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Musculoskeletal Chemotherapy

• Surgical resection is the primary treatment


• Some tumor cant be treated by surgery alone
• Adjuvant modalities like chemotherapy &
radiotherapy play an essential role
• Chemotherapy is the treatment of cancer with
one or more cytotoxic anti-neoplastic drugs as
part of standard regimen

• Radiation and surgery is local treatment which


directly target the cancer

• Chemotherapy is s systemic treatment


goals
• Curative
• Control : to shrink the tumor or to stop from
growing or spreading
• Palliation : to relieve symptoms, only improve
life quality without curing the disease
Types
• Neo adjuvant
• Adjuvant
• Palliative
• Intra arterial
Neo adjuvant
• Before surgery Disadvantages :
• Kills micro metastasis • Drug resistant cells may
• Kills tumor emboli at metastasis
surgery • Delay in control bulk
• Decrease drug resistant disease
in micrometastasis • Increased chance of
• Decrease tumor size systemic dissemination
Adjuvant
• After surgery Disadvantages :
• Improve survival rates • Spread of tumor by
• Decreased bulk and surgery may have
specific agents more occured
active
• Decreased drug
resistance
Palliative
• No surgery
• Poor general condition
• Improve 5 year survival rates
• Prevents metastasis
• Decrease tumor size
Mechanism of action
• Most of chemo drugs work by impairing
mitosis, targeting fast dividing cells (both
normal and cancer cells) -> side effects

• Cell cycle : a series of steps that both normal


cells and cancer cells go through in order to
form new cells
Cell cycle
• G0 (resting) phase :
depend on cell type can go from few hours to
few years
• G1 phase
• S phase
• G2 phase
• M phase (mitosis)
Drugs
• Alkylating agents : cyclophospamide,
ifosfamide
• Antimetabolites : methotrexate, 5fluorouracil
• Vinca alkaloids : vincristine
• Antibiotics : doxorubicin, bleomycin
• Miscellaneous : cisplatin
Drug toxicity
• Bone marrow supression
• Lymph tissue : immune supression
• GIT : stomatitis, vomit
• Skin : alopecia
• Gonads : oligospermia, amenorrhea, mutation
• Abortion, teratogenus
• Neuropathy, cardiomyopathy
Assesment of tumor response :
• Clinical
• Radiographic
• histological
Histological grading
HUVOS criteria :
• Grade I : no effect or little
• Grade II : necrosis area larger than tumor left
• Garde III : predominant necrosis tumor area
• Grade IV : no viable tumor
Responsive -> continue same regimen
Unresponsive -> chane chemo regimen
Chemo sensitivity
• High : Ewing`s tumor
• Moderate : myeloma
• Relative resistant : osteosarcoma
THANK YOU

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