The high-risk individual merits treatment intensification. However, there are concerns with CERT. More supportive care is necessary as toxicity is higher. Treatment related death is a reality. Hence before we set out to prescribe concurrent chemoradiation we would need to stratify them according to the risk factors, their performance status and bear in mind the costs involved in intensive support during treatment.
Apart from chemoradiation we need to explore emerging treatment strategies such as fractionated radiation therapy, and targeted therapies such as epidermal growth factor receptor blockade which might offer better if not similar results but with lesser toxicity.
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