Radiation is accumulative in your body. Every bit you get adds up. Every bit of sunshine, dental x rays, CT scans, and of course the big gun, treatment, all adds to a total tolerable number before it begins to do damage of its own. We learned much about this from survivors of Hiroshima who developed various cancers later in life after their radiation exposure from "Little Boy" and those at Nagasaki who dealt with "Fat Man." At some point enough radiation will cause its own malignancies as it degrades the stability and mutates cellular DNA. Those of us that have had 72 grays are at risk, in about year 10, of osteosarcomas (bone cancer) in the mandible caused by the radiation exposure of the bone. The gift that keeps on giving......

Holding radiation is "reserve" is said too often for my own liking, especially now in the days of IMRT radiation, that delivers about half the dose that I got, with the same impact. Incomplete primary treatment, whether surgical oncologists like to admit it or not, is in the minds of many, a contributing factor to recurrences in about year 1.5 to 2.5 post treatment, when remaining non visible micro mets finally prosper in some area surrounding the original primary or in more remote areas far from the primary like the cervical nodes. Having said that, complete treatment without radiation as the safety net would be ideal because of the long term QOL issues with radiotherapy.