CLINICAL EVALUATION OF COMBINED RADIATION AND CHEMOTHERAPY IN GASTROINTESTINAL MALIGNANCIES

¹ From the University Surgical Clinic and the Department of Radiation Therapy, Montreal General Hospital, Montreal, Quebec, Canada

A series of patients with gastrointestinal malignancies have been studied from the viewpoint of evaluation of response to radiation, chemotherapy, and a combination of the two modalities. Evidence is presented to show that:

(1) There is a direct relationship between the amount of radiation delivered and tolerated and the response of the tumor itself. Radiation is best understood in terms of the Strandqvist curve relationships. A Strandqvist ratio is defined as that percentile level towards the ideal curve that has been attained for a specific patient.

(2) Combination of 5-fluorouracil and ionizing radiation produces the same response as radiation alone, provided the radiation is given in a sufficient amount. If not, the drug can act as a useful additive.

(3) The amount of radiation delivered is significantly less in those patients where drugs are employed in combination. The end results, however, demonstrate that addition of the drug to a lowered radiation dosage does not jeopardize the chance of the patient gaining a good result. Indications for combined therapy include patients where the field size is such that ideal Strandqvist values are difficult to achieve or in those patients where there is known disease outside the field of radiation.

(4) Responses have been measured in both subjective and objective categories; the majority of patients who feel better, do, in fact, show objective changes in tumor growth patterns. Anticancer treatments rarely make a patient feel better in a nonspecific manner.

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