There is ongoing discussion regarding the relative benefits of pre-operative and post-operative radiation. Both have their advantages and disadvantages. The outcome is dependent on the individual characteristics of the tumor and patient. In theory, cancer cells are growing faster before they are disturbed by surgery. At this time they should be more susceptible to radiation than in the postoperative, potentially oxygen-poor state. However, each patient's case must be assessed individually to determine the best treatment method.(1)
Preoperative radiation therapy:
The goal of this procedure is to kill tumor cells, shrinking the tumors and reducing the risk of metastases. Shrinking tumors with radiation may allow surgeons to remove tumors that were previously inoperable. The dosage for this procedure is usually moderate and it is used for medium-sized or advanced tumors of the head and neck, colorectum, bladder, soft-tissue sarcomas, and others.
Advantages
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lowers risk of local recurrence and distant metastases.
Disadvantages
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possibly obscures the extent of the tumor due to shrinkage and destruction of the margins of the tumor; this may impact the effectiveness of surgery.
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delay of surgery may cause anxiety in some patients
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increases risk of postoperative complications.
Postoperative radiation therapy:
This procedure has been shown to have the ability to eliminate any tumor cells still remaining after surgery and also reduces the occurrence of disease that may develop at the site of the surgery or in nearby lymph nodes. It is usually carried out 4-6 weeks after surgery, once the wound has healed. Postoperative radiation therapy has been shown to improve local control of head and neck, breast, gastrointestinal cancers, sarcomas etc.(1)
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