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Other Modes of Treatment

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

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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

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