Combined Chemotherapy, Radiotherapy, and Surgery in the Treatment of Advanced but Localized Solid Malignant Tumours1

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Abstract
The most effective use of chemotherapeutic agents is in a planned combined approach in the treatment of lesions in patients who would not be expected to have a good prognosis with standard therapy. For advanced squamous carcinomata, the combination of bleomycin and Methotrexate has been effective in reducing the size and extent of the tumours in this series. Chemotherapy alone does not “cure” cancers, but follow‐up radiotherapy or surgery should be used to achieve the best long‐term results. The use of chemotherapeutic agents for the treatment of carcinomata which are recurrent after previous radiotherapy or surgery is much less likely to be effective. Newer chemotherapeutic approaches are required to attempt to improve the outlook of patients with lesions which cannot be directly infused intraartcrially, for patients with massive lymph node involvement, and especially for patients who have recurrent lesions after previous irradiation or surgery. The combination of bleomycin and Methotrexate with vincristine was highly effective in some patients, but in two of eight patients given this combination by intravenous administration there was a fatal pancytopenia, and this combination is therefore not recommended. From our small experience of a good result in three patients treated with the combination or bleomycin, Methotrexate and hydroxyurea, two of whom had massive metastatic involvement of lymph nodes which responded to chemotherapy, while the other had a fungating carcinoma of lip recurrent after previous irradiation and surgery, it would seem that further use of this combination should be evaluated.Finally, it is imperative that all patients with advanced lesions or lesions which are not readily eradicated by standard means are better seen in a properly constituted consultative clinic for patients with malignant disease before therapy is commenced. No one clinician alone, be he physician, surgeon, or radiotherapist, can have all the appropriate expertise required for coping with patients with these most formidable problems. The opinions of others must be sought and obtained in order to be certain that each patient is given the most appropriate treatment in a well‐planned regimen. It is no longer appropriate for any one clinician to treat his patients with the expertise which he has available to himself and refer his failures for some other form of treatment which at that stage may well be ineffective.