Organ Preservetion in Cancer Management

Abstract

Radiation and surgery can be combined in many different ways. The general rationale for combining surgery and radiation is that mechanism of failure for the two techniques is different. Radiation rarely fails at the periphery of tumors, where cells are few in number and well vascularized. When radiation fails, it usually does so in the center of the tumor where there are large volumes of tumor cells, often under hypoxic conditions (Hellman, 2001).

A) Preoperative Radiotherapy:

Radiation can be given before or after surgery. Preoperative radiation has the advantages of sterilizing cells at the edges of resection and in the special circumstances of urirespectable tumors, reducing the tumor volume sufficiently to allow resection. There are disadvantages in the use of preoperative irradiation. The pathology reports are not valuable if the tumor is slow-growing or if the surgery is done shortly after the radiation, the consequ' ences of the radiation will not be represented in the pathologic

evaluation of the material because sufficient time was not allowed for tumor destruction and regression. Another disadvantage is that the patient is irradiated before the careful staging available at surgical exploration, and some patients who would not benefit from preoperative radiation are given this treatment. Metastasis may be found only at the time of surgery (Hellman, 2001).