Response to Neoadjuvant Therapy and Prognosis in Patients with Resectable Pancreatic Cancer: A Propensity Score Matching Analysis

( Min Sung Yoon ),( Hee Seung Lee ),( Chang Moo Kang ),( Woo Jung Lee ),( Jiyoung Keum ),( Min Je Sung ),( Seungseob Kim ),( Mi-suk Park ),( Jung Hyun Jo ),( Moon Jae Chung ),( Jeong Youp Park ),( Seu 대한소화기학회 2022 Gut and Liver Vol.16 No.1

Background/Aims: Controversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC. Methods: We reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC: 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 1:3 propensity score matching (PSM) was performed to reduce selection bias. Results: Compared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis. Conclusions: We observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies. (Gut Liver 2022;16:118-128)

Radiological Downstaging with Neoadjuvant Therapy in Unresectable Gall Bladder Cancer Cases

Agrawal, Sushma,Mohan, Lalit,Mourya, Chandan,Neyaz, Zafar,Saxena, Rajan Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.4

Background: Gall bladder cancer (GBC) usually presents as unresectable or metastatic disease. We conducted a feasibility study to evaluate the effect of neoadjuvant therapy (NAT) on radiologic downstaging and resectability in unresectable GBC cases. Materials and Methods: Patients with locally advanced disease were treated with chemoradiotherapy [CTRT] ( external radiotherapy (45Gy) along with weekly concurrent cisplatin $35mg/m^2$ and 5-FU 500 mg) and those with positive paraaortic nodes were treated with neoadjuvant chemotherapy [NACT (cisplatin $25mg/m^2$ and gemcitabine $1gm/m^2$ day 1 and 8, 3 weekly for 3 cycles). Radiological assessment was according to RECIST criteria by evaluating downstaging of liver involvement and lymphadenopathy into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Results: A total of 40 patients were evaluated from January 2012 to December 2014 (CTRT=25, NACT=15). Pretreatment CT scans revealed involvement of hilum (19), liver infiltration (38), duodenum involvement (n=22), colon involvement (n=11), N1 involvement (n=11), N2 disease (n=8), paraaortic LN (n=15), and no lymphadenopathy (n=6). After neoadjuvant therapy, liver involvement showed CR in 11(30%), PR in 4 (10.5%), SD in 15 (39.4%) and lymph node involvement showed CR in 17 (50%), PR in 6 (17.6%), SD in 4 (11.7 %). Six patients (CTRT=2, NACT=4) with 66.6 % and 83% downstaging of liver and lymphnodes respectively underwent extended cholecystectomy. There was 16.6 % and 83.3% rates of histopathological CR of liver and lymph nodes. All resections were R0. Conclusions: Neoadjuvant therapy in unresectable gall bladder cancer results in a 15% resectability rate. This approach has a strong potential in achieving R0 and node negative disease. Radiologic downstaging (CR+PR) of liver involvement is 40.5% and lymphadenopathy is 67.5%. Nodal regression could serve as a predictor of response to neoadjuvant therapy.

Recent Advances in the Neoadjuvant Treatment of Breast Cancer

Gábor Rubovszky,Zsolt Horváth 한국유방암학회 2017 Journal of breast cancer Vol.20 No.2

In the last few decades, neoadjuvant therapy for breast cancer has gained considerable therapeutic importance. Despite extensive clinical investigations, it has not yet been clarified whether neoadjuvant therapy would result in improved survival in comparison with the standard adjuvant setting in any subgroups of patients with breast cancer. Chemotherapy is especially effective in the treatment of endocrine insensitive tumors, and such therapeutic benefit can be assumed for patients with triple-negative, or hormone receptor-negative and human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, dose escalation, modification of the therapeutic regimens according to early tumor response, as well as the optimal sequence of administration are still matters of debate. There is a current debate between clinical experts regarding the concomitant and sequential administration of carboplatin and capecitabine, respectively, as part of the standard neoadjuvant treatment, as well as the use of bevacizumab, as part of the preoperative treatment. In case of HER2 positive tumors, an anti-HER2 agent can be administered as part of the preoperative treatment, and according to preliminary clinical data, dual HER2 blockade can also be reasonable. Further, chemotherapy-free regimens can be justified in highly endocrine sensitive tumors, while immune modulating agents may also gain particular importance in the case of certain subtypes of breast cancer. Several small-molecule targeted therapies are under clinical investigation and are expected to provide new neoadjuvant treatment options. However, novel, more predictive biomarkers are required for further evaluation of the neoadjuvant therapies, as well as the effect of novel targeted agents intended to be incorporated into neoadjuvant therapy.

