[Radiotherapy-chemotherapy combinations]

The combination of radiotherapy (RT) and chemotherapy (CT) has markedly improved the therapeutic results for those tumors which are both chemosensitive and radiosensitive, such as lymphomas, embryonal tumors, small cell lung carcinomas, breast cancers, etc. Despite some spectacular results reported following non-controlled studies, a significant increase in the total survival or the relapse free survival has never been documented in controlled trials in head and neck, anal, ovarian carcinomas. However, in these tumors, a combination of RT and CT may reduce the mutilations and sequellae caused by the treatment and may induce an increase in the survival in some subsets of patients. Further clinical research is needed along these lines. Cross resistance between ionizing radiation and cytotoxic drugs has recently become an important area for experimental research. This cross resistance appears to be relatively infrequent but possible, the best method for circumventing its occurrence is the delivery of both modalities as early as possible during the course of the treatment. This early administration is one of the aims of the integrated alternating regimen which has been developed in Villejuif since 1980. The results obtained in small cell lung carcinoma and non-Hodgkin lymphomas of a poor histologic type are remarkable. In cervix cancers and inflammatory breast cancers, no significant improvement in survival has yet been observed. In those four types of cancers, the early and late tolerance is acceptable and no untoward toxic effect has been identified.