Sequential combined therapy

The traditional approach to combining chemotherapy and radiotherapy has been to attempt to predict whether eradication of systemic disease or local tumour control is of most immediate concern, then deliver the appropriate treatment first; the other treatment is delayed until completion of the first. The main difficulties are the uncertain behaviour of individual tumours and the inevitable delay in delivery of one treatment. Chemotherapy as the first-line treatment has the added potential benefit that in downstaging the tumour it may reduce both the volume of tissue which requires irradiation and the radiation dose required to control the tumour.

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