Indications for combination of irradiation and surgery

1) The concept "either irradiation or surgery" for all clinical situations should be eliminated. In many clinical situations, one must think of the combined treatment both for the primary lesion and the regional metastases. Conservatism in both disciplines is to be preferred. 2) If irradiation has no place as the sole treatment for a disease, for example soft tissue sarcomas or parotid tumors, it does not mean that it has no place in the management of the disease. 3) The sequence of the modalities of treatment depends upon the structures involved and the extent of the surgical procedure. If one has to choose between a relatively low dose preoperative irradiation, like 3,000 to 4,000 rads or 5,000 to 6,000 rads postoperatively, the theoretical advantages of preoperative irradiation are outweighed by the proven effectiveness of postoperative irradiation in controlling the locoregional disease.