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Applications of Neoadjuvant Therapy in the Treatment of Gastrointestinal Cancers
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Applications of Neoadjuvant Therapy in the Treatment of Gastrointestinal Cancers

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (31 October 2024) | Viewed by 6144

Special Issue Editors

Dr. Tiago Biachi De Castria

E-Mail Website
Guest Editor
1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
2. Morsani College of Medicine, University of South Florida, Tampa, FL, USA
Interests: gastrointestinal malignancies; precision oncology; targeted therapy; adoptive cell therapies
Dr. Natally Horvat

E-Mail Website
Guest Editor
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Interests: rectal cancer; hepatobiliopancreatic cancer; LI-RADS; precision oncology; radiomics; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgery is often used to attempt to cure patients whose tumors are localized within the gastrointestinal (GI) tract. However, tumor complexity and morbidity delaying a timely return to intended oncology treatment (RIOT) are important drawbacks with upfront resection and may be associated with worse outcomes.

Neoadjuvant therapy is an attractive concept for any GI malignancy that allows us to test tumor behavior and select the right patient for a major procedure, to downsize a previously borderline or unresectable tumor, to treat micro-metastatic disease early, and to allow organ preservation.

In 1974, Dr. Norman Nigro and colleagues at Wayne State University introduced neoadjuvant chemoradiotherapy prior to abdominoperineal resection for anal cancer. They initially published a series in Diseases of the Colon and Rectum of three patients with anal squamous cell carcinoma treated with combined chemotherapy and radiation. The first two patients underwent surgical resection, and complete pathological response was seen. The third patient declined surgery and was free of recurrence after 14 months of follow-up. This combination became known as the “Nigro Protocol”, and after further study, it became the new standard of care in anal cancer.

Since Dr. Nigro’s successful experiment, several trials have demonstrated the benefits of adding preoperative chemotherapy and/or radiotherapy in the treatment landscape.

This Special Issue aims to provide a comprehensive review of neoadjuvant therapies in GI malignancies, exploring the clinical application, current evidence, and treatment prospect with this approach in different tumors.

Dr. Tiago Biachi De Castria
Dr. Natally Horvat
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neoadjuvant
  • preoperative
  • gastrointestinal malignancies
  • chemotherapy
  • radiotherapy
  • radiomics

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Published Papers (2 papers)

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Review

15 pages, 308 KiB  
Review
The Evolving Role of Neoadjuvant Radiation Therapy in Pancreatic Adenocarcinoma
by John Michael Bryant, Justyn Nakashima, Vaseem M. Khatri, Andrew J. Sinnamon, Jason W. Denbo, Pamela Hodul, Mokenge Malafa, Sarah Hoffe and Jessica M. Frakes
J. Clin. Med. 2024, 13(22), 6800; https://doi.org/10.3390/jcm13226800 - 12 Nov 2024
Cited by 1 | Viewed by 1304
Abstract
Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers. Surgical resection is the most reliable chance for cure, but high rates of positive margins and local failure persist. Neoadjuvant therapies (NAT), including chemotherapy and radiation therapy (RT), are being explored to [...] Read more.
Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers. Surgical resection is the most reliable chance for cure, but high rates of positive margins and local failure persist. Neoadjuvant therapies (NAT), including chemotherapy and radiation therapy (RT), are being explored to improve surgical outcomes, particularly in borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). This review aims to summarize the current landscape and future directions for neoadjuvant RT (NART) in PDAC. Methods: The review includes a detailed analysis of past and ongoing clinical trials investigating various NART approaches in PDAC, with an emphasis on different RT techniques, fractionation schemes, and their integration into multimodal treatment strategies. Results: Early evidence suggests that NART can improve resection margins and local control. However, recent trials, including the Alliance A021501 and LAP-07 trials, have failed to demonstrate significant survival benefits with the addition of RT to NAT. Nevertheless, nuances in trial design and execution continue to keep the question of NART open. Newer approaches, such as stereotactic magnetic resonance-guided adaptive radiation therapy (SMART), show promise in improving local control and survival, but further phase 3 trials are needed. Conclusions: While NART has shown potential in improving local control in PDAC, its impact on overall survival remains unclear. Ongoing trials, particularly those utilizing advanced techniques like SMART, are critical in defining the role of RT in the neoadjuvant setting for PDAC. Collaboration across multidisciplinary teams is essential to optimize treatment strategies and trial outcomes. Full article
(This article belongs to the Special Issue Applications of Neoadjuvant Therapy in the Treatment of Gastrointestinal Cancers)
17 pages, 4715 KiB  
Review
CT Imaging Assessment of Pancreatic Adenocarcinoma Resectability after Neoadjuvant Therapy: Current Status and Perspective on the Use of Radiomics
by Hala Khasawneh, Hanna Rafaela Ferreira Dalla Pria, Joao Miranda, Rachel Nevin, Shalini Chhabra, Dina Hamdan, Jayasree Chakraborty, Tiago Biachi de Castria and Natally Horvat
J. Clin. Med. 2023, 12(21), 6821; https://doi.org/10.3390/jcm12216821 - 29 Oct 2023
Cited by 5 | Viewed by 4167
Abstract
Pancreatic adenocarcinoma (PDAC) is the most common pancreatic cancer and is associated with poor prognosis, a high mortality rate, and a substantial number of healthy life years lost. Surgical resection is the primary treatment option for patients with resectable disease; however, only 10–20% [...] Read more.
Pancreatic adenocarcinoma (PDAC) is the most common pancreatic cancer and is associated with poor prognosis, a high mortality rate, and a substantial number of healthy life years lost. Surgical resection is the primary treatment option for patients with resectable disease; however, only 10–20% of all patients with PDAC are eligible for resection at the time of diagnosis. In this context, neoadjuvant therapy has the potential to increase the number of patients who are eligible for resection, thereby improving the overall survival rate. For patients who undergo neoadjuvant therapy, computed tomography (CT) remains the primary imaging tool for assessing treatment response. Nevertheless, the interpretation of imaging findings in this context remains challenging, given the similarity between viable tumor and treatment-related changes following neoadjuvant therapy. In this review, following an overview of the various treatment options for PDAC according to its resectability status, we will describe the key challenges regarding CT-based evaluation of PDAC treatment response following neoadjuvant therapy, as well as summarize the literature on CT-based evaluation of PDAC treatment response, including the use of radiomics. Finally, we will outline key recommendations for the management of PDAC after neoadjuvant therapy, taking into consideration CT-based findings. Full article
(This article belongs to the Special Issue Applications of Neoadjuvant Therapy in the Treatment of Gastrointestinal Cancers)
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