Radiotherapy + chemotherapy Flashcards
What are the intents of anti-cancer treatment?
curative:
- neoadjuvant (shrink tumour before main treatment eg. surgery)
- radical
- adjuvant (treatment after main treatment to help prevent recurrence)
palliative
What is the goal of curative treatment?
eliminate all cancer cells and prevent cancer recurrence
What is radical treatment?
part of curative treatment plan
may be curative on its own
may remove main cancer mass but require additional treatments to achieve cure
What is neoadjuvant treatment?
given before adjuvant treatment
objectives = shrink mass to make radical treatment easier
What is adjuvant treatment?
given after adjuvant treatment
objectives = deal with residual microscopic cancer cells + reduce risk of recurrence
Which cancer treatment type is most likely to be curative when used on its own?
early stage = surgery
What does palliative mean?
cannot be cured
does not necessarily mean end of life
How do you assess a patient’s fitness for treatment?
ECOG performance scale
0-2 = benefits of treatment outweigh risks
3-5 = risks of treatment outweigh benefits
What is included in systemic anti-cancer treatment (SACT)?
drug treatments
includes:
- cytotoxic chemotherapy
- targeted therapy
- immunotherapy
- endocrine therapy
Describe some types of cytotoxic chemotherapy
Phase-specific:
- M-phase-specific = disrupt mitosis, eg. paclitaxel
- S-phase-specific = disrupt DNA synthesis, eg. 5-fluorouracil
Non-phase-specific:
- active throughout all stages of cell cycle - damage DNA strands, eg. cisplatin
Paclitaxel MOA
microtubule inhibitor
5-fluorouracil MOA
anti-metabolites
Cisplatin MOA
alkylating agents
How do chemotherapy cycles generally go?
1 cycle = 3 weeks for most agents
drug given on first day of week 1
side-effects peak during week 2
expect recovery by end of week 3
Side effects of cytotoxic chemotherapy
brain fog
anxiety/depression
hot flashes/menopause
weak heart
nausea/vomiting
discoloured/cracked nails
loss of appetite
sexual dysfunction
skin sensitivity
hair loss
mouth sores
lower blood cell count
digestive distress
decreased urination
red urine
bone loss
poor coordination + tired muscles
swollen hands + feet
What drug is given in CML?
Imatinib - small molecule tyrosine kinase inhibitors
Side effects of immune checkpoint inhibitors
immune reactions not specific for cancer cells - autoimmune side effects can develop in any part of the body
Name an anti-oestrogen
tamoxifen - used in HER2+ breast cancer
Name an anti-androgen
bicalutamide - used in prostate cancer
Name a gonadotrophin analogue
goserelin - used in prostate cancer
How does radiotherapy work?
damages DNA strands
targeted to a specific part of the body
What is a radiotherapy dose-fractionation schedule?
X ‘gray’ (dose of radiation)
Y ‘fractions’ (number of sessions of treatment)
over Z weeks or days
What is external beam radiotherapy?
radiation source outside the body at a distance from the cancer being treated
majority of radiotherapy treatments delivered this way
radiation beams generated and focussed by a linear accelerator
What is brachytherapy?
radiation source is inside body and close to cancer being treated (can be used for certain cancers - eg. prostate cancer, cervix cancer)
What is radioisotope therapy?
radioactive isotope delivered into bloodstream and taken up preferentially by the cancer
used for specific cancers (eg. thyroid, bone metastases in prostate cancer)
Side effects of radiotherapt
early = fatigue, inflammation (eg. dermatitis, mucositis)
late = fibrosis, necrosis (eg. osteoradionecrosis), second cancers
