Why do I Need Systemic Treatment?
Dr. David Loeb: One of the more common questions that I am asked by patients, especially if the patient has a localized tumor that is only in one place, is, "Why do I need systemic therapy? Why do I have to go through chemotherapy - why can't a surgeon just remove this and that be the end of it?"
We know that, for high grade tumors, that's not adequate treatment, because in the days before we had effective chemotherapy, surgery was the only approach that was taken. And even if the patient had a tumor in an arm or a leg and the surgeon did an amputation (so clearly took all of the tumor away with lots of normal tissue around it), 80% of patients with osteosarcoma and Ewing's sarcoma, for example, would ultimately relapse in their lungs and die. And that's been taken as evidence that tumor cells have already spread to the lungs at the time of diagnosis, even if we can't find them. And so for that reason, patients with tumors like that need systemic chemotherapy even if the surgeon can take the tumor away, to prevent those cells that have spread to the lungs from growing and causing problems.