Potential impact of improvements in radiation therapy on quality of life and survival

The NCI goal for the U.S. is to reduce the cancer mortality rate to one-half by the year 2000. Part of this improvement will be due to use of state of art treatment on a population wide basis and in addition, major improvements in efficacy of treatment. More effective radiation therapy will result in fewer local failures, increased survival, reduced treatment associated morbidity, and less frequent complications of treatment. The latter two aspects are very important to quality of life. If radiation combined with other modalities (e.g., sensitizers) were to become of greatly enhanced efficacy, then the number of patients requiring cystectomy, abdominal perineal resection, pneumonectomy, amputation, etc., would come down. The beneficial consequence would be fewer patients subjected to permanent ileostomy, colostomy, etc. The increase in survival if local failure were eliminated was estimated to be the decrease in local failure less the same loss in the new local controls due to DM as obtained in the local control patients after conventional treatment. For all sites, patients experience higher survival rates if they do not have local failure. For those sites where loss due to metastasis is not high, more effective local therapy would result in numerically impressive gains in survival.