Surgical oncology from a radio-oncological perspective

Abstract

BACKGROUND: Oncological surgery and radiotherapy (RT) are both used in most malignant tumours. Multidisciplinary cooperative treatment design is the appropriate setting to effectuate consensual individually tailored therapy. Contrary to a pure referral system, specific diagnostic steps and treatment sequences are fine-tuned in multidisciplinary conferences. This not only results in improved outcome, but also better orientation for physicians and patients, who are not interested in disciplines but in overall treatment plans. METHODS: Review. RESULTS: Various topics for cooperation are identified. Perioperative RT permits limited resection (breast cancer, soft tissue sarcoma) and improves local control rates without widening the resection (breast cancer, rectal cancer, soft tissue sarcoma). Placing clips in the excision cavity requires communication between surgeon and pathologist to be helpful for RT. Limitations of surgery leading to incomplete resections and limits of RT leading to geographical miss or underdosage of the tumour are due to different factors: tissue boundaries versus tumour-volume and radiation tolerance of normal tissue. The time dimension of serious surgical and radiogenic side-effects is also different, surgical problems arising early, radiogenic problems arising over months and years after treatment. RT resembles systemic antineoplastic treatment regarding the way of action, and it resembles surgery with respect to its target orientation. CONCLUSIONS: Clinically relevant progress in oncological therapy is to be expected not only by progress in the various treatment modalities themselves, but also by improvements in the coordination of multimodality treatment.