Kinetics of primary tumor regression with chemotherapy: Implications for the timing of surgery

Medary, Irene; Aronson, Daniël C.; Cheung, Nai‐Kong V.; Ghavimi, Fereshteh; Gerald, William L.; Quaglia, Michael P. La

doi:10.1007/bf02306083

Cited by 34 publications

(11 citation statements)

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“…Medary et al reported the kinetics of primary embryonal tumor regression in 24 children having rhabdomyosarcoma (n=16), neuroblastoma (n=5), or hepatoblastoma (n=3) (10). These authors measured tumor volume decay over time and initial cell counts, but did not include sAFP kinetics as a measure of hepatoblastoma response to induction therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, Medary et al reported that in three cases of hepatoblastoma, a rapid initial reduction in primary tumor volume could be observed and that a plateau in any further tumor decay appeared after cycle two (treatment according to Children's Cancer Group, CCG-8881) (10). These authors suggested that post-induction complete resection of hepatoblastoma could be accomplished after chemotherapy cycle two or three.…”

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confidence: 99%

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Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics

Lovvorn

Ayers

Zhao

et al. 2010

Journal of Pediatric Surgery

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Purpose Hepatoblastoma is commonly unresectable at presentation, necessitating induction chemotherapy before definitive resection. To refine the paradigm for timing of resection, we questioned whether a plateau in hepatoblastoma responsiveness to neoadjuvant therapy could be detected by calculating tumor volume (TV) and serum α-fetoprotein (sAFP) kinetics. Methods To calculate TV and sAFP as measures of treatment responsiveness over time, infants having initially unresectable epithelial-type hepatoblastomas were identified at a single institution (1996-2008). Effects of therapy type, therapy duration, and lobe of liver involvement on TV, sAFP, margin status, and toxicity were analyzed. Results Of 24 infants treated for epithelial-type hepatoblastoma during this interval, 5 were resected primarily, and 15 had complete digital films for kinetics analysis. Both TV and sAFP decreased dramatically over time (p<0.0001). No statistically significant difference in mean TV or sAFP was detected after chemotherapy cycle 2. Left lobe tumors had greater presenting levels of and significantly slower decay in sAFP compared to right lobe tumors (p=0.005), although no statistically significant differences in TV existed between liver lobes. Resection margins did not change with therapy duration. Conclusions Measuring TV and sAFP kinetics accurately reflects hepatoblastoma responsiveness to induction therapy. Treatment toxicities may be reduced by earlier resection and tailoring of chemotherapeutic regimens.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics

Lovvorn

Ayers

Zhao

et al. 2010

Journal of Pediatric Surgery

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“…Most children undergo delayed surgery after the completion of the fifth cycle of induction chemotherapy, even though tumor volume reduction plateaus after the second or third cycle of chemotherapy. 39 Other groups are performing surgery as soon as locoregional disease appears, radiographically, to be resectable. 40 Although initial surgical resection is not often appropriate for patients with neuroblastoma, the principle of resection at the earliest feasible time should be considered.…”

Section: Risk and Treatment Stratificationmentioning

confidence: 99%

Neuroblastoma

Davidoff

2012

Seminars in Pediatric Surgery

161

115

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Neuroblastoma is a heterogeneous disease; tumors can spontaneously regress or mature, or display an aggressive, therapy-resistant phenotype. Increasing evidence indicates that the biologic and molecular features of neuroblastoma significantly influence and are highly predictive of clinical behavior. Because of this, neuroblastoma has served as a paradigm for biological risk assessment and treatment assignment. Most current clinical studies of neuroblastoma base therapy and its intensity on a risk stratification that takes into account both clinical and biologic variables predictive of relapse. For example, surgery alone offers definitive therapy with excellent outcome for patients with low-risk disease, while patients at high-risk for disease relapse are treated with intensive multimodality therapy. In this review recent advances in the understanding of the molecular genetic events involved in neuroblastoma pathogenesis are discussed, and how they are impacting the current risk stratification and providing potential targets for new therapeutic approaches for children with neuroblastoma. In addition, the results of significant recent clinical trials for the treatment of neuroblastoma are reviewed.

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“…Historically, surgical resection was attempted after four cycles of chemotherapy, and further chemotherapy was planned if the tumour was unresectable after four cycles. There is evidence to suggest that the radiographic response of the tumour to chemotherapy plateaus after two cycles and tumour cells may acquire resistance with increasing number of cycles of chemotherapy. The current consensus is to attempt earlier resection if tumours are amenable to surgical management after two cycles of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Effect of neoadjuvant chemotherapy on resectability of stage III and IV hepatoblastoma

Venkatramani

Stein

Sapra

et al. 2015

Journal of British Surgery

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Kinetics of primary tumor regression with chemotherapy: Implications for the timing of surgery

Cited by 34 publications

References 8 publications

Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics

Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics

Neuroblastoma

Effect of neoadjuvant chemotherapy on resectability of stage III and IV hepatoblastoma

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