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For rectal cancer, until recently post-operative radiotherapy was the standard of care for locally advanced disease, but RCTs have indicated that pre-operative administration may improve local control, with lower toxicity and reduced rectal cancer deaths (Colorectal Cancer Collaborative Group, 2001; Sauer et al, 2004).
Ad hoc corrections may improve local forecasts, but such models will likely be site specific.
This article comprehensively reviews the current clinical evidence for oxaliplatin-based chemo-radiotherapy that may improve local control and survival.
The current evidence suggests that this treatment strategy may improve local control whereas reducing the rate of distant metastasis.
There is some evidence that higher radiation doses may improve local control, but higher doses lead to increased morbidity, especially rectal bleeding (Pollack et al, 2002).
More recent meta-analysis support the hypothesis that modern postoperative radiotherapy may improve local control and survival [ 13], still further evidence is necessary.
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Using smaller fields that do not incorporate elective nodal regions may allow higher doses, and these may help improve local control and survival in a disease where current results are unacceptable.
By delivering radiation with greater precision, IMRT has been shown to minimize acute treatment-related morbidity, making dose escalation feasible, which may ultimately improve local tumor control [ 12].
Varying rates of local recurrence have been reported after intralesional surgical therapy, and have led to the suggestion that the use of local adjuvants such as phenol, peroxide, water, or liquid nitrogen may further improve local control.
With the available data, there are various options to intensify treatment for patients with locally advanced head and neck tumours: modern radiotherapy techniques provide tools for relative dose escalation within the tumour, particle therapy may further improve local control by increased biological effectiveness, and induction chemotherapy improves long-term survival in these patients.
This regimen may potentially minimize toxicity and improve local control in our study.
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CEO of Professional Science Editing for Scientists @ prosciediting.com