• 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