Vnitr Lek 2001, 47(8):548-552

[Possibilities of curative chemotherapy of solid tumours].

J Abrahámová: Onkologické oddelení Fakultní Thomayerovy nemocnice, Praha.

The author analyzes the terms "cure", "curability" in relation to solid tumours at different sites. The attitude to so-called cure changed with time as the therapeutic possibilities changed. At the same time various markers, prognostic and predictive factors (epidemiological, anatomical and cellular and molecular genetic), were sought and found. On an international scale the extent of the disease was defined more accurately and codified and this was reflected in the TNM system. The attitude to such biological phenomena as spontaneous remission or late metastases changed also. A quite new clinical meaning was acquired by the phenomenon described histopathologically as maturation. In the sixties for the first time complete remission of a disseminated testicular tumour was described after combined chemotherapy and complete remission of a disseminated gestational choriocarcinoma. At the same time reports were published on successful treatment of Wilms tumour of the kidneys. Germinal testicular tumours have become since the middle of the eighties (i.e. the period when routine use of cisplatinum started) the model of a "curable" tumour of adult age. With the introduction of adjuvant and neoadjuvant chemotherapy five-year survivals improve and thus also the prognosis of breast cancer. Empirically the number of years which elapsed after termination of treatment of different tumours and which are already "safe" and there is nofurther risk of a relapse of the original disease. However in the course of years which have elapsed since the platinum boom late post-therapeutic changes develop and late relapses (after more than 10 years) in cured originally generalized testicular tumours. The term "cure" has no doubt its limitations and applies only in relation to the sum of biological characteristics of a certain tumour.