No curative therapy is currently available for metastatic solid tumours. In western countries between 20 to 30% of the patients with colorectal cancer present themselves in stage IV. After resection of the primary tumour, often recurrence of cancer arises on the basis of micro metastases. Chemotherapy and radiotherapy can increase the life expectancy, though side effects influence strongly the quality of life. Also medical cost increases with increasing tumour stage, mainly due to adjuvant treatments and palliative care.
In developing countries delayed presentation of solid tumours in an advanced stage is another concern. More than two thirds of the patients with colorectal cancer have stage III or IV at presentation. The late presentation of advanced cancer in developing countries counts also for other types of tumours like prostate cancer, Wilms tumour, nephroblastoma, breast cancer, melanocarcinoma, orofacial tumours. A higher incidence of advanced cancer is seen in patients with a poor socio-economic status. Chemotherapy is not given regularly, because most of the patients are poor and a free health care facility is not available in most developing countries, these drugs are not affordable to many of the patients. Many countries of low or middle income have limited access to radiotherapy, and 22 African and Asian countries have this service not at all.
The last decade activation of the immune system is the main focus of the development of new cancer therapies, because some tumours are immunogenic. Phase I and II studies of melanoma-specific vaccines, like whole tumour cells, antigen peptides, antigen-pulsed dendritic cells, recombinant viruses, plasmids or naked DNA, and heat-shock proteins, were promising, though in the few large phase III randomized clinical trials the vaccines have altogether failed to prove their efficacy. These individual techniques only use one part of the mechanism of the immune system to attack tumours.
In the Czech Republic a novel surgical technique is being developed to treat metastatic solid tumours. This technique is named devitalisation, though in this protocol it will be called tumour devascularisation. Tumour devascularisation reduces the tumour suppressive properties by reducing the tumour load. This technique also activates anti-tumour immune reaction, due to the release of a huge amount of tumour antigens, the release of Heat Shock Proteins and stimulation of the dendritic cells. Furthermore a high infiltration of malignant cell clusters with the helper and cytotoxic T-lymphocytes might lead to further reduction of tumour load.
Based on these preclinical experiments and the collected case reports this tumour devascularisation procedure seems safe, it does not induce sepsis and the intervention might result in reducing cancer pain. This technique could be of a great value, because it is cheap, simple, easy to learn, quick and no chemo- or radiotherapy is involved.