ-sparing tr eatment. Potential disadvantages include increased toxicity and cost, potential delay in effective treatment, and obscuring of pathologic st aging. Neoadjuvant therapy in cancer treatment may be viewed in three categories: tumors in which neoadjuvant treatment has been shown effec tive, thus becoming standard therapy; tumors in which it has been show n to facilitate organ-sparing, and tumors in which its utility has not been shown. For patients with osteogenic sarcoma, for example, preope rative chemotherapy and limb salvage therapy have become the standard of care. Response to chemotherapy, ascertained by histologic review of the surgical specimen, can be used to tailor postoperative chemothera py. In patients with advanced laryngeal squamous cell carcinoma, neoad juvant chemotherapy followed by radiation has permitted laryngeal pres ervation in a majority of patients without compromising overall surviv al. Phase II and III studies conducted in women with breast cancer hav e demonstrated promising results for neoadjuvant chemotherapy given be fore radiation therapy and/or surgery. Phase III studies to compare ne oadjuvant therapy to standard therapy in patients with breast cancer a re underway. For neoadjuvant therapy, as with other innovations in can cer treatment, it is crucial that a new strategy must be compared clos ely to standard therapy in terms of recurrence, survival, and impact o n organ sparing, as well as quality of life and treatment costs.