Applications for Antimetastatic Therapies
The development of therapies directed toward either interrupting the metastatic cascade or decreasing its efficiency is an intriguing concept. For the most part, clinicians and scientists have concentrated their efforts on achieving a cure of malignant neoplasms. Therapies which decrease the efficiency of the metastatic cascade have been viewed as palliative. Surgery and/or radiation therapy are the traditional and most effective methods to excise or sterilize primary and regional disease. However, cure is unlikely if successful metastatic foci have been established prior to or during initial treatment. Small metastases are not often identifiable at the time of initial diagnosis and treatment. Careful clinical staging will usually uncover large metastatic deposits in organs accessible to non-invasive maneuvers. Newer technologies (i.e., CT scans) have resulted in an increased identification of smaller metastases. Cytotoxic chemotherapy was originally reserved for palliative therapy of patients with documented disseminated cancer. Nevertheless, in selected cancers, patients with a high probability of microscopic tumor spread are commonly treated systemically with single or combination cytotoxic chemotherapy. The major exception to this is the use of hormonal therapy for neoplasms arising in the accessory sex organs. In the last decade cytotoxic chemotherapy has improved dramatically resulting in the successful treatment of many types of leukemia, lymphoma and germ cell tumors. Remarkable cytoreduction has occurred in these tumors with a significant number of patients surviving for ≥ 5 years. Unfortunately, similar success has not been evident with the more common carcinomas.
KeywordsLymphoma Leukemia Adenocarcinoma Oncol Sarcoma
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