Perioperative Chemotherapy

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g .• breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example.

Inhalt
General Aspects.- Rationale for Perioperative Anticancer Treatment.- Surgical Intervention and Metastasis.- Effect of Chemotherapy and Radiotherapy on Wound Healing: Experimental Studies.- Influence of Perioperative cis-Platinum on Breaking Strength of Bowel Anastomoses in Rats.- Drug Selection for Perioperative Chemotherapy.- Techniques for Avoiding Surgical Complications in Chemotherapy-Treated Cancer Patients.- Methodological and Statistical Aspects in Perioperative Chemotherapy Trials.- What Is Perioperative Chemotherapy?.- Breast Cancer.- Preoperative Chemotherapy: Advantages and Clinical Application in Stage III Breast Cancer.- Short Perioperative Versus Long-Term Adjuvant Chemotherapy.- Preoperative Adjuvant Chemotherapy (Neoadjuvant) for Carcinoma of the Breast: Rationale and Safety Report.- Perioperative and Conventionally Timed Chemotherapy in Operable Breast Cancer.- Panel Discussion: Perioperative Chemotherapy for Breast Cancer.- Various Tumors.- Perioperative and Adjuvant Chemotherapy in Gastric Cancer.- The Risks of Perioperative Chemotherapy in Large-Bowel Cancer Surgery.- The Need for Pilot Studies and Surgery-Only Controls in Adjuvant Therapy Trials for Large-Bowel Cancer.- Clinical Experience with Preoperative Chemotherapy for Osteosarcoma.- Effect of Intensive Adjuvant Chemotherapy on Wound Healing in 69 Patients with Osteogenic Sarcomas of the Lower Extremities.- Combined-Modality Treatment with Induction Chemotherapy in Locally Advanced Squamous Cell Carcinoma of the Oral Cavity and Oropharynx.- Chemotherapy of Squamous Head and Neck Cancer: A Prospective Randomized Trial Comparing cis-Platinum and Bleomycin with Methotrexate and Vindesine.- Summary.- Present Status and Future Prospects in Perioperative Chemotherapy.