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

2. Treatment Options • Surgery • Chemotherapy • Hormonal Therapy • Immunotherapy • Gene Therapy • Radiation Therapy

3. Chemotherapy

4. First order kinetics • Cell-cycle phase specific • Cell-cycle phase non-specific

5. Chemotherapeutic Drugs • Alkylating agents • classic • nitrosoureas • miscellaneous DNA-binding agents • Antitumor antibiotics • Antimetabolites • folate/purine/pyrimidine analogues • ribonucleotidereductase inhibitors • Plant alkaloids • miscellaneous

7. Chemotherapy • ADJUVANT • postoperative • preoperative/induction/neoadjuvant • PRIMARY

8. 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

9. Combination chemotherapy Drug Resistance genetically unstable tumor cells large tumor size

10. Drug Toxicity • bone marrow suppression • stomatitis • ulceration of GIT • alopecia

11. Hormonal Therapy Estrogen receptor Progesterone receptor

12. Immunotherapy

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

14. Radiation Therapy

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

16. 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

17. RT • chemo be given before or concurrently w radiation

18. Side Effects

19. Cancer Prevention • Primary • Secondary • Tertiary * chemoprevention

20. Thank you