Dr Sura Findakly MBChB DGO CABOG Learning objectives 1Describe the clinical uses and evaluation parameters of chemotherapy 2Name the types of chemotherapeutic agents 3Identify side effects chemotherapy and its uses in different gynecological malignancies ID: 933082
Download Presentation The PPT/PDF document "Chemotherapy and Radiotherapy" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Chemotherapy and Radiotherapy
Dr. Sura FindaklyMBChB,DGO,CABOG
Slide2Learning objectives:
1.Describe the clinical uses and evaluation parameters of chemotherapy. 2.Name the types of chemotherapeutic agents.3.Identify side effects chemotherapy and its uses in different gynecological malignancies.4.Recognize types of radiotherapy. 5.List side effects of radiotherapy and reproduce its uses in different gynecological malignancies.
Slide3principle of chemotherapy
attain maximal therapeutic cytotoxic effects upon cancer cells without extreme toxicity to normal tissues.
Slide4Clinical uses of chemotherapy
1-Primary Therapy. first-line treatment.2-Adjuvant Therapy. undergone primary surgical staging and cytoreduction but are known to be at high risk for the presence of micrometastases
, and recurrence, or have persistent disease at the end of primary surgery.
3-Neoadjuvant Therapy.
before
cytoreductive
surgery.
4-Salvage Therapy.
recurrent disease after first-line chemotherapy.
Slide5Evaluation parameters defined by (WHO)
1-Complete Response. Disappearance of all evidence of disease for at least 1 month.2-Partial Response. The reduction of each measurable lesion by at least 50% for at least 1 month 3-Stable Disease. Maintenance for each lesion of criteria less than those required for either a partial response or increasing disease.4-progressive Disease. Increase of a lesion by at least 25% or the appearance of a new lesion within 1 month.
Slide6Chemotherapeutic Agents
*Alkylating agents are cell cycle nonspecific. prevents DNA duplication. eg Cyclophosphamide *Antimetabolites are similar in chemical structure to metabolites required by both normal and tumorous cells for cell division to occur.eg
methotrexate
.
*
Vinca
alkaloids
They bind to tubules, interfere with spindle formation. arrest of metaphase and inhibits mitosis.eg
Vincrestine
,
vinblastine
*
Antitumor antibiotics
have many different modes of action, including increasing cell membrane permeability, inhibiting DNA and RNA synthesis, and blocking DNA replication.
Slide7Common Side Effects of Chemotherapy
1-Local and dermal: alopecia (reversible) and photosensitivity, phlebitis, tissue necrosis. 2-Myelosuppression. (Neutropenia , Anemia, Thrombocytopenia)3-Infections. the severity and duration of the neutropenia and
integrity
of mucous membranes and skin.
Fever
in a
neutropenic
patient is sufficient evidence of occult infection
4-Cardiac Side Effects
Daunorubicin
and doxorubicin
irreversible
cardiomyopathies
: CHF, pleural effusions, heart dilation, and venous congestion.
Paclitaxel
(
Taxol
)
may cause asymptomatic and transient and atypical chest pain during infusion. resolve with slowing of infusion.
5-
Pulmonary
Side Effects
Bleomycin
sulfate may cause significant pulmonary fibrosis, lung examination , Pulmonary function tests baseline pulmonary capacity before the first dose, repeated as needed
Slide8Common Side Effects of Chemotherapy
6-Hepatic. Transient elevations in LFT7.GastrointestinalStomatitis and mucositis …antimetabolites, methotrexate and paclitaxel.
Nausea and vomiting.
Diarrhea…
nephrotoxicity
or electrolyte disturbances.
8-Acute allergic reactions
etoposide.Bleomycin
can cause anaphylaxis, skin reactions, fever, chills, and pulmonary fibrosis.
9.Genitourinary
Hemorrhagic cystitis
cyclophosphamide
Nephrotoxicity
cisplatin
. Irreversible renal damage
10.Neurotoxicity
.
vinca
alkaloids
peripheral, central, and visceral neuropathies.
Tinnitus or high-frequency hearing loss ..
cisplatin
Slide9Chemotherapy in Gynecologic Cancers
1-Ovarian Cancer after initial surgery. platinum (cisplatin , carboplatin) and paclitaxel in epithelial ovarian cancer. malignant germ cells: bleomycin, etoposide, and cisplatin (BEP)
2-Endometrial Cancer
advanced or recurrent metastatic
doxorubicin, platinum, and
paclitaxel
.
