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al from Canada · 05-20-2006, 12:24 PM

Dear Lani,

Here is an exerpt with link at the end.

There is a biological rationale for studying optimal timing of initiation of chemotherapy in relation to the surgical removal of the tumour. Experimental cell kinetic data support the hypothesis that timing of cytotoxics administration as close as possible to the operation may improve treatment outcome [1–4]. In mice bearing both a large primary tumour and a metastatic lesion, the removal of the former increased the proliferative fraction (rate) of the latter as compared with preoperative levels [3]. In this animal model, cyclophosphamide was most effective against metastatic growth when the drug was administered either preoperatively or immediately after tumour removal compared with delayed administration [4]. Other data provide a plausible rationale for initiation of chemotherapy as close as possible to the surgical removal of a tumour. Surgical trauma and removal of the primary tumour is known to enhance biological processes, which stimulate both wound healing [5] and may induce tumour progression [6]. Moreover, the results of a meta-analysis of trials on perioperative chemotherapy (PeCT) showed a reduced risk of relapse by 11% with early initiation of chemotherapy compared with a usual delayed administration, which started after removal of stitches and completion of wound healing [7].
Preoperative chemotherapy (PreCT) has been demonstrated to be beneficial for patients with breast cancer, allowing breast-conserving surgery in some of the patients [8]. One of the most effective regimens used in this setting is the combination of continuous infusion of 5-fluorouracil (5-FU), epirubicin and cisplatin (ECF). Smith et al. reported high complete remission rates in 50 patients with large operable breast cancer treated with this regimen. Ninety-eight per cent of these patients had significant tumour shrinkage, 66% had a complete clinical remission, and 27% a pathological complete response [9]. Surgery was performed after completion of 6 months of chemotherapy. The same investigators recently compared preoperative ECF with adriamycin and cyclophosphamide (AC) in a phase III randomised trial involving 426 patients with invasive operable breast cancer. The interim analysis showed a significant survival benefit for continuous infusional 5-FU-containing chemotherapy over conventional AC [10].

http://annonc.oxfordjournals.org/cgi...ull/14/10/1477

05-20-2006, 12:24 PM	#13
al from Canada Senior Member Join Date: Jul 2005 Location: Ontario, Canada Posts: 722	Dear Lani, Here is an exerpt with link at the end. There is a biological rationale for studying optimal timing of initiation of chemotherapy in relation to the surgical removal of the tumour. Experimental cell kinetic data support the hypothesis that timing of cytotoxics administration as close as possible to the operation may improve treatment outcome [1–4]. In mice bearing both a large primary tumour and a metastatic lesion, the removal of the former increased the proliferative fraction (rate) of the latter as compared with preoperative levels [3]. In this animal model, cyclophosphamide was most effective against metastatic growth when the drug was administered either preoperatively or immediately after tumour removal compared with delayed administration [4]. Other data provide a plausible rationale for initiation of chemotherapy as close as possible to the surgical removal of a tumour. Surgical trauma and removal of the primary tumour is known to enhance biological processes, which stimulate both wound healing [5] and may induce tumour progression [6]. Moreover, the results of a meta-analysis of trials on perioperative chemotherapy (PeCT) showed a reduced risk of relapse by 11% with early initiation of chemotherapy compared with a usual delayed administration, which started after removal of stitches and completion of wound healing [7]. Preoperative chemotherapy (PreCT) has been demonstrated to be beneficial for patients with breast cancer, allowing breast-conserving surgery in some of the patients [8]. One of the most effective regimens used in this setting is the combination of continuous infusion of 5-fluorouracil (5-FU), epirubicin and cisplatin (ECF). Smith et al. reported high complete remission rates in 50 patients with large operable breast cancer treated with this regimen. Ninety-eight per cent of these patients had significant tumour shrinkage, 66% had a complete clinical remission, and 27% a pathological complete response [9]. Surgery was performed after completion of 6 months of chemotherapy. The same investigators recently compared preoperative ECF with adriamycin and cyclophosphamide (AC) in a phase III randomised trial involving 426 patients with invasive operable breast cancer. The interim analysis showed a significant survival benefit for continuous infusional 5-FU-containing chemotherapy over conventional AC [10]. http://annonc.oxfordjournals.org/cgi...ull/14/10/1477 __________________ Primary care-giver to and advocate for Linda, who passed away April 27, 2006.