Locally advanced XXXX : chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience.

@entity5 @entity1 @entity137 @entity3
Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced @entity5 . It can downstage a @entity5 and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic @entity3 . This report reviews a single institution's experience of neoadjuvant chemotherapy prior to @entity5 over a 13-year period. One hundred and six @entity1 were treated with this intent. The @entity1 were analysed for their response to chemotherapy, treatment received, survival, relapse and @entity137 . The chemotherapy was feasible and the majority of @entity1 had a complete or partial response (58.5%). Eight @entity1 did not proceed to local treatment. Forty-six @entity1 had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of @entity1 died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n=6) or surgical intervention (n=2) were recorded in eight @entity1 (7.5%). On univariate analysis stage (P=0.04), @entity5 size (P=0.01), lymph node status (P=0.003), response to chemotherapy (P=0.045) and treatment (P=0.003) were all significant predictors of survival. On multivariate analysis, @entity5 size (P < 0.0001) and nodal status (P=0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced @entity5 , there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial.
