Parallel to the guided chemotherapy, the idea of mixed radio- and chemotherapy has led us over the years to several tentatives. In one of them, in collaboration with Dr. L. Goldman on a larger scale, chemotherapy was added to radiotherapy. (Note 1) In spite of the interesting immediate results, if chemotherapy was not further pursued, the ultimate fate of the patients thus treated was no better than that of the patients who had received radiation alone. Analysis of these various attempts has permitted us, however, to establish the conditions under which such a mixed treatment would appear especially indicated. Consequently, it is the type of offbalance present which is seen to determine the relationship between the two therapies, and respectively the procedure to be followed. The same relation has permitted to define the conditions under which chemotherapy would be indicated and added to radiotherapy. It should not be forgotten that through its action upon the fatty acids, radiation represents indirectly an agent of the same group to be added as the negative lipoids.

The cases with a type A offbalance which seem to respond insufficiently to medication with agents, represent an indication for the mixed treatment. Acting in conjunction with radiation, chemotherapy has appeared especially active. Chemotherapy started before, is continued actively during radiotherapy and following radiation, for a long time, even for years. The radiation acting as an adjuvant agent is usually applied in small doses, from only several hundred r to a few thousand r, in general much below those dosages known to induce by themselves alone therapeutic effect upon tumors. In cases with type D, as the radiotherapy represents an agent increasing the actual offbalance, an added chemotherapy with positive lipoids would have the role of correcting not only the existing manifestations but of preventing some of those which would be induced by radiotherapy. It would in fact have the specific aim to permit the continuation of radiotherapy while limiting its noxious influence.

The mixed therapy has to be guided by the routine test, with frequent analyses, in view of the rapid important changes which have been seen to occur. In these cases, it appears useful to follow especially the changes of the chloride index, those of peroxides in the urine which together with the surface tension, are seen to be not only particularly influenced by radiation but able to indicate the important change in offbalance.

Exceptionally good results were seen in the cases in offbalance type A treated by this mixed method when chemotherapy has been added to radiotherapy. These cases are especially interesting because of the persistent result obtained. The abnormally small amount of radiation often used, applied only on a localized spot, has served in these cases as an adjuvant to help to resolve particular local problems, while the chemotherapy, continued for a long time thereafter, to prevent the appearance of recurrences.

In the case of offbalance D, as the radiotherapy will increase the actual offbalance and the role of chemotherapy is to reduce the intensity of this offbalance and thus permit the continuation of radiation for its direct target effect the results are less interesting, differing less than in the first case from those obtained by radiation alone. The continuation of chemotherapy however after the radiation has been completed, has appeared especially helpful.