Radiotherapy

There has been increasing interest in pre-operative radiation at 5000-6000 rad for 5-6 weeks. This has been shown to improve survival and local control. Nevertheless it doubles the risk of wound infection delaying all future treatment including chemotherapy. 

Intra-operative radiation at 1500-2000 rad in close proximity is sometimes used for recalcitrant, multiply recurrent cases. Brachytherapy involves intraoperative placement of catheters which are then filled with radioactive pellets post-operatively. It is very effective but represents diffiicult logistic implementation (eg. shielding of the patient in the community when they go home). It is begun about 1 week after surgery and lasts about 1 week.

By en large, the most common use of radiation is the post-operative therapy regime. This is similar to the pre-operative regime in terms of dose (ie. 5000-6000 rad for 5-6 weeks).