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can be explained by a simple model that considers the probability of residual
local disease, the efficacy of PORT, the probability of metastatic disease, and
RT-induced mortality. This model suggests that the RT-induced mortality of PORT
is strongly dependent on field-size, and at least partly offsets the
improvement in OS afforded by PORT, especially with larger fields. Smaller RT
fields, tailored to treat the areas most likely to harbor residual cancer,
provide the highest therapeutic ratio. If larger RT portals are required, PORT
should be delivered with care to selected patients.
The data used do not reflect the impact of chemotherapy, which will reduce the
rate of distant metastases and enhance the efficacy of RT.