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Other Modes of Treatment
Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City
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Treatment Options Surgery Chemotherapy Hormonal Therapy Immunotherapy
Gene Therapy Radiation Therapy
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Chemotherapy
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First order kinetics Cell-cycle phase specific Cell-cycle phase non-specific
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Chemotherapeutic Drugs
Alkylating agents classic nitrosoureas miscellaneous DNA-binding agents Antitumor antibiotics Antimetabolites folate/purine/pyrimidine analogues ribonucleotide reductase inhibitors Plant alkaloids miscellaneous
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Chemotherapy ADJUVANT postoperative preoperative/induction/neoadjuvant
PRIMARY
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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
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Combination chemotherapy Drug Resistance genetically unstable tumor cells large tumor size
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Drug Toxicity bone marrow suppression stomatitis ulceration of GIT
alopecia
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Hormonal Therapy Estrogen receptor Progesterone receptor
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Immunotherapy
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Gene Therapy Replacement or deletion of tumor suppressor genes to enhance immune response to cancer cells
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Radiation Therapy
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Adjuvant (Preoperative)
Advantages minimize seeding make inoperable operable Disadvantages wound healing problems subsequent RT in positive margins?
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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
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RT chemo be given before or concurrently w radiation
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Side Effects
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Cancer Prevention Primary Secondary Tertiary * chemoprevention
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Thank you
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