경계절제성 또는 국소진행성 췌장암에서 수술 전 보조치료의 역할

이우진 ( Woo Jin Lee ),우상명 ( Sang Myung Woo ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.3

췌장암의 가장 효과적인 치료는 수술적 절제이나 10-20%에서만 가능하다. 그 이유는 췌장은 복막 후강에 위치하고 있어 암이 발생하더라도 초기에 특이적인 증상이 없고, 암조직이 빠르게 성장하여 진단 당시 이미 진행된 경우가 많기 때문이다. 절제 후에도 재발이 흔하여 근치적 절제수술후에도 5년 생존율이 20% 이하이다. 절제 이외의 치료 방법은 효과가 적어 전체 췌장선암종 환자의 5년 생존율은 5%이하로 매우 예후가 나쁜 종양이다. 정확하고 엄격한 수술 전 병기 판정과 절제가능성 평가에 따른 병기별 치료는 필수적이다. 절제가 불가능하나 원격전이가 없는 국소진행성 췌장암은 30-40%에서 관찰되며 중앙생존기간은 치료를 안 한 경우 6-8개월, 치료한 경우 10-12개월 정도이다. 이들 국소진행성 췌장암은 생존율 향상의 여지가 많아서, 보다 나은 치료 효과를 얻기 위해 가장 적극적이고 집중적인 관심이 필요한 상태의 췌장암이라 할 수있다. 췌장암의 절제술에 있어서 경계성 절제가능성 췌장암의 개념의 등장의 배경은 낮은 R0 절제율과 힘든 절제 후의 나쁜 예후에 있다. 최근 다중검출 CT의 발전으로 새로이 분류된 경계성 절제가능성 췌장암군은 절제연 양성의 위험성이 높아 다학적 치료법의 좋은 적용군이라 할 수 있다. 최근R1이나 R2 절제의 가능성이 높은 경우 무리한 수술보다는 수술 전 항암요법과 방사선요법 후 영상학적으로 진행하지않거나 개선되어 혈관침습이 국소적인 경우 혈관 절제나 재건을 포함한 근치적 수술을 시도하여 비교적 좋은 결과들이 보고되고 있다. 수술 전 화학요법 또는 화학방사선치료는 수술 후 치료에 비해 미세원격전이가 있어 나중에 진행하여 명백한 원격전이가 보이는 환자들에게는 불필요한 절제수술을 막을 수 있다. 또한 수술 후 보조요법을 못하는 환자가 1/3에 달하는 상황에서 전신상태가 비교적 좋을 때 여러 다양한 치료를 시도할 수 있다. 최근 췌장암에 효과적인 몇몇 약제들이 소개되면서 이들 약제의 방사선치료와의 병합치료에 대한 기대 역시 증가하고 있다. 하지만 아직 그 정의에서 각 병원마다 차이가 많고 치료 및 효과의 판정에서도 확립되지 않은부분이 많아 잘 짜여진 기준을 가진 전향적 무작위 대조 연구가 필요하다. 또한 수술 전 항암 또는 방사선치료 효과를 정확히 평가할 수 있는 영상 검사나 병리학적 기준이 필요하며 향후 개개인에 맞는 맞춤형 치료의 개발 및 효과를 볼 수 있는 환자군을 선택하는 것이 필요하겠다. Surgical resection offers the only chance of cure for nonmetastatic exocrine pancreatic cancer. However, only 15 to 20 percent of patients have potentially resectable disease at diagnosis; approximately 40 percent have distant metastases, and another 30 to 40 percent have locally advanced unresectable tumors. Typically, patients with locally advanced unresectable pancreatic cancer have tumor invasion into adjacent critical structures, particularly the celiac and superior mesenteric arteries. The optimal management of these patients is controversial, and there is no internationally embraced standard approach. Therapeutic options include chemoradiotherapy or chemotherapy alone. While it is reasonable to restage and reevaluate the potential for resectability after neoadjuvant therapy, the frequency of a complete resection and long-term survival is low for patients who initially have categorically unresectable tumors. Others have disease that is categorized as “borderline resectable.” While these patients are potentially resectable, the high likelihood of an incomplete resection has prompted interest in strategies to “downstage” the tumor or to increase the likelihood of a margin-negative resection prior to surgical exploration using neoadjuvant therapy. The rationale for neoadjuvant therapy is as follows. First, it is to improve the selection of patients for whom resection will not offer a survival benefit (i.e., those who rapidly progress to metastatic disease during preoperative therapy). Second, it is to increase rates of margin-negative resections, which is the major goal of surgery. Third, it is to start an early treatment of micrometastatic disease. Initial attempt at downstaging with chemotherapy, chemoradiotherapy, or a combination followed by restaging and surgical exploration in responders rather than upfront surgery is suggested. Korean J Pancreas Biliary Tract 2016;21(3):117-127

