Perioperative Chemotherapy: Rationale, Risk and Results PDF
Preview Perioperative Chemotherapy: Rationale, Risk and Results
Recent Results 98 in Cancer Research Founding Editor P. Rentchnick, Geneva Managing Editors Ch. Heifarth, Heidelberg· H.-f. Senn, St. Gallen Associate Editors M. Baum, London· C. von Essen, Villigen V. Diehl, Koln . W. Hitzig, Zurich M. F. Rajewsky, Essen· C. Thomas, Marburg Perioperative Chemotherapy Rationale, Risk and Results Edited by U. Metzger F. Largiader H.-J. Senn With 48 Figures and 45 Tables Springer-Verlag Berlin Heidelberg New York Tokyo Proceedings of an International Symposium, 17/18 March 1983, Zurich University Hospital Dr. Urs Metzger Chirurgische Onkologie Departement Chirurgie U niversiUitsklinik 8091 ZUrich, Switzerland Professor Dr. Felix Largiader Departement Chirurgie UniversiUitsklinik 8091 Zurich, Switzerland Professor Dr. Hans-J6rg Senn Kantonsspital St. Gallen Medizinische Klinik C 9007 St. Gallen, Switzerland Sponsored by the Swiss League against cancer ISBN-13: 978-3-642-82434-0 e-ISBN-13: 978-3-642-82432-6 DOl: 10.1007/978-3-642-82432-6 Library of Congress Cataloging in Publication Data. Main entry under title: Perioperative chemo therapy. (Recent results in cancer research; 98). Proceedings of the "Perioperative Chemotherapy" Symposium, held 17118 March 1983 at the Zurich University Hospital. Includes bibliographies and index. 1. Cancer-Adjuvant treatment-Congresses. 2. Metastasis-Prevention-Congresses. I. Metzger, U. (Urs), 1945-. II. Largiader, Felix. Ill. Senn, Hansjarg. IV. "Perioperative Chemotherapy" Symposium (1983 : Zurich University Hospital) V. Series: [DNLM: l. Neoplasm Metastasis-prevention & control congresses.,2. Neoplasms-drug therapy-congresses, 3. Neoplasms-surgery-congresses. 4. Postoperative Complications-prevention & control-congresses. RE106P v. 98 / QZ 267 P445 1983J RC26l.R35 vol. 98 616.99'4 s 85-2747 [RC27l.A35J [616.99'406IJ This work is subject to copyrigth. All rights reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, fe-use of illustrations, broadcasting, repro duction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use a fee is payable to 'Ver wertungsgesellschaft Wort', Munich. © Springer-Verlag Berlin Heidelberg 1985 Softcover reprint of the hardcover 1st edition 1985 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free ·for general Lise. Product Liability: The publisher can give no guarantee for information about drug dosage and appli cation there of contained in the book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting: v. Starck'sche Druckereigesellschaft m.b.H., Wiesbaden Binding: J.Schiiffer OHG, Grlinstadt 212513140-543210 Preface 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 stage (103 to 106 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. In the continuous search for an optimal timing of surgery and chemo therapy in the multimodality approach to cancer, the disease-oriented Committees for Breast and Gastrointestinal Tumors of the Swiss Group for Clinical Cancer Research il1itiated the idea of a »Periopera tive Chemotherapy" Symposium to be held at Zurich University Hospital. The aim was to collect basic research data and to update cli nical experience with peri operative chemotherapy, to optimize the sequence of treatment modalities and to give surgeons and chemothe rapists advice for future directions in both basic and clinical research in the combined effort in cancer therapy. Very early in the organization of the Symposium it became evident that only a broad spectrum of international lecturers would assure achieve ment of the goals mentioned above. With the assistance of the Zurich VI Preface and Swiss Cancer League and some private institutions it was possible to arrange a meeting of some of the most competent and experienced people in the field of peri operative chemotherapy. We have to express our thanks to those who presented papers at the Symposium, all acknowledged experts in their field, and to their col leagues who contributed to the published papers in this volume. We would also like to thank Dr. T. Thiekotter of Springer-Verlag for his advice and patient cooperation~ Our thanks also go to Drs. D. Mona, C. Favez, and S. Youssef, and other members of the secretarial staff who helped in the excellent organization of the meeting in Zurich. It seems that increasing numbers of surgeons throughout the world are prepared to subject their results to peer review and audit, and to accept the demanding discipline of multidisciplinary controlled trials. Such collaboration between surgical and medical oncologists will lead to steady improvements in the definitive management of patients with cancer. It is hoped that this publication may encourage further comb ined efforts in clinical cancer research. Zurich and St. Gallen, Spring 1985 U. Metzger F. Largiader H.-J. Senn Contents General Aspects . F. M. Schabel, Jr. t Rationale for Peri operative Anticancer Treatment . R. Keller Surgical Intervention and Metastasis ...... . 11 R. Shamberger Effect of Chemotherapy and Radiotherapy on Wound Healing: Experimental Studies . . . . . . . . . . . . . . . . . . .. '. 