Abstract
Despite therapies that substantially improve patient survival, late distant cancer recurrence still remains a problem. Tumor cells have been found to disseminate from the primary tumor before its detection and colonize specific niches around blood capillaries, known as the perivascular niche. The subsequent engrafting of disseminating tumor cells at distant sites is thought to be the cause of these recurrences in addition to sustained quiescence. An emerging body of evidence points to the role of the microenvironment in mediating the resistance of solid primary tumors and hematopoietic malignancies. In particular, studies have identified soluble factors located in the perivascular niche that confer protection from chemotherapy and radiation. As a consequence, adjuvant chemotherapy can be modified to target the perivascular niche and thus aid in the management of metastatic relapse.
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