Combined-Modality Therapy

By William M. Mendenhall, MD

The main types of treatment for cancer are surgery, radiation therapy, and chemotherapy.  Combined-modality therapy implies that a patient is treated with two or more of these treatment modalities.  These combinations are used when it is possible to improve the chance of cure or decrease the risk of significant complications by using two or three modalities rather than just one.

Examples of combined-modality treatment include the use of a neck dissection (an operation to remove lymph nodes from the neck) after radiation therapy for cancers of the mouth or throat region. The operation is done to reduce the risk of recurrence in the neck and improve the chance of cure. Another example is adjuvant (“helper”) radiation therapy given before surgery for rectal cancer to reduce the risk of recurrence, increase the likelihood of cure, and reduce the likelihood that the patient will require a permanent colostomy. Yet another example of combined-modality therapy is administration of two to three cycles of chemotherapy before radiation therapy for Hodgkin’s disease to improve the probability of cure.

Before any treatment is started, the recommended treatment, the reasons it is recommended, the procedures to be carried out, the expected or possible side effects or complications, and the expected benefits are all explained to the patient and family. The patient must give permission for treatment, based on this knowledge (“informed consent”), before treatment is given.