Transoral robotic surgery-based therapy in patients with stage III-IV oropharyngeal squamous cell carcinoma

Park, Young Min,Kim, Hye Ryun,Cho, Byoung Chul,Keum, Ki Chang,Cho, Nam Hoon,Kim, Se-Heon Elsevier 2017 Oral oncology Vol.75 No.-

<P><B>Abstract</B></P> <P><B>Objective</B></P> <P>TORS-based therapy including chemotherapy or RTx was administered to patients with stage III-IV OPSCC. We analyzed the oncological and functional outcomes of stage III-IV OPSCC patients who underwent TORS-based therapy.</P> <P><B>Materials and methods</B></P> <P>Between May 2008 and May 2016, 80 patients participated in this clinical trial.</P> <P><B>Results</B></P> <P>A negative margin was identified in 66 patients (82.5%) and a positive margin in 14 (17.5%). TNM stages were III in 13 patients (16.3%) and IV in 67 patients (83.8%). Of the patients, 13 received surgery alone, 28 had adjuvant RTx and 39 had adjuvant CCRTx. At last follow-up, 67 patients had no evidence of disease, seven were alive with disease, and six had died. Local recurrence developed in 2 patients and regional recurrence in 10. Five-year overall survival was 88.8%, disease-specific survival was 89.9%, and recurrence-free survival was 78.3%. The 5-year disease-specific survival of OPSCC patients with p16+ disease was 93.2%, which was higher than 89.0% of patients with p16− disease, but the difference was not statically significant. On multivariate analysis, only extranodal extension showed a significant relationship with recurrence-free survival on Cox regression analysis.</P> <P><B>Conclusion</B></P> <P>TORS-based therapy showed excellent oncological and functional outcomes for treatment of stage III-IV OPSCC. For advanced T stage OPSCC, clear margins were obtained using TORS-based therapy and patients with clear margins showed good local control. Risk stratification of patients based on pathological information obtained after surgery and decision about additional treatment based on the information helped improve OS and DSS of OPSCC patients.</P> <P><B>Highlights</B></P> <P> <UL> <LI> TORS-based therapy was administered to patients with stage III-IV OPSCC. </LI> <LI> 5-year disease-specific survival was 89.9%, and recurrence-free survival was 78.3%. </LI> <LI> 5-year disease-specific survival of p16+ OPSCC was 93.2%. </LI> <LI> 5-year disease-specific survival of p16− OPSCC was 89.0%. </LI> <LI> 93.8% patients showed favorable results with a FOSS score of 0–2. </LI> </UL> </P>

진행된 자궁경부암에서 방사선치료 단독과 항암 화학요법 및 방사선치료 병용요법의 결과

김진희,최태진,김옥배,Kim, Jin-Hee,Choi, Tae-Jin,Kim, Ok-Bae 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.3

