| Abstrakt: |
The aim of the present review of various classic and novel therapeutic strategies in oncology is critical discussion of its efficacy to answer the question: is it realistic and even possible to win the war against cancer. Although technological progress in radiotherapy (RT) has led to the development of many sophisticated 3D, 4D techniques, the use of RT as a sole modality has become more and more limited to the tumors in the early stage of disease, in favor of combined surgery-RT-chemotherapy (CHT) therapies. Nevertheless, patients’ curability has never reached a level higher than 95% (stereotactic hypofractionated RT – limited to small tumors only). The CHT for solid malignant tumors is not effective enough, and therefore it is mainly combined with surgery and RT as a method of the boost. Common use of partial or complete regression (PR, CR) as end-points of its efficacy is irrelevant, since it is quasi-quantified tumor cell clearance but not cell kill effects, and the regrowth delay (the time the tumor takes to regrow to the size [volume] at the beginning of therapy) is the only proper end-point. The efficacy of various genetic, molecular, immuno, and antiangiogenic modalities tested in many clinical studies is critically discussed, and it has generally showed some therapeutic benefits, but somewhat unspectacular. It has been well documented that genotypes and phenotypes of the tumors (even within the same location, stage, and histology) are individually highly heterogeneous. Therefore, the term “average probability” referred to individual patients becomes meaningless, and moreover, this term has never been replaced by “certainty” yet. Statistics of many studies and trials consist of various pitfalls and biases. Thus, although we and our patients are more often winners on the individual battlefields, the winning, of the whole war against cancer seems to be possible (hope), but not for sure (real). [ABSTRACT FROM AUTHOR] |
