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
ribonucleotide reductase inhibitors
Plant alkaloids
miscellaneous

7. Chemotherapy ADJUVANT postoperative preoperative/induction/neoadjuvant
PRIMARY

8. 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

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

10. Drug Toxicity bone marrow suppression stomatitis ulceration of GIT
alopecia

11. Hormonal Therapy
Estrogen receptor
Progesterone receptor

12. Immunotherapy

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

14. Radiation Therapy

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

16. 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

17. RT
chemo be given before or concurrently w radiation

18. Side Effects

19. Cancer Prevention
Primary
Secondary
Tertiary
* chemoprevention

20. Thank you