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With fewer than 50 stage III patients treated by combined therapy reported in the literature,7-10 the answer to this question can only be speculative. Worldwide five-year survival is 27.2% and even in the best hands, irradiation yields a survival rate of only 33.5%11 Presumably, radiocurability of stage III lesions is limited by tumor radioresistance, the high incidence of lymph node metastases (44%-66%),4 the difficulties of treatment of lesions involving the lower vagina, and the debilitation and lowered host resistance induced by the advanced carcinoma. We would add one further limitation from our experience, that of microscopically unidentifiable tumor nests which persits in a static, almost symbiotic relationship with the host after apparent curative radiotherapy. At a later date, aggressive behavior of these tumor nests may be activated either spontaneously or secondary to lowered host resistance from age, other disease, or disruption of tissues by subsequent surgery. Prompt pelvic
Greiss FC. Can the Results be Improved by Combining Radiation and Elective Radical Hysterectomy and Lymphadenectomy? JAMA. 1965;193(13):1105–1106. doi:10.1001/jama.1965.03090130033009
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