Cancer Treatment

The radiation oncologist has a pivotal role to play in a multidisciplinary cancer team. With the collaboration of allied disciplines, i.e. surgical oncology, medical oncology and radiology and oncopathology, the radiation oncologist can make decision regarding the management of cancer in a more comprehensive manner. For the better part of 20th century, treatment for the cancer patients was relatively limited and comprehensive institutional management was not in order. The surgical curative procedures were the first to be developed and only in the last 5-6 decades, the curative radiation therapy and curative anticancer drug therapy have emerged in a scientific manner. Over the past 20 to 25 years, changing therapeutic strategy have rendered the liner care model obsolete. We now know that many cancer patients require a multimodality approach. Apart from long term local control of disease, long term survivors have been observed in many variety of cancers.

A very good example of multimodality therapy is the results of preoperative radiotherapy and surgery in oesophageal cancers. Five-year cure rates with either surgery or radiotherapy alone were practically unheard of. A short radiotherapy course followed by esophagectomy has resulted in 33% 5-year cure rates in carcinoma of oesophagus. The role of preoperative radiotherapy has also an established place in cancers of the rectum, endometrium, bladder and certain head and neck tumors. Similarly, postoperative radiotherapy is being used in the prevention of locoregional failure, thereby improving the survival in a number of solid tumors. Radiotherapy following curative surgery has especially been used in the management of breast cancer, urinary bladder, colo-rectal malignancies, cancer cervix, head and neck cnacers and soft tissue sarcomas. Combination of chemo-radiation therapy is widely used in the treatment of cancer. Anterior or neoadjuvant chemotherapy prior to the locoregional treatment by surgery and/or radiation therapy are practiced in esophageal cancer, anal cancers, and in advanced breast, bladder and head and neck cancers. However the concomitant use of chemo-irradiation is still approached with caution, since both the modalities produce additive toxicities which can be intense. The systemic chemotherapeutic agents acting as adjuncts to surgery and radiation therapy have proven their beneficial role in improving tumor control and survival.

Wilm’s tumor is the paradigm for multimodal treatment of a paediatric malignant solid tumor. The CMF chemotherapy developed by Bonnadonna and coworkers in Milan, Italy since the 1970s has been a key factor in the improved control and survival in breast patients.

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