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Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City
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Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Jan 05, 2016

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Page 1: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Other Modes of Treatment

Pierette Y. Kaw, MD, FPCSDepartment of Surgery

The Medical City

Page 2: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Treatment Options

SurgeryChemotherapyHormonal Therapy ImmunotherapyGene TherapyRadiation Therapy

Page 3: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Chemotherapy

Page 4: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

First order kineticsCell-cycle phase specificCell-cycle phase non-specific

Page 5: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Chemotherapeutic Drugs Alkylating agents classic nitrosoureas miscellaneous DNA-binding agents Antitumor antibiotics Antimetabolites folate/purine/pyrimidine analogues ribonucleotide reductase inhibitors Plant alkaloids miscellaneous

Page 6: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.
Page 7: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Chemotherapy

ADJUVANT postoperative

preoperative/induction/neoadjuvant

PRIMARY

Page 8: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

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

Page 9: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Combination chemotherapy Drug Resistance genetically unstable tumor cells large tumor size

Page 10: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Drug Toxicity

bone marrow suppressionstomatitisulceration of GITalopecia

Page 11: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Hormonal Therapy

Estrogen receptorProgesterone receptor

Page 12: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Immunotherapy

Page 13: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Gene Therapy

Replacement or deletion of tumor suppressor genes to enhance immune response to cancer cells

Page 14: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Radiation Therapy

Page 15: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Adjuvant (Preoperative)

Advantages minimize seeding make inoperable operable Disadvantages wound healing problems subsequent RT in positive

margins?

Page 16: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

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

Page 17: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

RT

chemo be given before or concurrently w radiation

Page 18: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Side Effects

Page 19: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Cancer Prevention

Primary Secondary Tertiary* chemoprevention

Page 20: Other Modes of Treatment Pierette Y. Kaw, MD, FPCS Department of Surgery The Medical City.

Thank you