목적 : 진행된 자궁경부암에서 방사선치료 단독과 비교하여 항암화학요법과 방사선 병용치료의 성적을 후향적으로 분석하였다. 재료 및 방법 : 계명대학교 동산의료원 치료방사선과에서 1988년 6월부터 1993년 12월까지 FIGO병기 IIb, III, IV자궁경부암으로 근치적 방사선치료를 받은 76명의 환자를 대상으로 하였다. 모든 환자는 외부방사선치료와 강내방사선치료를 시행받았다. 방사선 단독으로 치료한 환자는 36명이었고 Cisplatin을 포함한 항암화학요법후 방사선치료를 시행한 환자는 40명이었다. 병기는 FIGO 분류상 IIb가 48명. IIIa가 3명, IIIb가 23명, IVa가 2명이었고 환자의 평균 연령은 53세이었고 환자의 추적기간은 7개월에서 95개월로 중앙추적기간은 58개월이었다. 결과 :완전관해는 방사선치료 단독군은 31명$(86.1\%)$, 병용치료군은 32명$(80\%)$로 통계적으로 유의한 차이가 없었다. 전체 환자의 5년생존률은 $67.3\%$이었고 병기별 5년 생존률은 IIb가 $74\%$, IIIa는 $66.7\%$, IIIb는 $49.8\%$, IVa는 $50\%$이었다. 치료방법에 따른 5년생존률은 방사선치료단독군은 $74.1\%$, 병용치료군은 $61.4\%$(P=0.4)로 통계적으로 유의한 차이가 없었다. 5년 무병생존률은 방사선치료 단독군은 $65.8\%$, 병용치료군은 $57.5\%$(P=0.27)이었고 5년 국소제어률은 방사선치료 단독군은 $71.5\%$, 병용치료군은 $60\%$(P=0.17)이었으며 5년 원격제어률은 방사선치료 단독군은 $80.7\%$, 병용치료군은 $89.9\%$(P=0.42)이었다. 치료에 따른 골수억제는 방사선치료 단독군에서 4명 $(11.1\%)$, 병용치료군에서는 9명$(22.5\%)$가 관찰되었다. Grade 11 방광염이 방사선치료 단독군에서 2명에서 관찰 되었고 grade II 직장염이 방사선치료 단독군에서 2명, 병행치료군에서 2명, 외과적 수술이 필요했던 직장천공 1명과 보존적으로 치료된 장폐쇄 1명이 방사선치료 단독군에서 관찰되었다. 치료에 따른 부작용은 양군간에 유의한 차이가 없었다. 결 론:진행된 자궁경부암에서 방사선치료 단독군과 비교하여 항암화학요법과 방사선 병용요법이 생존률, 치료실패, 부작용 등에 영향을 미치지 않았다. Purpose : This is retrospective study to compare the results of radiation therapy alone and neoadjuvant chemotherapy and radiation in advanced stage of uterine cervical cancer. Materials and Methods : Seventy-six Patients who were treated with definitive radiation therapy for locally advanced cervical cacinoma between June 1988 and December 1993 at the department of radiation oncology, Keimyung University Dong-san Hospital. Thirty six patients were treated with radiation therapy alone and forty patients were treated with cisplatin based neoadjuvant chemotherapy and radiation therapy. According to FIGO staging system. there were 48 patients in stage IIb, 3 patients in stage IIIa, 23 patients in stage lIIb and two patients in stage IVa with median age of 53 years old. Follow-up periods ranged from 7 to 95 months with median 58 months. Results : Complete response (CR) rate were $86.1\%$ in radiation alone group and $80\%$ in chemoradiation group. There was no statistical difference in CR rate between the two groups. Overall five-year survival rate was $67.3\%$. According to stage, overall five-rear survival rates were $74\%$ in stage IIb, $66.7\%$ in stage IIIa, $49.8\%$ in stage IIb, $50\%$ in stage IVa. According to treatment modality overall five year survival rates were $74.1\%$ in radiation alone and $61.4\%$ in chemoradiation group (P=0.4) Five rear local failure free survival rates were $71.5\%$ in radiation alone group and $60\%$ in chemoradiation group (P=0.17). Five year distant metastasis free survival rates were $80.7\%$ in radiation aione group and $89.9\%$ in chemoradiation group (P=0.42). Bone marrow suppression (more than noted in 3 cases of radiaion alone group and 1 case of chemoradiation group. Grade II retal complication was noted in 5 patients of radiation group and 4 patients In chemoradiation group. Bowel obstruction treated with conservative treatment (1 patient) and bowel perforation treated with surgery (1 patient) were noted in radiation alone group. There was no statistical difference in complication between two groups. Conclusion : There was no statistical difference in survival, failure and complication between neoadjuvant chemotherapy and radiation versus radiation alone in locally advanced uterine cervical carcinoma.

Modifications to Treatment Plan of Rectal Cancer in Response to COVID-19 at the Philippine General Hospital

Sofia Isabel T. Manlubatan,Marc Paul J. Lopez,Mark Augustine S. Onglao,Hermogenes J. Monroy III 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.4

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression.Methods: This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated.Results: Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality.Conclusion: Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

Update on Diagnosis and Treatment of Colorectal Cancer

Chan Wook Kim Ewha Womans University School of Medicine 2022 EMJ (Ewha medical journal) Vol.45 No.4

The rate of colorectal cancer (CRC) has altered. Early-onset CRC patients are increasing, and it is one of the main causes of cancer-related death. Based on epidemiologic change, the CRC screening program needs to be changed. To increase compliance, non-invasive screening techniques are developed. Although CRC survival has increased, the oncologic prognosis of metastatic CRC is remains poor. Even in metastatic CRC, which is the most difficult to treat, attempts are being made to increase the survival rate by active surgical therapy with the creation of chemotherapeutic regimens and targeted treatment based on genomic information. Due to the introduction of aggressive chemotherapy regimens, targeted therapy based on genomic features, and improvements in surgical technique, the role of surgical treatment in metastatic CRC has expanded. Metastatic CRC surgery was indicated for liver, lung, and even peritoneal seeding. Local ablation therapy was also effectively used for liver and lung metastasis. Cytoreductive surgery and intraperitoneal chemotherapy were tried for peritoneal seeding and demonstrated good results in a subgroup of patients, although the right indication was carefully assessed. At the same time, one of the key goals of treatment for CRC was to maintain functional outcomes. Neoadjuvant treatment, in particular, helped rectal cancer patients preserve functional results while maintaining oncologic safety. Rectal cancer organ preservation techniques are now being researched heavily in a variety of neoadjuvant treatment settings, including immunotherapy and whole neoadjuvant therapy. Precision medicine based on patient and disease characteristics is currently being used for the diagnosis and treatment of CRC.

