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Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.

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Cover of Holland-Frei Cancer Medicine

Holland-Frei Cancer Medicine. 6th edition.

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Adjuvant and Neoadjuvant Chemotherapy

, MD, ScD (hc), , MD, , MD, and , MD.

Most cancer chemotherapy is given to patients with clinically manifest cancer. For a few disease entities, chemotherapy for obvious metastatic disease is curative. The advantage of treating patients whose body burden of residual cancer is smaller has proved so persuasive that the profession and patients have accepted the technique of postsurgical chemotherapy, acknowledging that this entails treating some patients whose body burden is already zero. Thus, adjuvant therapy after surgery has been demonstrated to be curative in several diseases for which surgery alone has low cure rates and chemotherapy alone cannot cure the manifest metastatic condition. Wilms tumor and osteosarcoma are the prime examples. In many diseases, there is evidence of prolonged disease-free survival and of longer survival, such as stage II and III breast cancer,9, 10 stage III ovarian cancer,11 and stage III colon cancer.12 Because the adjuvant treatment is aimed at micrometastatic disease remote from the primary tumor, exploration of chemotherapy before surgery has been undertaken in a few types of cancer. In addition to earlier exposure of the micrometastases, when they may be smaller, this neoadjuvant, induction, or primary chemotherapeutic approach has two additional beneficial characteristics. First, regression of the primary lesion serves as a bioassay that the micrometastases will also likely be sensitive.13 Failure of the primary neoplasm to regress affords an opportunity to shift chemotherapeutic treatment while there is still a chance of affecting the micrometastases with a new regimen. Second, regression of the primary tumor may make primary surgery unnecessary, allowing curative radiotherapy, as in some head and neck cancers and as shown in a large series of patients with breast cancer in France.14 In other instances, surgery after chemotherapy may be technically easier, although not always less radical, because there is no certainty that every cell has been eradicated at the original boundaries. Induction chemotherapy has allowed a major reduction in amputations, however, in favor of limb-sparing surgery. Induction chemotherapy often diminishes mastectomy for large breast cancers in favor of lumpectomy and radiotherapy. Induction chemotherapy may also significantly enhance the effectiveness of radiotherapy for other tumors.

By agreement with the publisher, this book is accessible by the search feature, but cannot be browsed.

Copyright © 2003, BC Decker Inc.
Bookshelf ID: NBK13569

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