17 U. Engelmann, W. Sonntag, and G. H. Jacobi Influence of Perioperative cis-Platinum on Breaking Strength of Bowel Anastomoses in Rats ............... 35 V. Hofmann, M. Berens, and G. Martz Drug Selection for Perioperative Chemotherapy . . . . . . . . . 40 J.H. Raaf Techniques for A voiding Surgical Complications in Chemotherapy-Treated Cancer Patients. . . . . . . . 46 R.D. Gelber Methodological and Statistical Aspects in Perioperative Chemotherapy Trials ......... 53 What Is Perioperative Chemotherapy? ......... 64 Breast Cancer ......................... 65 A. N. Papaioannou Preoperative Chemotherapy: Advantages and Clinical Application in Stage III Breast Cancer. 65 VIll Contents R. Nissen-Meyer, H Host, K. Kjellgren, B. Mansson, and T. Norin Short Peri operative Versus Long-Term Adjuvant Chemotherapy. 91 1. Ragaz, R. Baird, R. Rebbeck, A. Goldie, A. Coldman, and 1. Spinelli Preoperative Adjuvant Chemotherapy (Neoadjuvant) for Carcinoma of the Breast: Rationale and Safety Report . . . 99 A. Goldhirsch Peri operative and Conventionally Timed Chemotherapy in Operable Breast Cancer . . . . . . . . . . . . . . . . . . 106 Panel Discussion: Peri operative Chemotherapy for Breast Cancer 114 Various Thmors . . . . . . . . . . . . . . . . . . . . . . . . . 116 P. Schlag and W. Schreml Perioperative and Adjuvant Chemotherapy in Gastric Cancer .. 116 U. Metzger The Risks of Peri operative Chemotherapy in Large-Bowel Cancer Surgery . . . . . . . . . . . . . . . . . . . .. . .. 122 W. Weber-Stadelmann The Need for Pilot Studies and Surgery-Only Controls in Adjuvant Therapy Trials for Large-Bowel Cancer . . . . . 126 H P. Honegger, M. Cserhati, A. R. von Hochstetter, V. Hofmann, and P. Groscurth Clinical Experience with Preoperative Chemotherapy for Osteosarcoma . . . . . . . . . . . . . . . . . . . . . . 130 O. Bertermann, R. C. Marcove, and G. Rosen Effect of Intensive Adjuvant Chemotherapy on Wound Healing in 69 Patients with Osteogenic Sarcomas of the Lower Extremities . . . . . . . . . . . . . . . . . . . . . . . . .. 135 R. Abele, W. Lehmann, G. Pipard, and P. Alberto Combined-Modality Treatment with Induction Chemotherapy in Locally Advanced Squamous Cell Carcinoma of the Oral Cavity and Oropharynx . . . . . . . . . . . . . . . . . 142 H-W. von Heyden, M. Schroder, A. Scherpe, 1. Borghardt 1 1.-H Beyer, G. A. Nagel, H Ge/'hartz, B. Foth, E. Kastenbauer, M. Westerhausen, W. Caliebe, H Rudert, R. Liffers, 1. Hofmann, and B. Schneider Chemotherapy of Squamous Head and Neck Cancer: A Prospective Randomized Trial Comparing cis-Platinum and Bleomycin with Methotrexate and Vindesine ........ 148 Contents IX Summary . .............. . ..... 153 U. Metzger, P. Largiader, and H.-f. Senn Present Status and Future Prospects in Peri operative Chemotherapy .................. . 153 SUbject Index . 156 List of Contributors * Abele, R. 1421 Lehmann, W. 142 Alberto, P. 142 Liffers. R. 148 Baird, R. 99 Mansson, B. 91 Berens, M. 40 Marcove, R. C. 135 Bertermann, O. 135 Martz, G. 40 Beyer, J.-H. 148 Metzger, U. 122,153 Borghardt, J. 148 Nagel, G. A. 148 Caliebe, W. 148 Nissen-Meyer, R. 91 Coldman, A. 99 Norin, T. 91 Cserhati, M. 130 Papaioannou, A. N. 65 Engelmann, U. 35 Pipard, G. 142 Foth, B. 148 Raaf, J. 46 Gelber, R. D. 53 Ragaz, J. 99 Gerhartz, G. 148 Rebbeck, R. 99 Goldhirsch, A. 106 Rosen, G. 135 Goldie. A. 99 Rudert, H. 148 Groscurth, P. 130 Schabel, F. M. t 1 Heyden, von H.-W. 148 Scherpe, A 148 Hochstetter, von A. R. 130 Schlag, P. 116 Hofmann, J. 148 Schneider, B. 148 Hofmann, V. 40,130 Schreml, W. 116 Honegger, H. P. 130 Schroder,M. 148 Host, H. 91 Senn, H.-J. 153 Jacobi, G. H. 35 ;]hamberger, R. 17 Kastenbauer, E. 148 Sonntag, W. 35 Keller, R. 11 Spinelli, J. 99 Kjellgren, K. 91 Weber-Stadelmann, W. 126 Largiader, F. 153 Westerhausen, M. 148 * The address of the principal author is given on the first page of each contribution I Page on which contribution begins Frank M. Schabel, Jr. t Director, Chemotherapy Research, Southern Research Institute, Birmingham, USA Frank M. Schabel, Jr. died suddenly and unexpectedly at the 13th International Cancer Congress in Vienna, on 30 August 1983. With his death we have lost one of the most brilliant and creative researchers in cancer treatment. His fundamental concepts developed in experimen tal cancer chemotherapy are well known all over the world. These con cepts led directly to immediate, high-dose postoperative chemotherapy as an adjuvant to potentially curative surgery. There is no doubt that Frank M. Schabel's work initiated the idea of perioperative chemo therapy; hence, he might be called the father of perioperative adjuvant treatment of cancer. The editors of this volume are truly glad to start with the introduction given by Frank M. Schabel on the rationale of perioperative anticancer treatment, one of his last testimonies, which reflects his outstanding scientific ability, his intellectual integrity, and his talent for clarifying and solving the intricate problems of drug action in cancer. The Editors
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