Tumor Histopathological Response to Neoadjuvant Chemotherapy in Childhood Solid Malignancies: Is it Still Impressive?

Abstract

The management of oncological malignancies has significantly improved over the last decades. In modern medicine, new concepts and trends have emerged paving the way for the era of personalized and evidence-based strategies adapted to the patients’ prognostic variables and requirements. Several challenges do exist that are encountered during the management, including the difficulty to assess chemotherapy response with certainty. Having known that neoadjuvant chemotherapy might be the only solution for a proportion of patients with tumors that are unresectable at diagnosis, emergence of strategies that use risk group-directed therapy became an integral part in the management of oncological malignancies. Tumor histopathological change post neoadjuvant chemotherapy is one of the most important predictors of management outcome and is being used in many chemotherapy protocols as an essential determinant of the most suitable postoperative chemotherapy regimen. Bone tumors are the classic models of this approach; however, other childhood solid tumors show significant variations in outcome as a result of tumor histopathological response to neoadjuvant chemotherapy. The aim of this review is therefore to summarize the significance of histopathological responses seen after neoadjuvant chemotherapy in childhood solid tumors. Moreover, it suggests that the effect on tumor histopathology through modifying neoadjuvant chemotherapy and, on the other hand, toxicities from intensifying adjuvant chemotherapy might either necessitate the change of a number of arm groups in different protocol regimens or include newer chemotherapeutic agents adjuvantly for better outcome and lesser toxicities in poor tumor histopathological responders.

The efficacy and safety comparison of first-line chemotherapeutic agents (high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide) for osteosarcoma: a network meta-analysis

“…Rosen et al [31] measured the tumor response at the time of surgery to assess the efficacy of preoperative MTX. A good histologic response with > 90% tumor necrosis was observed in 25 of 32 (78%) patients with primary disease after four weekly doses of 8-12 g/m 2 [31,32]. The response rate of the combination of MTX has not been clearly defined [33].…”

The effectiveness of high-dose chemotherapy with autologous hematopoietic stem cell transplantation in the treatment

“…Как и в описанной J. Whelan и соавт. группе [7], в большинстве случаев не наблюдалось достаточного морфологического ответа со стороны первичного очага, что считается одним из основных предикторов вероятности возникновения локального рецидива [10] наряду с объемом первичной опухоли [11].…”

SuperHistopath: A Deep Learning Pipeline for Mapping Tumor Heterogeneity on Low-Resolution Whole-Slide Digital Histopathology Images

“…Our custom-designed CNN for superpixel classification consists of 6 convolutional layers (32,32,64,64,128, 128 neurons, respectively) of 3 x 3 filter size and 3 max-pooling layers, followed by a "flatten" layer and a dense layer of 256 neurons ( Figure 2). A superpixel RGB image (post-interpolation) was used as input into the network and normalized from range 0-255 to range 0-1 using the maximum value.…”