Possible Drawback of Radiotherapy: Rational and Experimental Bases of Post-Surgical Therapies
Radiotherapy has a clear role in the management of secondary spread. It is used for elective treatment of subclinical disease in defined high-risk groups, for palliation of clinical metastases, to reach secondary spread in anatomically, pharmacologically, or immunologically privileged sanctuaries, as a cytotoxic agent in total body irradiation, and lately in combination therapy with chemotherapy. Radiotherapy has a demonstrated positive role in the control of secondary spread, despite being a localized form of therapy and although distant metastases represent the major cause of failure in cancer therapy, except for tumors of the central nervous system and head and neck. A new era of multidisciplinary approach, based on knowledge of the biology of the tumor, is here and the role of radiotherapy in a combined modality approach needs réévaluation in an attempt to explore the optimal effectiveness of each treatment method: surgery, radiotherapy, chemotherapy, hormone therapy, and perhaps also immunotherapy. Much remains to be understood about how these different treatment modalities work in synergism of antagonism with each other and their optimal timing and combination so as not to over- or undertreat the patient. The old hierarchic approach of first the surgeon, then the radiotherapist, then the endocrinologist, and finally the chemotherapist should be replaced by an initial management decision including all the various disciplines working cooperatively.
KeywordsLeukemia Germinal Oncol Neutropenia Cyclophosphamide
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