Tumor Microenvironment Modulation by Neoadjuvant Erlotinib Therapy and Its Clinical Impact on Operable EGFR-Mutant NSCLC

안병철,박찬이,김문수,이종목,최진호,김혜영,이건국,유남희,이영주,한지연 대한암학회 2024 Cancer Research and Treatment Vol.56 No.1

Purpose Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have greatly improved survival in EGFR-mutant (EGFRm) non–small cell lung cancer (NSCLC); however, their effects on the tumor microenvironment (TME) are unknown. We assessed the changes induced by neoadjuvant erlotinib therapy (NE) in the TME of operable EGFRm NSCLC. Materials and Methods This was a single-arm phase II trial for neoadjuvant/adjuvant erlotinib therapy in patients with stage II/IIIA EGFRm NSCLC (EGFR exon 19 deletion or L858R mutations). Patients received up to 2 cycles of NE (150 mg/day) for 4 weeks, followed by surgery and adjuvant erlotinib or vinorelbine plus cisplatin therapy depending on observed NE response. TME changes were assessed based on gene expression analysis and mutation profiling. Results A total of 26 patients were enrolled; the median age was 61, 69% were female, 88% were stage IIIA, and 62% had L858R mutation. Among 25 patients who received NE, the objective response rate was 72% (95% confidence interval [CI], 52.4 to 85.7). The median disease-free and overall survival (OS) were 17.9 (95% CI, 10.5 to 25.4) and 84.7 months (95% CI, 49.7 to 119.8), respectively. Gene set enrichment analysis in resected tissues revealed upregulation of interleukin, complement, cytokine, transforming growth factor β, and hedgehog pathways. Patients with upregulated pathogen defense, interleukins, and T-cell function pathways at baseline exhibited partial response to NE and longer OS. Patients with upregulated cell cycle pathways at baseline exhibited stable/progressive disease after NE and shorter OS. Conclusion NE modulated the TME in EGFRm NSCLC. Upregulation of immune-related pathways was associated with better outcomes.

Study of neoadjuvant chemotherapy in advanced malignant ovarian germ cell tumors at a tertiary center in western India

Abhilash Vasanth,Shilpa M Patel,Ruchi Arora,Chetana D Parekh,Pariseema Dave,Bijal M Patel,Priyanka Vemanamandhi 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.2

Objective: To study clinical characters and outcomes in patients of malignant ovarian germcell tumor (MOGCT) undergoing surger y following neoadjuvant chemotherapy (NACT). Methods: Retrospective study of patients undergoing surger y following NACT for MOGCT atour institute. Platinum based chemotherapy was given in all patients in NACT. Results: Between March 2013 and Februar y 2023, 30 patients had surger y after NACT. Patient’s median age was 22 years (range, 12 to 35 years) and median follow up 42months(range, 6 to 132 months). Majority had endodermal sinus tumor (n=12), dysgerminoma (n=9)and mixed GCT (n=7). All had either International Federation of Gynecology and Obstetrics(FIGO) stage 3 (n=19) or FIGO stage 4 disease (n=11). Complete response to NACT seen in5 patients and 23 patients had partial response. Fertility sparing surger y in 18 patients andcomplete surger y in 12 patients. Suboptimal surger y was seen in 4 patients. Currently, 20of 30 patients are alive and disease free, 3 lost for follow up and 7 patients had progressionafter adjuvant therapy. Five patients had mortality—4 with progression and 1 with bleomycintoxicity. Fifteen of 17 eligible patients have resumed menstruation and one had successfulpregnancy. Prognostic factors noted in study are stage, optimal surger y and viable tumor inhistopathology. Dysgerminoma had better outcome than other histology. Conclusion: NACT may be a reasonable option in patients with extensive unresectable diseaseor in whom fertility sparing is not possible or in the poor general condition. Fertility sparingsurger y can be attempted post neoadjuvant chemotherapy without adversely affecting prognosis.