F) very important! 1) a well-considered order of surgical and therapeutic treatments by consulting specialists and 2) choice of a sequential operation technique

■ Reinforcement of radiotherapy by chemotherapy: In simultaneous chemoradiotherapy, the radiation is combined with chemotherapy at the same time; in sequential treatments, this is done sequentially.

■ The aim of the parallel administration is to exploit both the cytotoxic properties of radiotherapy and chemotherapy since there are different mechanisms of action in the cell. In addition, some cytostatics enhance the special effect of radiotherapy.

■ These substances are called radiosensitizers. Typical representatives are cisplatin, taxol, and 5FU. In addition, the treatment time is shortened by the combination compared to the sequential procedure. Also, this increase in therapy intensity has a positive effect on the benefit of the treatment, because fewer cells enter into accelerated growth, but gradually go under.

■ For many types of tumors, it has been shown that better healing results can be achieved through this intensive therapy. This applies to head and neck cancer, esophageal cancer, lung cancer, anal carcinoma, and bladder carcinoma. An operation can be avoided under certain circumstances. Alternatively, such treatment may also be in preparation for surgery. This increases the likelihood of getting the tumor under local control in the long term, compared to surgery alone.

■ In addition, it is often possible to operate organ-preserving. In rectal cancer (rectal cancer) this means that the sphincter muscle can be obtained more often after surgery. In some patients with pancreatic cancer, this is only a resection possible. Overall, however, the increased intensity of therapy also requires more intensive concomitant therapy, as there are more and more side effects on rapidly renewing tissues. This affects the formation of blood and mucous membranes.

■ Under normal treatment, these side effects decline rapidly after the end of treatment and have no lasting adverse effect. Occasionally, for their prevention and treatment, however, a hospital stay in the radiation clinic is necessary.

■ To further increase the effectiveness of chemoradiotherapy and to improve the side effects are now widely subject to clinical research. The radiation clinic participates and is responsible for a number of these multicentric studies.