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Combined Chemo And Radiation Therapy

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Doctor Explains Why We Combine Chemotherapy and Radiation for Lung Cancer

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Role Of Radiation In Early Stage And Locally Advanced Non

Definitive radiation therapy has been part of the standard of care for patients with locally advanced NSCLC for almost 5 decades. Combined modality therapy with chemoradiation became the preferred treatment of these patients based on multiple clinical trials showing improved survival . Conventionally fractionated radiation therapy remains the standard, and attempts at dose escalation have failed to show a benefit in this patient population . Newer technologies such as intensity modulated radiation , image guided radiation therapy, and proton therapy are increasingly being utilized or studied to lower rates of toxicity with combined modality therapy.

SBRT has also begun to be used more frequently in patients with oligometastatic disease, including lung, liver, and bone metastases. Recent data has shown excellent control rates with encouraging progression free survival in patients with oligometastatic NSCLC . Conventionally fractionated radiotherapy, in combination with chemotherapy, can also be considered in patients with oligometastatic disease not amenable to treatment with SBRT and may improve survival in a select subset of patients with minimal extrathoracic disease .

What Are The Common Side Effects Of Radiation Therapy

Radiation therapy is called a local treatment. This means that it only affects the specific area of the body that is targeted. For example, radiation therapy to the scalp may cause hair loss. But people who have radiation therapy to other parts of their body do not usually lose the hair on their head.

Common physical side effects of radiation therapy include:

Skin changes. Some people who receive radiation therapy experience dryness, itching, blistering, or peeling on the skin in the area being treated. Skin changes from radiation therapy usually go away a few weeks after treatment ends. If skin damage becomes a serious problem, your doctor may change your treatment plan. Lotion may help with skin changes, but be sure to check with your health care team about which cream they recommend and when to apply it. It is also best to protect affected skin from the sun. Learn more about skin-related treatment side effects.

Fatigue. Fatigue is a term used to describe feeling physical, emotional, and mental exhaustion even if you are getting enough rest and sleep. Many patients experience fatigue. Your level of fatigue may increase if you are receiving more than 1 type of treatment, such as radiation therapy combined with chemotherapy. Learn how to cope with fatigue.

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Can Organ Preservation By Nom Be Further Optimized

Habr-Gama et al. reported the results of a more intense CRT regimen of 54 Gy in 30 fractions with 3 concurrent cycles of 5-FU/folinic acid every 21 days, followed by 3 further cycles of consolidation chemotherapy before response assessment 9 weeks after completion of CRT: initial cCR in 70 patients with T2-3 distal rectal cancer was 68%, and sustained cCR at 1 year of follow-up 57% . Another prospective watch-and-wait approach from Denmark evaluated patients with low-lying cT2-3, cN0-1 rectal cancer . Patients were treated with an increased radiation dose and concurrent oral tegafur-uracil. Response was assessed 6 weeks after CRT by endoscopy/biopsy and MRI, and complete responders were prospectively observed. A total of 40 out of 51 eligible patients met the criteria of cCR. With a median follow-up of 24 months, the 1- and 2-year cumulative incidence of local regrowth for these 40 patients were 15% and 26%, respectively. All these patients were successfully salvaged without additional recurrences.

Combining Radiation And Chemotherapy May Improve Outcomes

Salivary Gland Cancer

CURE

In the right cancer, radiation and chemotherapy can make a powerful duo.

Like many people with cancer, Gordon Cole underwent a variety of treatments. After receiving a diagnosis of stage 4 rectal cancer in August 2003, the 63-year-old commercial real estate appraiser in Greensboro, N.C., endured multiple surgeries, several rounds of different chemotherapy agents and targeted therapies, and radiation.

As part of his treatment regimen, Cole also received chemoradiotherapy chemotherapy and radiation given concurrently on two occasions. The first time was just after his diagnosis, with an oxaliplatin-based regimen, Cole says, while the second time was more recent, sandwiched between two three-month segments of standard chemotherapy.

Side effects werent too bad, he says, just fatigue toward the last quarter of radiation, and of course, the usual sensitivity to cold from the oxaliplatin. Radiation therapy and chemotherapyestablished treatments for an array of cancer typeswere traditionally given at separate intervals. But CRT is rapidly becoming the regimen of choice in a growing number of cases.

Chemoradiation is now the standard of care for several types of solid tumors that are intermediate stage, says Everett E. Vokes, chairman of the department of medicine at the University of Chicago. For example, it is widely used for treating lung, esophageal, and head and neck cancers, he adds.

