MULTIMODAL STRATEGIES AS PREREQUISITE FOR ORGAN-SALVAGING TUMOR SURGERY

Curative therapy for solid tumors often requires combined-modality tre atment. In the following paper the importance of different strategies as prerequisite for organ salvaging tumor surgery and for successful t reatment will be shown. Unfavorable surgical conditions (eg. site, ext ent of the tumor) often result in nonresectability or mutilating surge ry. Preoperative therapies must try to achieve a maximum turner shrink age aiming at attaining resectability and preservation of organ functi on and life. The exact evaluation of the response to preoperative ther apy is important since the degree of the response correlates directly with outcome. Unfavorable response to preoperative therapy means unfav orable prognosis and requires further, more aggressive therapy. A very important parameter in this evaluation is the ''histologic response'' , measured by the degree of tumor devitalization at the time of defini tive surgery. However, even in cases with complete clinical and histol ogical remission, complete resection of the tumor after preoperative t reatment is essential. Despite goad response to preoperative treatment followed by complete resection, therapy must be sufficiently continue d after surgery. Preoperative therapy should achieve maximum tumor con trol, that means total necrosis of all tumor cells to make a complete resection of the devitalized tumor easier and to get the possibility t o preserve organ function.