Combining Radiation and Chemotherapy May Improve Outcomes

In the right cancer, radiation and chemotherapy can make a powerful duo. 

Like many people with cancer, Gordon Cole underwent a variety of treatments. After receiving a diagnosis of stage 4 rectal cancer in August 2003, the 63-year-old commercial real estate appraiser in Greensboro, N.C., endured multiple surgeries, several rounds of different chemotherapy agents and targeted therapies, and radiation.

As part of his treatment regimen, Cole also received chemoradiotherapy (CRT)—chemotherapy and radiation given concurrently (at the same time)—on two occasions. The first time was just after his diagnosis, with an oxaliplatin-based regimen, Cole says, while the second time was more recent, sandwiched between two three-month segments of standard chemotherapy.

“Side effects weren’t too bad,” he says, “just fatigue toward the last quarter of radiation, and of course, the usual sensitivity to cold from the oxaliplatin.” Radiation therapy and chemotherapy—established treatments for an array of cancer types—were traditionally given at separate intervals. But CRT is rapidly becoming the regimen of choice in a growing number of cases.

Chemoradiation is now the standard of care for several types of solid tumors that are intermediate stage,” says Everett E. Vokes, chairman of the department of medicine at the University of Chicago. For example, it is widely used for treating lung, esophageal, and head and neck cancers, he adds.

During the past two decades, combining chemotherapy and radiation has changed the face of treatment. Certain chemotherapy agents help sensitize radiation so that it works better, and provide a systemic effect in addition to the local effect of the radiation, potentially preventing or delaying metastasis. If high doses of either modality are needed, it is sometimes possible to use a smaller dose of each to accomplish the same results, but with lower toxicity or the need for less (or no) surgery.

In many cases, the addition of chemotherapy to radiation actually leads to improvements in overall survival versus just using radiation alone.

The idea of combining drugs with radiation is not entirely new. Researchers first experimented with the combined modalities more than 50 years ago, and an early trial conducted at the Mayo Clinic in Rochester, Minn., showed that administering chemotherapy and radiation simultaneously improved the effectiveness of radiation and might, in some instances, be curative for patients with pancreatic, colorectal and stomach cancer. In 1979, researchers in England took this idea further and developed a theory about the interaction of radiation therapy and chemotherapy. Called “spatial cooperation,” the theory proposed that the action of radiation and chemotherapeutic drugs is directed toward different target sites in the body and work independently of each other. Radiation tends to target localized tumors, while chemotherapy drugs are likely to be more effective in eliminating micrometastases.

“In many cases, the addition of chemotherapy to radiation actually leads to improvements in overall survival versus just using radiation alone,” says Mitchell Kamrava, a radiation oncologist with the University of California, Los Angeles Health System. “We have seen this in many tumors, from the brain down to the pelvis.”

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