ABSTRACT
The goal of combining systemic therapy (mainly chemotherapy, but also hormone therapy as well as, increasingly, the newer targeted molecular therapies) and radiotherapy is to increase local tumour control, relapse-free survival and overall survival. Clinical trials have shown that systemic therapy given concurrently with radiotherapy can result in improved local control in a range of different disease sites, and in some cases this has also translated into improved survival.1 It is probably under-explored as a therapeutic strategy since much of the thrust of radiation research has been on issues such as oxygenation, fractionation, conformation of dose to target volume and dose escalation. Whilst these developments in radiation oncology are important, the chemotherapy literature has arguably demonstrated much bigger therapeutic gains from successful combination therapy, ranging from the seminal results with Hodgkin’s disease to recent gains in the adjuvant therapy of HER-2 positive breast cancer. In the radiation context, this is best exemplified by the progressive dose escalation studies in early prostate cancer, which to date have only shown improvement in biochemical outcomes with no overall survival benefit. In contrast, a range of studies using combinations of radiation and hormone therapy have, in locally advanced prostate cancer, consistently shown significant survival gains (Table 52.1).
