Concurrent chemoradiation: myth or reality

Conclusions

The chemoradiation is now the conventional therapeutic modality in numerous solid tumors with important increased of survival rates. The clinical usefulness of chemical agents with radiation could be further strengthened if differential enhancement of radiation killing existed between rapidly proliferating cells and slowly proliferating cells, simulating a form of accelerated radiotherapy treatment. Chemoradiation may improve local control more than radiotherapy alone because the tumor cells accounting for radiotherapeutic failure may be more suceptible to cycle-specific agents and this integration does not require the supradditive effect and it is more important the timing of the combined treatment, with targets toward the repopulating cells during radiotherapy. Other similarities are the importance of daily dose per fraction and the rate of damage accumulation.

There is now a new evidence in Oncology, chemoradiation for the treatment of solid tumors, but still there are multiples problems to resolve: the greater toxicities in combined treatment, that require a narrow multidisciplinary oncologist team, the future of the new technologies to delivery radiation and the new drugs, the new biologic targeting agents and the implementation of the molecular targets to select the appropriate patients that could benefit from combined treatment. The toxicities are the major disadvantages of chemoradiation and many times the patients require hos- pitalization for fluid and nutritional support: this is «the cost of cure» The more intensive therapies should be reserved for those patients with rapidly proliferating tumors and to spare those who may not benefit from its use. Chemoradiation in the last 30 years has been a myth but from now appears as a clinic reality in cancer treatment but more basic and clinical investigation will be necessary on this exciting area.