The benefits of preoperative radiation therapy include: (1) the allowance of time for patients to undergo vigorous supportive therapy (eg, nutritional, pulmonary, cardiac) to optimize their condition in preparation for subsequent surgery, (2) prevention of marginal recurrences, (3) prevention of wound implantation of tumor cells at surgery, and (4) control of subclinical disease at the primary site and in the lymph nodes.
Radiobiologically, the tumor cells are in their maximal state of oxygenation in a preoperative setting and this may confer a therapeutic advantage, as the malignant cells would be more radio-responsive. Postoperatively, with scarring and a disruption of the normal vasculature, any remaining malignant cells in the surgical bed may be in a suboptimal environment with respect to their oxygenation and thus may not respond as well to radiation.
Drawbacks to preoperative therapy include: delay of surgery by perhaps to 21/2 to 3 months; the radiation dosage may adversely impact on subsequent postoperative healing; radiation dose limitations.
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