Trimble E L, Ungerleider R S, Abrams J A, Kaplan R S, Feigal E G, Smith M A, Carter C L, Friedman M A
National Cancer Institute, Bethesda, Maryland.
Cancer. 1993 Dec 1;72(11 Suppl):3515-24. doi: 10.1002/1097-0142(19931201)72:11+<3515::aid-cncr2820721619>3.0.co;2-a.
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 radiation therapy given before surgery. Potential advantages include improved local and distant control, direct evaluation, and organ-sparing treatment. Potential disadvantages include increased toxicity and cost, potential delay in effective treatment, and obscuring of pathologic staging. Neoadjuvant therapy in cancer treatment may be viewed in three categories: tumors in which neoadjuvant treatment has been shown effective, thus becoming standard therapy; tumors in which it has been shown to facilitate organ-sparing, and tumors in which its utility has not been shown. For patients with osteogenic sarcoma, for example, preoperative 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 chemotherapy. In patients with advanced laryngeal squamous cell carcinoma, neoadjuvant chemotherapy followed by radiation has permitted laryngeal preservation in a majority of patients without compromising overall survival. Phase II and III studies conducted in women with breast cancer have demonstrated promising results for neoadjuvant chemotherapy given before radiation therapy and/or surgery. Phase III studies to compare neoadjuvant therapy to standard therapy in patients with breast cancer are underway. For neoadjuvant therapy, as with other innovations in cancer treatment, it is crucial that a new strategy must be compared closely to standard therapy in terms of recurrence, survival, and impact on organ sparing, as well as quality of life and treatment costs.
新辅助治疗在癌症治疗中发挥着越来越重要的作用。最初定义为在局部治疗前给予的全身治疗，这一概念已扩展到包括手术前给予的放射治疗。潜在优势包括改善局部和远处控制、直接评估以及保留器官的治疗。潜在劣势包括毒性增加和成本上升、有效治疗可能延迟以及病理分期模糊。癌症治疗中的新辅助治疗可分为三类：新辅助治疗已被证明有效的肿瘤，因此成为标准治疗；已被证明有助于保留器官的肿瘤，以及其效用尚未得到证明的肿瘤。例如，对于骨肉瘤患者，术前化疗和保肢治疗已成为标准治疗方法。通过对手术标本的组织学检查确定的化疗反应可用于调整术后化疗。对于晚期喉鳞状细胞癌患者，新辅助化疗后放疗使大多数患者能够保留喉部，且不影响总体生存率。在乳腺癌女性患者中进行的II期和III期研究表明，在放疗和/或手术前给予新辅助化疗取得了有前景的结果。比较乳腺癌患者新辅助治疗与标准治疗的III期研究正在进行中。对于新辅助治疗，与癌症治疗的其他创新一样，至关重要的是，必须在复发、生存、对保留器官的影响以及生活质量和治疗成本方面，将新策略与标准治疗进行密切比较。
