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Chemotherapy in Head and Neck Cancer

Chemotherapy in Head and Neck Cancer. Introduction. 500,000 new cases of squamous cell cancer of the head and neck worldwide per year; 40,00 new cases per year in the United States. How do they act?. Classical chemotherapy is directed at metabolic sites essential to cell replication

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Chemotherapy in Head and Neck Cancer

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  1. Chemotherapy in Head and Neck Cancer

  2. Introduction • 500,000 new cases of squamous cell cancer of the head and neck worldwide per year; 40,00 new cases per year in the United States

  3. How do they act?

  4. Classical chemotherapy is directed at metabolic sites essential to cell replication • Tumor Cells Replicate more frequently than normal cells • However, currently available chemotherapy does not specifically recognize neoplastic cells • Highest morbidities in rapidly dividing cells: bone marrow, GI mucosa, and hair cells

  5. CHEMOTHERAPY OPTIONS IN HEAD AND NECK CANCER Can use chemo in 4 main ways:- • Neoadjuvant (Induction) chemotherapy • Concurrent (Concomitant) chemotherapy • Adjuvant (Post-op) chemotherapy • Palliative chemotherapy

  6. Pre treatment work up • History and clinical examination • Haematological tests: Hb%, TC,DC, Platelet Count • Urine Examination • Biochemistry: BUN, S.Creartinine, LFT • Radiology: CXR, CT and MRI where needed • USG abdomen • ECG • Audiogram • Nutritional Status

  7. Chemotherapeutic Agents • Alkylating agents • Antimetabolites • Antitumor Antibiotics • Alkaloids • Taxanes

  8. Alkylating Agents • Influences the structure and function of DNA • Example:cyclophosphamidecisplatin ( Platinum compund)

  9. Cisplatin

  10. Cisplatin • Side Effects • Severe Nausea and Vomiting up to 5 days after administration • Nephrotoxicity- Usually the dose limiting toxicity • Ototoxicity – High Frequency Hearing Loss, Tinnitus • Neurotoxicity.

  11. Squamous cell ca • 80 – 120 mg / m2 every 3 weeks • Good prehydration

  12. Cyclophophamide • Squamous cell ca, lymphomas, leukemias • Haemorrhagic cystitis • N/v , alopecia, neutropenia

  13. Antimetabolites • Blocks nucleic acid synthesis • Example: methotrexate, 5FU

  14. Methotrexate

  15. Methotrexate • Toxicities: • Myelosupression, mucositis, alopecia, N/V and Diarrhea Most common • Renal Toxicity in Higher Doses

  16. 5 - Fluorouracil • Antimetabolite - Like Methotrexate deprives cells of essential precursors of DNA synthesis • Pyrimidine analog which has a stable flourine atom in place of hydrogen at position 5 of the uracil ring.

  17. 5-FU • Side Effects • MUCOSITIS • Other side effects include bone marrow supression, N/V, alopecia and anorexia

  18. Antitumor Antibiotics • Group of related antimicrobial compounds produced by Streptomyces species in culture • Doxorubicin • Bleomycin • Actinomycin D

  19. Doxorubicin • Lymphomas, sarcomas, esthesioneuroblastomas • Cardiotoxic • Alopecia, nausea, vomiting, diarrhoea

  20. Bleomycin • Squamous cell ca, Lymphoma • Pneumonitis, pulmonary fibrosis • Anaphylaxis, alopecia

  21. Actinomycin D • Rhabdomyosarcoma • Myelosupression • GI effects

  22. Alkaloids • Bind free tubulin resulting in arrest of cells in metaphase • Examples: vincristine, vinblastine

  23. Taxanes • Causes formation of abnormal bundles of microtubules. • Examples: paclitaxel and docetaxel

  24. THANK YOU

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