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April 25, 1966

Comment: Combination Therapy— Irradiation, Surgery, and Chemotherapy

JAMA. 1966;196(4):348. doi:10.1001/jama.1966.03100170090029

Although preoperative irradiation advocated by the. contributors of this series has generated some enthusiasm, the limitations and differences in Bloedorn's and Paulson's approaches require discussion. Bloedorn succinctly presents the rationale of his technique; its main benefit is in the conversion of inoperable lesions into resectable ones by means of irradiation. The irradiation technique is not detailed but consists of full tumoricidal doses (5,000 to 6,000 rad) followed by surgery after an interval of four to six weeks. The method of improving survival results is combining two full courses of treatment.

Paulson advocates a tumor dose of 3,000 rad which modifies the lesion by better localizing its extent and making resection easier. This dose is subcancerocidal and references are given in the experimental and clinical literature to support his regimen. Presurgical irradiation in a small or moderate dose is an adjuvant to the operation and is applied to operable lesions. The