Radiotherapy + chemotherapy

Question 1

What are the intents of anti-cancer treatment?

Answer 1

curative:
- neoadjuvant (shrink tumour before main treatment eg. surgery)
- radical
- adjuvant (treatment after main treatment to help prevent recurrence)

palliative

Question 2

What is the goal of curative treatment?

Answer 2

eliminate all cancer cells and prevent cancer recurrence

Question 3

What is radical treatment?

Answer 3

part of curative treatment plan
may be curative on its own
may remove main cancer mass but require additional treatments to achieve cure

Question 4

What is neoadjuvant treatment?

Answer 4

given before adjuvant treatment
objectives = shrink mass to make radical treatment easier

Question 5

What is adjuvant treatment?

Answer 5

given after adjuvant treatment
objectives = deal with residual microscopic cancer cells + reduce risk of recurrence

Question 6

Which cancer treatment type is most likely to be curative when used on its own?

Answer 6

early stage = surgery

Question 7

What does palliative mean?

Answer 7

cannot be cured
does not necessarily mean end of life

Question 8

How do you assess a patient’s fitness for treatment?

Answer 8

ECOG performance scale
0-2 = benefits of treatment outweigh risks
3-5 = risks of treatment outweigh benefits

Question 9

What is included in systemic anti-cancer treatment (SACT)?

Answer 9

drug treatments
includes:
- cytotoxic chemotherapy
- targeted therapy
- immunotherapy
- endocrine therapy

Question 10

Describe some types of cytotoxic chemotherapy

Answer 10

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

Question 11

Paclitaxel MOA

Answer 11

microtubule inhibitor

Question 12

5-fluorouracil MOA

Answer 12

anti-metabolites

Question 13

Cisplatin MOA

Answer 13

alkylating agents

Question 14

How do chemotherapy cycles generally go?

Answer 14

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

Question 15

Side effects of cytotoxic chemotherapy

Answer 15

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

Question 16

What drug is given in CML?

Answer 16

Imatinib - small molecule tyrosine kinase inhibitors

Question 17

Side effects of immune checkpoint inhibitors

Answer 17

immune reactions not specific for cancer cells - autoimmune side effects can develop in any part of the body

Question 18

Name an anti-oestrogen

Answer 18

tamoxifen - used in HER2+ breast cancer

Question 19

Name an anti-androgen

Answer 19

bicalutamide - used in prostate cancer

Question 20

Name a gonadotrophin analogue

Answer 20

goserelin - used in prostate cancer

Question 21

How does radiotherapy work?

Answer 21

damages DNA strands
targeted to a specific part of the body

Question 22

What is a radiotherapy dose-fractionation schedule?

Answer 22

X ‘gray’ (dose of radiation)
Y ‘fractions’ (number of sessions of treatment)
over Z weeks or days

Question 23

What is external beam radiotherapy?

Answer 23

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

Question 24

What is brachytherapy?

Answer 24

radiation source is inside body and close to cancer being treated (can be used for certain cancers - eg. prostate cancer, cervix cancer)

Question 25

What is radioisotope therapy?

Answer 25

radioactive isotope delivered into bloodstream and taken up preferentially by the cancer
used for specific cancers (eg. thyroid, bone metastases in prostate cancer)

Question 26

Side effects of radiotherapt

Answer 26

early = fatigue, inflammation (eg. dermatitis, mucositis)

late = fibrosis, necrosis (eg. osteoradionecrosis), second cancers