Keyword: Adjuvant

ABSTRACT: Introduction: Neutrophil extracellular traps (NETs) are web-like structures composed of decondensed chromatin and neutrophil granule proteins. Accumulating evidence suggests that NETs are involved in tumor progression, invasion, and metastasis in breast cancer. Therefore, investigating changes in NET formation during anticancer therapy and their potential use as a marker of treatment efficacy is of particular interest.
Objective: To evaluate the dynamics of induced NET formation during neoadjuvant endocrine therapy (NET) in patients with hormone receptor (HR)-positive breast cancer and to determine its association with changes in primary tumor size.
Materials and Methods: The study included 50 patients with stage II–III HR-positive breast cancer who received neoadjuvant endocrine therapy for 3–6 months. Endocrine therapy included letrozole and toremifene (Fareston); in a subset of patients, toremifene was combined with ovarian suppression using triptorelin (Diphereline). Induced NET formation in peripheral blood was assessed using the method developed by I.I. Dolgushin with pyrogenal stimulation, followed by May–Grünwald azure-eosin staining and microscopy. NET-forming neutrophils were counted per 100 neutrophils. Primary tumor size was assessed by ultrasonography (US) and mammography (MMG). Statistical analysis included the Wilcoxon signed-rank test, Friedman test, and Spearman’s rank correlation.
Results: In the three-time-point analysis of patients with serial measurements (n=32), the median number of induced NETs was 2 [0; 15] at baseline, 0 [0; 1.5] after 3 months, and 2 [0; 6] after 6 months of neoadjuvant endocrine therapy; the overall change did not reach statistical significance (p=0.051). After 3 months of treatment, a reduction in primary tumor size was observed. On US, the median tumor size decreased from 25.0 [22.0; 36.25] to 21.0 [18.0; 27.25] mm (p<0.001), while on MMG it decreased from 29.0 [21.5; 36.5] to 24.0 [18.0; 30.5] mm (p=0.049). The median relative reduction was 16.0% and 11.8%, respectively. No statistically significant correlation was found between changes in NET formation and the percentage change in tumor size after 3 months: US, rₛ=0.139, p=0.351; MMG, rₛ=0.015, p=0.918.
Conclusion: Changes in induced NET formation were observed during neoadjuvant endocrine therapy, with the lowest values recorded after 3 months of treatment. However, no association was established between changes in NET formation and the degree of primary tumor size reduction. These interim findings do not support the use of induced NET dynamics as a standalone marker of radiological response to neoadjuvant endocrine therapy and warrant further evaluation in a larger cohort.

ABSTRACT: Background: Adjuvant chemotherapy is the standard of care after radical resection of stage III colon cancer. Key process quality indicators include the use of standard regimens, timely treatment initiation, treatment completion, and documentation of reasons for deviations. In Kazakhstan, data on these indicators and regional patient pathways remain limited.
Objective: To assess process quality indicators of adjuvant chemotherapy after radical surgery, taking into account subsequent treatment provided at the patients’ place of residence.
Materials and Methods: This single-center retrospective cohort study included 45 patients aged ≥18 years with morphologically confirmed stage III colon cancer who underwent radical resection at the National Scientific Oncology Center between January 9, 2021, and December 5, 2023. Patients with distant metastases at surgery, prior neoadjuvant chemotherapy, or rectal cancer were excluded. Subsequent treatment was mainly provided at the patients’ place of residence, and data were retrieved from medical records. We assessed treatment administration, reasons for non-initiation, use of standard regimens, time to treatment initiation, proportion of planned cycles completed, and reasons for non-completion. Descriptive statistics were performed using IBM SPSS Statistics. Interregional comparisons were not performed due to small and uneven subgroup sizes.
Results: Adjuvant chemotherapy was administered to 36/45 patients (80.0%). Among nine untreated patients, one had medical contraindications, one refused treatment, and the reason was undocumented in seven. Standard regimens were used in 34/36 patients (94.4%). Among 34 patients with available timing data, median time to treatment initiation was 5.4 weeks (range, 1.0–11.7), and 31 (91.2%) started within 8 weeks. Among 34 patients with data on planned cycles, the median proportion of completed cycles was 70.8% (range, 25.0–100.0%); 15 (44.1%) completed the full course and 17 (50.0%) received ≥75% of planned cycles. Among 19 patients who did not complete treatment, reasons included progression in seven, toxicity in three, and coronavirus infection, drug unavailability, and death due to stroke in one case each; the reason was undocumented in six. Patients represented 12 regions, with subgroup sizes of 1–18 patients.
Conclusions: Most patients received standard adjuvant chemotherapy and initiated treatment within the recommended timeframe; however, fewer than half completed the full planned course. Reasons for non-completion were heterogeneous and should not be interpreted as a single marker of inadequate quality of care. Incomplete documentation and interregional patient pathways limited the assessment. Expansion of the registry and standardized data exchange are required for further analysis.

ABSTRACT: Introduction: Given the difficulties in assessing response of the primary tumor and metastatic lesions in gastric cancer patients using standard RECIST 1.1 criteria, there is a need to search for new biomarkers to evaluate treatment efficacy, especially at early stages after therapy initiation. Perfusion computed tomography is a functional imaging technique that provides qualitative and quantitative information about tumor microcirculation and can serve as a tool for predicting or assessing treatment response, helping to optimize and individualize subsequent patient management.
Objective: To evaluate the role of perfusion CT (PCT) in monitoring response to neoadjuvant chemotherapy in patients with locally advanced gastric cancer.
Materials and Methods: The results of PCT in 28 patients aged 36 to 76 years with histologically confirmed gastric cancer who received combined treatment at the A.F. Tsyb Medical Radiological Research Center between June 2023 and June 2026 were analyzed. Baseline CT, supplemented by perfusion imaging, was performed before treatment initiation to assess tumor extent and obtain baseline perfusion parameters. Follow-up PCT was performed before surgery to evaluate treatment efficacy and changes in perfusion parameters.
Patients were divided into 2 groups: 12 of 28 patients with regression grade 1a/b according to the scale established by K. Becker (2003) were considered "responders" to neoadjuvant chemotherapy, and 16 of 28 patients with regression grade 2/3 were considered "non-responders." Quantitative PCT analysis was based on interpretation of perfusion parameter values automatically calculated from the region of interest (ROI) placed within the tumor. The following PCT parameters were analyzed: blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface area (PS).
Results: The obtained perfusion data were subjected to both qualitative and quantitative analysis. Qualitative analysis included interpretation of parametric perfusion maps automatically generated by the software for each perfusion parameter. For each group, the significance of changes in each parameter was assessed using the paired Wilcoxon test. In patients who responded to treatment, a statistically significant decrease in BF, BV, and PS perfusion parameters was observed (p < 0.05). In patients who did not respond to treatment, none of the parameters changed significantly (p > 0.1 for all). Differences in BF and BV dynamics between groups were highly significant (p < 0.01), with significantly greater changes in responders. For PS, the difference was also significant (p = 0.04), although less pronounced. When assessing the prognostic value of baseline PCT parameters, none of the parameters reached statistical significance (p > 0.05); only PS showed a weak trend toward lower values in the responder group.
Conclusion: CT perfusion parameters reflect tissue vascularization and can serve as objective quantitative biomarkers of tumor response to neoadjuvant treatment. Baseline low PS values are associated with a likelihood of clinical response to preoperative chemotherapy in gastric cancer. Further studies with larger sample sizes are needed to clarify the prognostic role of PCT.