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September 11, 1972

Comment: Operate and/or Irradiate?

JAMA. 1972;221(11):1259-1260. doi:10.1001/jama.1972.03200240039013

Before 1950, when radiation doses ranged from 150 to 400 kv, combining surgery and radiotherapy was always done cautiously. Large doses of such quality of irradiation led to late changes in connective tissues and vessels. It was reasoned that preoperative irradiation sclerosed blood and lymph vessels, so that as the tumor regressed, the surgeon would not only have a safer margin, but would not be as likely to disseminate the cancer during surgery. When irradiation was given in the immediate postoperative period, it eradicated foci of microscopic cancer cells or entrapped them in a fibrotic scar so they could not spread. The initial concern in combining both methods was that it might lead to so great a chance of morbidity that it could offset the gain in tumor control. Routine use of preoperative or postoperative irradiation in head and neck cancers was rare.

Thinking changed in the 1950s for two