Preoperative chemotherapy for operable solid tumours

Accumulating evidence suggests that most common solid tumours in man have latent metastases when clinically detected. Further evidence indicates that when the primary focus is resected, its micrometastases may become enhanced as a result of immunosuppression and other tumour-promoting factors at work in the perioperative period. In this favourable setting, the development of new metastases may also be facilitated from cells forced into the circulation during operative manipulations. It is suggested that the above events are important in the treatment outcome and that they may be prevented to some extent if treatment is first directed to the systemic component of these tumours; resections of the primary focus can be more advantageously done later. Results from experimental and clinical studies as well as many theoretical considerations support the potential value of this approach in the management of operable solid tumours.