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<title>Neoadjuvant therapy</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Neoadjuvant therapy</span></span>

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</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: lightblue">Neoadjuvant therapy</th></tr><tr><th scope="row" class="infobox-label"><a href="Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th><td class="infobox-data"><span class="reflink nourlexpansion"><a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D020360">D020360</a></span></td></tr></tbody></table>

<p><b>Neoadjuvant therapy</b> is the administration of <a href="Therapy" title="Therapy">therapeutic</a> agents before a main treatment. One example is neoadjuvant <a href="Hormone" title="Hormone">hormone</a> therapy prior to radical <a href="Radiotherapy" class="mw-redirect" title="Radiotherapy">radiotherapy</a> for <a href="Adenocarcinoma" title="Adenocarcinoma">adenocarcinoma</a> of the <a href="Prostate" title="Prostate">prostate</a>. Neoadjuvant therapy aims to reduce the size or extent of the cancer before using radical treatment intervention, thus both making procedures easier and more likely to succeed and reducing the consequences of a more extensive treatment technique, which would be required if the tumor were not reduced in size or extent.

</p><p>Another related concept is that neoadjuvant therapy acts on <a href="Micrometastasis" title="Micrometastasis">micrometastatic</a> disease. The downstaging is then a surrogate marker of efficacy on undetected dissemination, resulting in improved longtime survival compared to the surgery-alone strategy.

</p><p>This systemic therapy (<a href="Chemotherapy" title="Chemotherapy">chemotherapy</a>, <a href="Immunotherapy" title="Immunotherapy">immunotherapy</a> or hormone therapy) or radiation therapy is commonly used in cancers that are locally advanced, and clinicians plan an operation at a later stage, such as <a href="Pancreatic_cancer" title="Pancreatic cancer">pancreatic cancer</a>. The use of such therapy can effectively reduce the difficulty and <a href="Morbidity" class="mw-redirect" title="Morbidity">morbidity</a> of more extensive procedures.

</p><p>The use of therapy can turn a tumor from untreatable to treatable by shrinking the volume. Often, it is unclear which surrounding structures are directly involved in the disease and which are just showing signs of inflammation. By administering therapy, a distinction can often be made. Some doctors give the therapy in the hope that a response is seen, and they can then decide what is the best course of action. In some cases, <a href="Magnetic_resonance_imaging" title="Magnetic resonance imaging">magnetic resonance imaging</a> can predict the response of a patient to neoadjuvant therapy, for example in <a href="Ovarian_cancer" title="Ovarian cancer">ovarian cancer</a>.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup>

</p><p>Not everyone is suitable for neoadjuvant therapy because it can be extremely toxic. Some patients react so severely that further treatments, especially surgery, are precluded, and the patient is rendered unfit for <a href="Anesthetic" title="Anesthetic">anesthetic</a>.<sup id="cite_ref-pmid34992796_2-0" class="reference"><a href="#cite_note-pmid34992796-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup>

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<ul><li><a href="Adjuvant_chemotherapy" class="mw-redirect" title="Adjuvant chemotherapy">Adjuvant chemotherapy</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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</style><cite id="CITEREFDeenPriestMcLeanGill2019" class="citation journal cs1">Deen SS, Priest AN, McLean MA, Gill AB, Brodie C, Crawford R, et al. (July 2019). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656714">"Diffusion kurtosis MRI as a predictive biomarker of response to neoadjuvant chemotherapy in high grade serous ovarian cancer"</a>. <i>Scientific Reports</i>. <b>9</b> (1): 10742. <a href="Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2019NatSR...910742D">2019NatSR...910742D</a>. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fs41598-019-47195-4">10.1038/s41598-019-47195-4</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656714">6656714</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/31341212">31341212</a>.</cite></span>

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<li id="cite_note-pmid34992796-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid34992796_2-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFGroenewoldOlthofBosch2022" class="citation journal cs1">Groenewold MD, Olthof CG, Bosch DJ (January 2022). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703124">"Anaesthesia after neoadjuvant chemotherapy, immunotherapy or radiotherapy"</a>. <i>BJA Education</i>. <b>22</b> (1): <span class="nowrap">12–</span>19. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.bjae.2021.08.002">10.1016/j.bjae.2021.08.002</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703124">8703124</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/34992796">34992796</a>.</cite></span>

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<div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2></div>

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<ul><li><cite id="CITEREFValentiniCocoPicciocchiMorganti2002" class="citation journal cs1">Valentini V, Coco C, Picciocchi A, Morganti AG, Trodella L, Ciabattoni A, et al. (July 2002). "Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients". <i>International Journal of Radiation Oncology, Biology, Physics</i>. <b>53</b> (3): <span class="nowrap">664–</span>674. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0360-3016%2802%2902764-5">10.1016/S0360-3016(02)02764-5</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12062610">12062610</a>.</cite></li>

<li><cite id="CITEREFTollefsonBoorjianFarmerFrank2012" class="citation journal cs1">Tollefson MK, Boorjian SA, Farmer SA, Frank I (December 2012). "Downstaging to non-invasive urothelial carcinoma is associated with improved outcome following radical cystectomy for patients with cT2 disease". <i>World Journal of Urology</i>. <b>30</b> (6): <span class="nowrap">795–</span>799. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs00345-012-0855-8">10.1007/s00345-012-0855-8</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22447397">22447397</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:231833">231833</a>.</cite></li>

<li><cite id="CITEREFRosenblattSherifRintalaWahlqvist2012" class="citation journal cs1">Rosenblatt R, Sherif A, Rintala E, Wahlqvist R, Ullén A, Nilsson S, Malmström PU, et al. (Nordic Urothelial Cancer Group) (June 2012). "Pathologic downstaging is a surrogate marker for efficacy and increased survival following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive urothelial bladder cancer". <i>European Urology</i>. <b>61</b> (6): <span class="nowrap">1229–</span>1238. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.eururo.2011.12.010">10.1016/j.eururo.2011.12.010</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22189383">22189383</a>.</cite></li>

<li><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20150104183648/http://www.cancer.gov/cancertopics/factsheet/Therapy/adjuvant-breast">"Adjuvant and Neoadjuvant Therapy for Breast Cancer"</a>. US National Institutes of Health (NIH). Archived from <a rel="nofollow" class="external text" href="https://www.cancer.gov/cancertopics/factsheet/Therapy/adjuvant-breast">the original</a> on 4 January 2015.</cite></li></ul>

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