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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 Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City
Treatment Options • Surgery • Chemotherapy • Hormonal Therapy • Immunotherapy • Gene Therapy • Radiation Therapy
First order kinetics • Cell-cycle phase specific • Cell-cycle phase non-specific
Chemotherapeutic Drugs • Alkylating agents • classic • nitrosoureas • miscellaneous DNA-binding agents • Antitumor antibiotics • Antimetabolites • folate/purine/pyrimidine analogues • ribonucleotidereductase 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 suppression • stomatitis • ulceration of GIT • alopecia
Hormonal Therapy Estrogen receptor Progesterone receptor
Gene Therapy • Replacement or deletion of tumor suppressor genes to enhance immune response to cancer cells
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
Cancer Prevention • Primary • Secondary • Tertiary * chemoprevention