Present Status and Future Prospects in Perioperative Chemotherapy

Abstract

For methodological reasons a clear distinction should be made between preoperative and perioperative chemotherapy. Preoperative and perioperative chemotherapy have somewhat different goals. Preoperative chemotherapy may have the advantage of providing markers for responsiveness. This might be considered as one of the end-points, as it has been by Rosen in osteogenic sarcoma. In selected cases, resectability might be enhanced by preoperative chemotherapy. With this therapeutic approach, we lose the ability to stage adequately at the time of tumor diagnosis. If we can ultimately show a clear advantage in terms of overall survival it is not really necessary to know in fine detail what we are doing. The problem is that the risks always become apparent first (early toxicity, lack of response, inability of adequate staging), before we have any idea of how much weight we can put on the benefit side of the scale. In deciding between preoperative and perioperative chemotherapy another problem is the additional length of time for which a patient is eligible before the exclusion criteria apply; an example is given with reference to the modalities of radiation and surgery: preoperative radiation therapy for rectal cancer may have some benefit for local control, but this benefit is useless if small liver or peritoneal metastases are detected at laparotomy.