Resection
Resection is usually the most effective way of achieving local control, but:
- If surgery is used alone to achieve local control, then planned radical excision should be possible with negative margins for disease.
- Sometimes excision alone can be performed, but the surgery may result in significant "mutilation" and this may not be acceptable to the patient or family.
- If surgery is not possible with wide margins, then radiation therapy (RT) can be given before surgery to sterilize microscopic disease at the margins of the tumor.
- Surgery can be done after pre-operative RT with narrow margins to excise viable tumor in the center of the tumor mass.
- Post-operative RT can also be given. No significant differences have been found between pre and post-operative radiotherapy in terms of tumor control, but there are advantages and disadvantages for both approaches.
Some Differences between Pre and Post-operative RT:
PRE-OPERATIVE RT |
POST-OPERATIVE RT |
Easy to plan accurately as the tumor is still in place |
Much harder to plan as the tumor is gone, tumor bed is harder to identify and the entire extent of the post-surgical bed needs therapy |
Smaller RT treatment volume |
Larger RT treatment volume |
Pathology information not as good
|
Better pathology information |
In theory more effective as blood vessels have not been disrupted by surgery |
In theory deals with bulk of tumor immediately and that should improve efficacy of treatment |
Associated with significant risk of early wound healing delay (10 - 20%). |
Associated with significantly increased risk of fibrosis and scarring in the long term |
