Hanafy Ehab, Al Jabri Abdullah, Gadelkarim Gelan, Dasaq Abdulaziz, Nazim Faisal, Al Pakrah Mohammed
Prince Sultan Oncology Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
J Investig Med. 2018 Feb;66(2):289-297. doi: 10.1136/jim-2017-000531. Epub 2017 Sep 27.
The management of oncological malignancies has significantly improved over the last decades. In modern medicine, new concepts and trends have emerged paving the way for the era of personalized and evidence-based strategies adapted to the patients' prognostic variables and requirements. Several challenges do exist that are encountered during the management, including the difficulty to assess chemotherapy response with certainty. Having known that neoadjuvant chemotherapy might be the only solution for a proportion of patients with tumors that are unresectable at diagnosis, emergence of strategies that use risk group-directed therapy became an integral part in the management of oncological malignancies. Tumor histopathological change post neoadjuvant chemotherapy is one of the most important predictors of management outcome and is being used in many chemotherapy protocols as an essential determinant of the most suitable postoperative chemotherapy regimen. Bone tumors are the classic models of this approach; however, other childhood solid tumors show significant variations in outcome as a result of tumor histopathological response to neoadjuvant chemotherapy. The aim of this review is therefore to summarize the significance of histopathological responses seen after neoadjuvant chemotherapy in childhood solid tumors. Moreover, it suggests that the effect on tumor histopathology through modifying neoadjuvant chemotherapy and, on the other hand, toxicities from intensifying adjuvant chemotherapy might either necessitate the change of a number of arm groups in different protocol regimens or include newer chemotherapeutic agents adjuvantly for better outcome and lesser toxicities in poor tumor histopathological responders.
在过去几十年中，肿瘤恶性疾病的管理有了显著改善。在现代医学中，新的概念和趋势不断涌现，为适应患者预后变量和需求的个性化及循证策略时代铺平了道路。在管理过程中确实存在一些挑战，包括难以确定评估化疗反应。已知新辅助化疗可能是一部分诊断时无法切除肿瘤的患者的唯一解决方案，因此，采用风险分组导向治疗的策略成为肿瘤恶性疾病管理中不可或缺的一部分。新辅助化疗后肿瘤组织病理学变化是管理结果的最重要预测指标之一，并且在许多化疗方案中被用作确定最合适术后化疗方案的关键决定因素。骨肿瘤是这种方法的经典模型；然而，由于肿瘤对新辅助化疗的组织病理学反应，其他儿童实体瘤的结果显示出显著差异。因此，本综述的目的是总结儿童实体瘤新辅助化疗后组织病理学反应的意义。此外，它表明，通过调整新辅助化疗对肿瘤组织病理学的影响，以及另一方面，强化辅助化疗的毒性，可能需要改变不同方案中的多个分组，或者辅助使用更新的化疗药物，以在肿瘤组织病理学反应较差的患者中获得更好的结果和更低的毒性。
