The role of infusional chemotherapy and radiation in organ preservation

Chemotherapeutic agents, used alone or in combination, have had a largely palliative effect in the treatment of solid tumors. The curative ability of these agents has been limited to about 15% of cases, in large measure due to chemotherapy's failure to accomplish locoregional control, leaving surgery or irradiation for local control of primary disease as modes of treatment. In many cases, however, surgery is not a feasible alternative, and radiation therapy may fail because of radioresistance. Whether this is caused by anoxia or by the innate radioresistance of the tumor cell, radiation oncologists have tried a number of methods to overcome the resulting insensitivity. Experience with the continuous concomitant infusion of various cytotoxic agents and radiation therapy in the treatment of advanced malignancies has been encouraging. The resultant radiosensitization has let to an increased rate of locoregional clearance of advanced carcinomas with a worthwhile increase in survival rates. The use of infusion chemo- and radiation therapy also has allowed the use of an organ-sparing program in all but the most advanced stages. There are already encouraging reports on successful organ-sparing treatment programs for carcinoma of the anus, esophagus and bladder. (ABSTRACT TRUNCATED)