[Impact of tumor doubling time on the therapeutic strategy: application to so-called synchronous metastases of colorectal cancers].
An exhaustive review of tumor doubling time (TDT) is presented, showing that growth of a solid malignancy remains subclinical for three-quarters of its duration and that tumor growth is close (but not strictly identical) to an exponential type. The TDT can be transiently accelerated after an aggression, particularly after surgery (which induces immunodepression and stimulation of growth factors during healing). In contrast, the TDT can be slowed by effective chemotherapy. Based on these elements, the classical attitude of waiting 3 to 6 months before resecting synchronous liver metastases from a colorectal primary is illogical, as it has only a 5 to 10% chance of detecting new metastases during this interval. Therapeutic decisions must therefore be exclusively based on surgical technical considerations, rather than erroneous oncologic considerations. In terms of the tumor growth, it is better to operate once rather than twice. In terms of the patient's quality of life and socio-economic aspects, one operation is also preferable to two. Resection of the primary tumor and synchronous metastases should therefore be performed during the same operative procedure whenever possible.
Elias
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Service de Chirurgie Oncologique, Institut Gustave-Roussy, Villejuif.
D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011788:Quality of Life; D012959:Socioeconomic Factors; D013997:Time Factors