Preoperative cancer treatments are on the rise, and here's where it gets intriguing—this shift is transforming how we approach cancer care, with medications like chemotherapy, immunotherapy, and hormone therapy increasingly administered before surgery. A new report reveals that these strategies not only make surgeries less invasive but also provide doctors with vital insights into how tumors respond to treatment, paving the way for more personalized and effective therapies.
The latest data, published in the Journal of the American College of Surgeons, highlights significant increases in the use of neoadjuvant systemic therapy—that is, treatments delivered through the bloodstream before surgical intervention—for various cancers, particularly pancreatic, gynecologic, and abdominal lining cancers such as peritoneal and mesenteric cancers.
This comprehensive report is based on the National Cancer Database (NCDB), a joint effort between the American College of Surgeons and the American Cancer Society. The database covers around 75% of all cancer cases diagnosed in the United States, offering unique insights often missing from other sources, like detailed tumor biology and hospital stay durations.
Analyzing over 22 million cases from 1,250 CoC-accredited hospitals spanning from 2004 to 2022—the most recent full data set—the report paints a compelling picture of evolving cancer treatment practices. Co-author Ronald Weigel emphasizes that this data not only supports ongoing research but also aims to inform the public about cutting-edge developments in cancer therapies, surgical options, and outcomes.
But here's where it gets controversial... The report notes that from 2010 to 2022, the use of neoadjuvant therapy skyrocketed for certain cancers—nearly quintupling for gynecologic cancers from 7% to 34%, more than tripling for pancreatic cancer from 12% to 40%, and almost doubling for rare abdominal cancers (peritoneum, omentum, mesentery) from 23% to 47%. This trend signifies a major shift: while traditionally surgery was the first line of defense against solid tumors, now targeted medications are often employed upfront to shrink tumors and better understand how they respond.
Judy Boughey, MD, FACS, a leading breast and melanoma surgeon and senior author of the study, explains that neoadjuvant therapy's greatest benefits are twofold: shrinking the tumor to enable less invasive (sometimes even robotic) surgeries and providing critical feedback on how the cancer reacts to treatment. If a tumor responds well, there’s a higher likelihood of successful outcomes; if not, clinicians can pivot quickly to alternative strategies.
Diving deeper into specific cancers:
Prostate Cancer: This is the most common cancer among men. The report highlights a significant rise in non-surgical treatment options over recent years. In 2022, about 60% of prostate cancer patients received treatments other than surgery, up from 54% in 2018. When surgery was performed, prostate removal was overwhelmingly the choice, occurring in 85% of cases. The report also emphasizes that higher PSA levels (>20) and more advanced tumor stages increase the risk of mortality.
Esophageal Cancer: The use of immunotherapy in treating esophageal cancer shot up from 8% in 2018 to 30% in 2022. Despite this progress, early detection remains a challenge—about half of the patients are diagnosed at stage 4, an advanced and often less treatable phase. The authors stress the urgent need for better screening methods to catch the disease earlier, which could allow for less invasive treatments and improved survival.
Melanoma: Known as a potentially deadly skin cancer if not caught early, melanoma’s most affected areas are the torso and upper limbs. The study notes that melanomas on the scalp and neck tend to have poorer survival outcomes. A factor worsening prognosis is ulceration, where the melanoma breaks down the skin’s top layer, also linked to decreased survival rates.
Looking ahead, the authors promise that future reports will expand focus to other cancers, providing more insights and data that are seldom available elsewhere. Their goal is to continuously inform both medical professionals and the public about the latest advances and challenges in cancer treatment.
So, what do you think? Could the increasing use of pre-surgical therapies revolutionize your outlook on cancer treatment? Or does this trend raise questions about over-reliance on newer, less-established approaches? We invite you to share your thoughts—are we truly headed toward more effective, less invasive cancer care, or are there risks we might be overlooking?
