Recurrent Disease
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Radiotherapy Failure
Feasibility of surgical removal
Surgical resection is another consideration for localized persistence of a tumor following radiotherapy. In some cases, this is a viable option, whereas other patients will not be eligible for surgical salvage, due to issues such as poor overall health, devascularization of tissue in the irradiated field increasing the surgical complication risk, or due to the presence of a widely infiltrating relapse lesion that is unlikely to be completely removed.
Due to the technical problems and seriousness of potential complications, surgical resection is more commonly performed in a post-radiation relapsed lesion that is still potentially curable, such as persisting prostate, bladder, esophageal, or head and neck cancer following radiotherapy (22, 23, 24, 25, 26, 27, 28, 29 ,30). This is in distinct contrast to re-irradiation, which is usually less radical in its intent and more commonly applied for palliation.
If resective surgery is undertaken for a radiotherapy relapse situation, the operation will typically be more difficult than a similar operation performed in the absence of prior radiotherapy (25), the effectiveness may be lower (23, 29, 30), and the complication rate likely increased (24, 25, 27, 28), including fatal complications ( 27, 28).
Written by Donald B. Fuller, M.D. – Radiation Oncologist