world cancer report - iarc

expectation of poor outcome, adjuvant
therapies combining chemotherapy and
radiotherapy have been developed and,
when added to surgery, may be regarded
as an integral part of modern surgical
oncology.
Neoadjuvant use of radiotherapy has
been developed to help downstage
tumours such as rectal carcinoma. Some
irresectable tumours may become
resectable following such treatment.
Similar results can be obtained by
chemotherapy in the management of
large, awkwardly placed hepatic colorectal
metastatic disease, and this can
transform certain tumours from irresectable
to resectable lesions. Neo-adjuvant
therapy may also decrease the rate
of regional recurrence after curative
resection of aggressive carcinomas,
exemplified by pancreatic exocrine adenocarcinoma
[8].
The goal of cytoreductive surgery is to
remove as much as possible of the
tumour mass. Such elimination of large
portions of known malignant deposits is
1
Fig. 6.5 Contrast-enhanced magnetic resonance imaging (MRI) of an intraductal papillary mucinous
tumour of the pancreas in an adult patient who was subsequently treated by total pancreatectomy.
1 = common bile duct; 2 = pancreatic duct with multiple dilations caused by the presence of tumour tissue;
R = right, L = left.
2
referred to as “debulking”. Cytoreductive
surgery is widely employed as the
primary treatment of ovarian cancer,
with both five-year survival and median
survival better for patients with small
residual masses. Some of these findings
may, however, be a reflection of
patients selected for surgery rather
than a treatment-related change in the
natural history of disease. Cytoreductive
surgery is usually combined with
subsequent chemotherapy and radiotherapy.
There is increasing use of
cytoreductive surgery and intraperitoneal
chemotherapy for peritoneal carcinomatosis
from ovarian cancer.
Recent advances in intraoperative
radiotherapy have the potential to offer
additional strategies in the management
of inaccessible or poorly resected
cancers, typified by tumours of the biliary
tract. Biliary cholangiocarcinomas
can be managed by the placement of
intraoperative radiotherapeutic sources
as adjuvant treatment following either
resection or failed resection.
The future
Typically within more developed countries,
there is now a range of fully equipped and
staffed specialist cancer hospitals or
major centres with specialized cancer
units. Despite this infrastructure, in many
countries, surgical oncology still remains
apart on both a local and national level.
Adoption of new technologies in cancer
surgery should be guided by scientific evidence
of benefit for the patient and costeffectiveness
in relation to current practice.
During the evaluation phase, access
to the technology should be restricted to
multi-centre controlled clinical trials within
a critical academic oncology climate.
Such a programme of action will safeguard
continuing progress in outcomes of
cancer care, while at the same time keeping
the economic burden within reasonable
and sustainable limits [2].
Surgical oncology 275