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