Five or 10 years ago it was common to think about treating cancer only by surgery or radiation or
chemotherapy , depending on the stage of the disease. Two or all three therapies might be used, but usually only one at a time and in the sequence mentioned—surgery if the tumor was localized , then radiation if there was an actual or potential recurrence , then chemotherapy if the cancer involved vital organs or had spread so far that surgery or radiation had to be ruled out.
Recently there has been great interest in using what is called combination or multimodality treatment. Many aggressive forms of cancer therapy incorporate two or three of the standard treatment methods. There is no universal agreement yet on what the best combination or best sequence is for most malignancies. But broad principles have emerged.
• When tumors are large, locally aggressive and touch adjacent structures, radiation or chemotherapy might be
given before surgery. This will shrink the tumor and make the surgical procedure much simpler. This is called
neo-adjuvant therapy. In hospitals with special radiotherapy equipment, radiation will sometimes be given
during surgery to kill invisible or microscopic tumor cells that might cause the cancer to come back in the
future.
• Both radiation and chemotherapy may be given after surgery. Radiation will usually be used if the surgeon
finds during the operation that the tumor is invading nearby tissues that couldn't be removed.
• Radiation and chemotherapy have also been combined in an attempt to produce a more powerful antitumor
effect than either treatment can produce alone. Radiation, for example, has a more powerful killing action
