Chemotherapy and radiotherapy--competitors or partners?

Radiation is curative in many types of localized cancer, whereas chemotherapy is rarely curative in either localized or widespread cancer. For this reason, chemotherapy should never be employed in any situation where it might hinder or prevent the administration of a potentially curative dose of radiation. However, in Burkitt's tumor in Africa, where a multicentric origin seems to be much more probable, cyclophosphamide, 40 mg/kg intravenously repeated every 3 to 4 weeks, has occasionally been curative. In the treatment of Wilms' tumor, surgery, radiation and chemotherapy are essential for optimal results. In acute leukemia, chemotherapy with the conventional agents, as well as newer drugs such as cytosine arabinoside and L-asparaginase, is the treatment of choice, with radiation being useful mainly in treatment of localized disease in the bones or in the central nervous system. The great interest in L-asparaginase at the present time lies in the fact that certain neoplastic cells have a specific nutritional requirement for the amino acid L-asparagine, whereas no normal cells appear to have this requirement. In many cases of advanced neoplastic disease, the partnership of radiation therapy to reduce large bulky lesions composed to a large extent of nonproliferating cells, followed by chemotherapy to destroy the few surviving and now perhaps proliferating cells remaining in the original mass or in metastases, would seem to offer the greatest promise of theoretical and practical benefit.