other modes of treatment pierette y. kaw, md, fpcs department of surgery the medical city
TRANSCRIPT
Other Modes of Treatment
Pierette Y. Kaw, MD, FPCSDepartment of Surgery
The Medical City
Treatment Options
SurgeryChemotherapyHormonal Therapy ImmunotherapyGene TherapyRadiation Therapy
Chemotherapy
First order kineticsCell-cycle phase specificCell-cycle phase non-specific
Chemotherapeutic Drugs Alkylating agents classic nitrosoureas miscellaneous DNA-binding agents Antitumor antibiotics Antimetabolites folate/purine/pyrimidine analogues ribonucleotide reductase inhibitors Plant alkaloids miscellaneous
Chemotherapy
ADJUVANT postoperative
preoperative/induction/neoadjuvant
PRIMARY
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
Combination chemotherapy Drug Resistance genetically unstable tumor cells large tumor size
Drug Toxicity
bone marrow suppressionstomatitisulceration of GITalopecia
Hormonal Therapy
Estrogen receptorProgesterone receptor
Immunotherapy
Gene Therapy
Replacement or deletion of tumor suppressor genes to enhance immune response to cancer cells
Radiation Therapy
Adjuvant (Preoperative)
Advantages minimize seeding make inoperable operable Disadvantages wound healing problems subsequent RT in positive
margins?
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
RT
chemo be given before or concurrently w radiation
Side Effects
Cancer Prevention
Primary Secondary Tertiary* chemoprevention
Thank you