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Coping With The Side Effects Of Radiation Therapy

Everyone’s experience with radiation therapy is different. Side effects vary from person to person, even when given the same type of treatment. Before your treatment, ask your health care team which physical side effects are possible and what to watch for. You may also experience emotional side effects. Seeking out mental health support to help with anxiety and stress is important.

Ask your health care team about ways to take care of yourself during the treatment period, including getting enough rest, eating well, and staying hydrated. Ask whether there are any restrictions on your regular exercise schedule or other physical activities. If so, talk with them about another way to get regular exercise.

Continue to talk to your health care team throughout your treatment. Tell them when side effects first appear, worsen, or continue despite treatment. That will help your health care team provide ways to help you feel better during and after treatment.

Chemotherapy And Radiation For Cancer Treatment

Cancer cells lose their ability to be controlled in natural growth and reproduction by the body and multiply very fast, often migrating through metastasis to other parts of the body in addition to the original site. Normal cells know when to stop growing, particularly in repair situations, but cancer cells are different from normal cells in ignoring the bodys signals to stop growth.

The cancer cells become erratic and keep multiplying rapidly and, if not controlled or killed, the cancer cells disrupt normal and essential cell functions, crowd out normal tissue of organs and eventually, if not stopped, cause organ failure resulting in death. Cancer cells mimic healthy cells and unfortunately camouflage themselves to sometimes go unrecognized by immune cells defending our bodies. The current standards of care for cancer unchanged for decades are chemotherapy, radiation and surgery.

Radiation treatments for cancer, or radiotherapy, involve the use of radioactivity including ionizing radiation from Gamma-rays, X-Rays or Cobalt-60 as killing agents in therapy. Chemotherapy involves chemical agents and drugs that attempt to disrupt cancer cell growth and kill cancer cells.

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What Are Side Effects

Chemotherapy and radiation therapy are the two most common types of cancer treatment. They work by destroying these fast-growing cells. But other types of fast-growing healthy cells also can be damaged along with cancer cells, causing adverse reactions, or side effects.

Side effects can range from tiredness and nausea to hair loss and blood clotting problems. Because each person responds a little differently to treatment and it’s hard for doctors to predict exactly how the body will react, they’ll closely watch a child who is being treated for cancer. Doctors weigh the amount and severity of side effects against the benefits of treatments.

Fortunately, most side effects are temporary. As the body’s normal cells recover, these problems start to go away. There are also good supportive treatments that can lessen the side effects.

Side effects vary:

  • Some can be merely unpleasant, while others can be much more serious.
  • Some show up right away, while others develop over time.
  • Some kids have just a few, while others have many over the course of treatment.

Living With And Managing Ovarian Cancer

Chemo, Radiation in Head/Neck Cancer

Getting a diagnosis of ovarian cancer can affect nearly every aspect of your life. Between symptoms of the disease, side effects from treatment, and the emotional impact on you and your loved ones, you may feel like your world has turned upside down. It’s normal to feel a wide range of emotions and wonder what the future holds when facing a cancer diagnosis.

The prognosis of ovarian cancer varies depending on when the disease was diagnosed. Ovarian cancer is easiest to treat if caught early, and people diagnosed with stage 1 ovarian cancer have a five-year survival rate of 93%. Survival rates drop when cancer is more advanced and spreads to other areas of the body. Overall, the overall five-year survival rate for people with all types of ovarian cancers is 49%.

If you have questions or concerns about how your diagnosis is affecting your day-to-day life, talk to your cancer care team. They can help find support groups so you can talk to others with a similar diagnosis or help you connect with ovarian cancer survivors who can provide an understanding shoulder to lean on. Its important to remember that even the strongest, most resilient people need support. Asking for support from family, friends, and healthcare providers is one of the best things you can do as you navigate your ovarian cancer journey.

