Multimodal Cancer Therapies

Flashcards for reviewing key vocabulary and concepts in Multimodal Cancer Therapies

Epidemiology of Cancer

The incidence of cancer is increasing, but its mortality is declining.

Most Common Cancer Diagnoses (in descending order)

Prostate, Breast, Skin melanoma, CRC, Lung, Non-Hodgkin lymphoma

Most Common Causes of Cancer Mortality

Lung, Colorectal, Pancreatic, Prostate, Breast, Unknown Primary Site, Liver, Non-Hodgkin lymphoma

Intent of Cancer Treatment

Curative (definitive treatment) and Palliative (no cure)

Modalities of Cancer Treatment

Surgery, Radiotherapy, Systemic Therapy

Tumour Considerations for Treatment

Histopathology, staging, pathology/organ of origin, natural history/tempo of disease, tumour grade, operable/inoperable, clinical trials.

Patient Considerations for Treatment

Frailty, comorbidities, ECOG, preferences, age, health, social support.

Treatment Considerations for Treatment

Previous treatment, contraindications to treatment.

Goals of Cancer Treatment

Balancing benefits of treatment, minimising toxicity, patient preferences

Multimodal Cancer Treatment

Maximise benefit while minimising side effects by any combination of chemotherapy, radiotherapy, surgery, and endocrine therapy.

Local and Regional Cancer Treatment

Surgery and Radiotherapy

Radiotherapy + Chemotherapy Combination

Local disease treated with Radiotherapy; distant metastases treated with Chemotherapy

"Best Therapy" Definition

Sterilising tumour cells with least toxicity

Disease Progression

Cancer continues to grow despite treatment (resistant)

Pseudoprogression

Tumours change in size in response to treatment, but is not actually getting worse

Gray (Gy)

Absorption of 1J of energy per kg of matter.

Fraction (Radiotherapy)

Number of treatments delivered.

Indirect Effect of Radiotherapy

Water molecule ionization creates reactive oxygen species -> DNA damage.

Radiotherapy Fractions

Dividing treatment into fractions allows normal tissue to recover and repair damage in between treatments

External Beam Therapy

High-energy X-rays or particles are directed at the tumour from outside the body using a linear accelerator.

Brachytherapy

A radioactive source is placed inside or very close to the tumour (within the body), providing highly localised treatment.

Radiotherapy Simulation - Immobilisation

Reproducible position for treatment. Computer modelling & making of devices which immobilise the patient and protect vulnerable areas from radiation.

Radiotherapy Planning

Delineate target volumes and organs at risk. Optimise dose to treatment target while minimising dose to normal tissues (organs at risk).

Radiotherapy Treatment Schedule

Daily treatment, multiple fractions up to 8-9 weeks, 5 days/week.

Curative Intent of Radiotherapy

Definitive (primary treatment), neoadjuvant (before primary treatment), adjuvant (after primary treatment).

Palliative Intent of Radiotherapy

Relieve pain, bleeding, obstruction.

Pre-operative Radiotherapy Benefits

Reduce size and prevent local seeding

Pre-chemotherapy radiotherapy benefit

Increase spatial cooperation as RT treats local & regional cancer, chemo treats distal spread.

Independent Toxicity in Radiotherapy and Chemotherapy

Radiotherapy and chemotherapy have different dose limiting toxicities, allowing delivery of treatment with higher efficacy and fewer effects.

Synergism of Radiotherapy and Chemotherapy

Sensitises tumour cells to concurrent chemotherapy

Determinants of Radiotherapy Toxicity

Site treated, Volume of normal tissue treated, Total dose, Fraction size.

Therapeutic Ratio

Ratio of tumour response for a given level of normal tissue damage

Treatment Modalities and Disease Targeting

Surgery and radiotherapy are directed at local and regional disease, while chemotherapy is a systemic modality

Types of Radiotherapy

External Beam and Brachytherapy

Multimodal Cancer Treatment Aim

Maximising cure rate and treatment benefit, while minimising acute and late toxicities.

Multidisciplinary Cancer Care

Patients see multiple medical professionals in their cancer journey and work together as multidisciplinary team to deliver the best care