Progress in cancer management. Keynote address

Management of cancer has changed drastically since the end of World War II. From the turn of the century up to that time, surgery had been the bulwark against cancer. Now in addition, over 2000 medical oncologists and over 1000 radiologists play a large role in cancer management. The majority of these were trained within the past decade through resources provided by the National Cancer Act. Early radiotherapeutic equipment caused such toxicity that scientific articles in the 1920s and 1930s questioned the utility of radiotherapy, just as they would chemotherapy at a later date. Improvement in cancer cure rates due to surgery, modern anesthesia, blood transfusions and antibiotics for serious cancers, had plateaued at about 30%. Since the introduction of the first cobalt units and then linear accelerators into medical practice in the mid-1950s, an additional 90,000 patients a year are curable by the use of radiotherapy alone, or in combination with surgery (1980 data). The first chemotherapy was introduced in about 1950, but effective treatment with drugs in the clinic really began in the 1960s. By 1970, some 11,000 patients were curable by drugs alone. Now, with the capability for combining all three therapies, chemotherapy alone, or in conjunction with radiotherapy and surgery, is responsible for the eradication of cancer in some 46,000 patients a year. There are two prime therapeutic targets for the 1980s: First, those approximately 100,000 patients treated with radiotherapy for cure who subsequently develop local recurrences; and second, the approximately 200,000 patients who, when operated on or treated with radiotherapy for localized tumors, still develop recurrent cancers at sites distal to the primary due to micrometastases. Prospects for controlling both types of treatment failures are bright and will be reviewed.