Archives of Surgical Oncology

The perioperative window presents a long overlooked but important opportunity to prevent relapses in breast and other cancers

Abstract

Michael Retsky

My colleagues and I have been studying an anomalous relapse pattern in breast cancer. This project started in 1993 when data from Italy and UK showed that 50 to 80% of all relapses in patients treated only with surgery occurred in an early wave of relapses in the first 3 years post-surgery. We proposed a reasonable explanation. It appears that the surgery to remove a primary tumour causes systemic inflammation for a week. During that time, dormant single malignant cells and avascular deposits escape from dormancy and appear as relapses within 3 years. The multi-national authors of our reports include medical oncologists, surgeons, anaesthesiologists, physicists, and other scientists from several fields. A potential solution seems to exist based on our analysis. That therapy is the common inexpensive analgesic ketorolac administered as iv at the time of surgery and perhaps as oral drug for a few days after surgery. We edited a book and published a number of papers including one recently (1). Two animal models support our findings (2,3). Another paper suggests a way to prevent some late relapses (4) and a second retrospective clinical trial was reported (5).