3-Cervical Cancer
chemoradiation
cisplatin
or a combination of
cisplatin
and 5-FU
Slide10R adiotherapy
kills cells by the use of ionizing radiation:• X -rays• g amma-rays• β -particles.can lead to breakage of DNA directly or indirectly via production of free radicals with curative and palliative intent
Slide11Delivery of radiotherapy
Radiation may be given by external beam therapy and/or brachytherapy.1. External beam therapy:• radiation is distant from the patient2. Brachytherapy:• placement of radioactive source directly within or around the tumour site (e.g. intravaginal/ intrauterine
brachytherapy
for cervical cancer)
•
advantage
—higher radiation dose to the
tumour
, lower exposure to normal tissue.
• Side effects may be reduced by giving radiotherapy in divided doses so that normal tissues can recover.
3. Interstitial implants are another form of
brachytherapy
. Various sources of radiation may be configured as radioactive wires or seeds and placed directly within tissues. Hollow guide needles are to a target tumor volume. After the position of the guide needles is confirmed
radiologically
, they can be threaded with the radioactive sources and the hollow guides removed.
Slide12Toxicity of radiotherapy
. The severity of normal tissue reaction to radiation depends on: total dose, dose fraction, treatment volume, and radiation energy.1-Skin Toxicity. erythema, desquamation, and pruritus2-Hematologic Toxicity. The volume of marrow irradiated and the total radiation dose determine the severity of myelosuppression3-Gastrointestinal Toxicity
Acute
Complications. Nausea, vomiting, and diarrhea commonly occur 2 to 6 hours after abdominal or pelvic irradiation.
Long
-term Complications. Chronic diarrhea, obstruction (bowel adhesions), and fistula formation <1% of cases
4-Genitourinary Toxicity
Cystitis:
pain, urgency,
hematuria
, and urinary frequency.
Vesicovaginal
fistulas and
ureteral
strictures
Vulvovaginitis
:
erythema
, inflammation, mucosal atrophy, inelasticity, and vaginal ulcer. Adhesions and
stenosis
of the vagina ….Rx vaginal dilation
Slide131-Cervical Cancer
Radiation therapy with curative intent uses both external-beam and intracavitary radiation. Palliative radiation for advanced cervical cancer may use either modality for control of bleeding, management of disease in the pelvis, and relief of pain.The goal of external irradiation in cervical cancer is to sterilize metastatic disease to pelvic lymph nodes and the parametria
and/or to decrease the size of the cervix
to allow optimal placement of
intracavitary
radioactive sources.
Definitive radiation therapy is an acceptable alternative to radical surgery for women with
early stage disease
(stages IA, IB1, and
nonbulky
IIA). concurrent
cisplatin
-based chemotherapy
The treatment volume for women undergoing adjuvant external radiation therapy usually involves the
whole
pelvis, with larger fields for patients with higher stage disease.
Patients with known or suspected metastatic disease to
periaortic
lymph nodes may be considered for
extended field
irradiation
Slide142- Endometrial Cancer
after surgical staging : estimated risk recurrenceadnexal or pelvic metastases, involvement of lymphovascular space, grade 2 disease with invasion > 50% into the
myometrium
, or
grade 3 disease with any amount of
myometrial
invasion
:
high risk of recurrence
adjuvant radiation therapy
.
For high-risk disease confined to the uterus,
whole-pelvic therapy or vaginal
brachytherapy
may
be used.
For high-risk disease outside of the uterus but confined to the pelvis,
whole-pelvis radiation with or without vaginal
brachytherapy
should
be employed.
Women with more
extensive
disease undergo
extended-field radiation or whole-abdomen radiation.
Primary radiation therapy may be employed in women who are considered to be at high surgical risk, such as the elderly and those with significant comorbidities.
Slide15Ovarian &Vaginal Cancer
3-Ovarian Cancer: Radiotherapy controversial4-Vaginal CancerRadiotherapy : primary treatment for vaginal cancer. squamous cell carcinoma: whole-pelvic radiation therapy followed by intracavitary or interstitial brachytherapy. lesions involving the lower third of the vagina should have the inguinal and femoral lymph nodes included in the external-beam treatment field.
Extended field radiation to include
periaortic
lymph nodes may be needed if imaging studies reveal
bulky pelvic or
periaortic
disease.
Slide165-Vulvar Cancer
squamous cell in origin. the mainstay of treatment of stages I and II vulvar cancer is surgical, radical vulvectomy plus inguinal and pelvic lymphadenectomy. Adjuvant radiation therapy benefits patients with close or positive surgical margins, as well as patients with positive inguinal lymph nodes.In patients with vulvar squamous
cancer
(stage III or IV)
chemoradiation
may reduce the need for more radical surgery; primary pelvic
exenteration
.
Slide17SUMMARY:
Knowing chemotherapy and radiotherapy types, side effects and its uses in different gynecological malignancies is important to prevent and treatcomplications of their use.
Slide18THANK YOU