Preoperative radiotherapy in cancer

Abstract

A review of experience with preoperative radiotherapy in cancer shows that full dose radiation followed by radical surgical extirpation of the tumor and the node-bearing areas has been used successfully in the management of neoplasms arising in many anatomical sites, eg, head and neck, breast, and bladder. It has not been associated with increased surgical difficulty or morbidity. Moderate doses of radiotherapy given in a short period of time followed by radical surgery has also been associated with improved results in the management of many tumor sites, eg, Duke C carcinoma of the rectum, and carcinoma of the middle third of the esophagus and has diminished the incidence of local recurrence of nodes in the neck. The apparently favorable effects of moderate doses of radiation is of practical interest because of the shorter time under radiation for the patient, the decreased interval before operation, and the probable decrease in operative morbidity. It is of theoretical interest since it is difficult to explain its effect solely or even primarily as due to intracellular injury. An extracellular mechanism should be sought to explain this apparent effect of the radiation.