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Other Modes of Treatment

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  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

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

  7. 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

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

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

  10. Hormonal Therapy Estrogen receptor Progesterone receptor

  11. Immunotherapy

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

  13. Radiation Therapy

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

  15. 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

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

  17. Side Effects

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

  19. Thank you