Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City

Treatment Options Surgery Chemotherapy Hormonal Therapy Immunotherapy Gene Therapy Radiation Therapy

Chemotherapy

First order kinetics Cell-cycle phase specific Cell-cycle phase non-specific

Chemotherapeutic Drugs Alkylating agents classic nitrosoureas miscellaneous DNA-binding agents Antitumor antibiotics Antimetabolites folate/purine/pyrimidine analogues ribonucleotide reductase inhibitors Plant alkaloids miscellaneous

Chemotherapy ADJUVANT postoperative preoperative/induction/neoadjuvant PRIMARY

Preoperative/Induction/Neoadjuvant Advantages decrease tumor burden/size treatment without delay of postop recovery assess tumor’s response clinically & pathologically Disadvantages patient selection problems w tumor localization, margin analysis, pathologic staging *rates of infection, necrosis-no significant difference

Combination chemotherapy Drug Resistance genetically unstable tumor cells large tumor size

Drug Toxicity bone marrow suppression stomatitis ulceration of GIT alopecia

Hormonal Therapy Estrogen receptor Progesterone receptor

Immunotherapy

Gene Therapy Replacement or deletion of tumor suppressor genes to enhance immune response to cancer cells

Radiation Therapy

Adjuvant (Preoperative) Advantages minimize seeding make inoperable operable Disadvantages wound healing problems subsequent RT in positive margins?

Postoperative Advantages proper histologic evaluation RT modified on the basis of margin status Disadvantages larger radiation dose due to contamination less radiosensitive due to hypoxia postop adhesions exposes more bowel to radiation

RT chemo be given before or concurrently w radiation

Side Effects

Cancer Prevention Primary Secondary Tertiary * chemoprevention

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