The surgeon and the immunotherapy of cancer

The cancerolytic effect of active systemic immunotherapy, which has been shown experimentally able to eradicate a complete population of tumour cells provided they are not very numerous, has been confirmed in various forms of human leukemia and in a few solid tumours against which it was applied as treatment of the imperceptible residual disease which remains after chemotherapy or surgery. Its main indication is thus this residual disease composed of cells which are left behind after chemotherapy of systemic tumours, for this treatment obeys the laws of first degree kinetics, and surgery and/or radiotherapy which, even if they remove or completely sterilise a local tumour, often leave behind a few cells which have already migrated to the future sites of metastases. Active systemic immunotherapy of large volume tumours, especially when combined with chemotherapy, is of doubtful efficacy. Local immunotherapy has given interesting results but its clinical indications are not yet clear.