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Rational Combinations Of Radiation And Targeted Therapy In The Preclinical Setting

PARP proteins are involved in DDR and inhibitors of PARP have been widely studied for radiosensitization both preclinically and in the clinic . Currently, there are four PARP inhibitors in the clinic: Olaparib, Rucaparib, Niraparib, and Talazoparib . The efficacy of this combination therapy has also been studied in preclinical models of human non-small cell lung cancer : Calu-3 and Calu-6 cell lines. Even though both cell lines exhibited increased radiosensitization following Olaparib treatment in vitro, only xenografts of Clau-6 showed increased response to combination RT in vivo. Difference in response between Clau-3 and Clau-6 were most likely due to microenvironmental factors that contributed to the sensitivity of cells, indicating that preclinical modeling must be approached unbiased and carefully with the appropriate TME . Talazoparib and Niraparib have also been studied for their sensitizing effects. Primary melanoma cultures treated with combination therapy of Talazoparib, Niraparib and radiation, demonstrate that both PARP inhibitors sensitize melanoma cells to IR . A short-term phase 1 clinical trial looking at the efficacy of combination therapy of radiation and Olaparib has determined the safety of the combination regimen in doses up to 200 mg/day without any side effects .

Table 1 List of radiosensitizers, respective mechanism of actions and preclinical models used to study them.

What Is Radiation Therapy

Radiation therapy uses high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons, to destroy or damage cancer cells.

Your cells normally grow and divide to form new cells. But cancer cells grow and divide faster than most normal cells. Radiation works by making small breaks in the DNA inside cells. These breaks keep cancer cells from growing and dividing and cause them to die. Nearby normal cells can also be affected by radiation, but most recover and go back to working the way they should.

While chemotherapy and other treatments that are taken by mouth or injection usually expose the whole body to cancer-fighting drugs, radiation therapy is usually a local treatment. This means its usually aimed at and affects only the part of the body needing treatment. Radiation treatments are planned so that they damage cancer cells with as little harm as possible to nearby healthy cells.

Some radiation treatments use radioactive substances that are given in a vein or by mouth. Even though this type of radiation does travel throughout the body, the radioactive substance mostly collects in the area of the tumor, so theres still little effect on the rest of the body.

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When Radiotherapy Is Used

Radiotherapy may be used in the early stages of cancer or after it has started to spread.

It can be used to:

  • try to cure the cancer completely
  • make other treatments more effective for example, it can be combined with chemotherapy or used before surgery
  • reduce the risk of the cancer coming back after surgery
  • relieve symptoms if a cure is not possible

Radiotherapy is generally considered the most effective cancer treatment after surgery, but how well it works varies from person to person.

Types Of Cancer Treatment

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There are many types of cancer treatment. The types of treatment that you receive will depend on the type of cancer you have and how advanced it is.

Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and radiation therapy. When you need treatment for cancer, you have a lot to learn and think about. It is normal to feel overwhelmed and confused. But, talking with your doctor and learning about the types of treatment you may have can help you feel more in control. Our list of Questions to Ask Your Doctor About Treatment may help.

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What Are The Side Effects Of Radiotherapy

Radiotherapy itself does not hurt but may have other temporary or permanent side effects. This might happen if radiation damages healthy cells close to the cancer cells being treated. The kinds of side effect you may experience, and how significant they are, can vary and depend on your general health, the dose of radiotherapy given, the part of your body being treated, and any other cancer treatments you may be receiving.

Some people who receive radiotherapy feel few side effects, or even none, and can carry on with everyday activities. Others experience more significant side effects. Usually, people have side effects due to radiotherapy after a few weeks of receiving treatment. They can continue for a while even after treatment is complete.

Common side effects include:

Many of these are temporary and resolve over time but others, such as infertility, may be permanent. Your medical team will be very experienced in helping patients who are receiving radiotherapy and can give you information and support in managing any side effects.

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Effects Of Radiation Therapy: Cellular Damage

Traditionally, RT has been reported to arrest cancer cell proliferation by inducing DNA damage through stimulation of cell death mechanisms such as apoptosis, necrosis, and senescence. However, radiation can also inhibit cell proliferation by disrupting the neoplastic cells physically through damage to the cell membrane and organelles, and thereby interfering with signal transduction . Damage to several organelles including the endoplasmic reticulum, ribosome, lysosome, and mitochondria have been implicated in the effects of RT-induced tumor cell death .

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Special Diet Needs While On Radiation Therapy

Radiation can cause side effects that make it hard to eat, such as nausea, mouth sores, and throat problems called esophagitis. Since your body uses a lot of energy to heal during radiation therapy, it is important that you eat enough calories and protein to maintain your weight during treatment.

If you are having trouble eating and maintaining your weight, talk to your doctor or nurse. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or read more about side effects.

Why People With Cancer Receive Radiation Therapy

Radiation therapy is used to treat cancer and ease cancer symptoms.

When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

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