Chemotherapy

Types
• Single agent chemotherapy
• Combination chemotherapy
Combination chemotherapy
• designed to circumvent drug
resistance and enhance cell kill.
• Chemotherapeutic agents kill a con-
stant fraction of cells (first order kinet-
ics).
• One dose of cytotoxic drug results in
10²-10⁴ cells being killed. Hence, since
the average number of cells in a clini-
cally detected malignant tumour is
approximately 10¹²cells, several cour-
ses of chemotherapy are required to
eradicate a tumour.
Chemotherapy
• Curative ex. In gestational tro-
phoblastic neoplasia, ovarian
germ cell tumor.
• Palliative ex in ovarian carci-
noma
Curative chemotherapy
• Fixed number of cycles given
• Correct dose and schedule
maintained sometimes at the
cost of increasing toxicity .
Palliative chemotherapy
• the intent of treatment is to
minimise disease pro gression
and maintain quality of life.
Carcinoma ovary
Neoadjuvant, adjuvant chemotherapy
Radiotherapy
Radiotherapy for Carcinoma
cervix

• Advantages
– Applicable for all stages of disease
– As effective as surgery in early stages
– Lesser primary mortality and immediate morbidity as
compared to surgery
– Preferred in patients unfit for surgery because of medi-
cal conditions or extreme obesity
• Techniques
– Brachytherapy
– Teletherapy
Brachytherapy

• Radiation sources placed adjacent to the tumor by means

of intra-uterine tandems and vaginal colpostats
• Inverse square law : The dose of radiation at any given
point is inversely proportional to the square of the distance
from the source of the radiation
The dose decreases rapidly as the distance from the ap-
plicator increases
• Personnel protected by afterloading techniques
• Computerized dosimetry plots isodose curves by taking
into account tumor geometry and placement of radiation
sources
• Brachytherapy helps in achieving central control of the tu-
mor
 Brachytherapy

• Point A
– It is a paracervical area located 2 cm lateral to the cervical canal and
2 cm above the external os
– It corresponds to the crossing of the ureters under the uterine artery
– Adequate summated dose to point A to achieve central control of the
tumor is ~ 7500 – 8000 cGy
• Point B
– It is located 3 cm lateral to point A on the same horizontal plane
– It corresponds to the site of the Obturator lymph nodes on the lateral
pelvic wall
– The prescribed dose to point B is 4500 – 6000 cGy depending upon
the bulk of parametrial and side wall disease
Techniques of Brachytherapy

• Low dose radiation (LDR)

– Paris technique
• One application : 120 hrs
– Manchester technique
• Two applications : 72 hrs each repeated after 7 days
– Stockholm technique
• Three applications : 24 hrs each at weekly intervals

• High dose radiation (HDR)

– Five fractions of 700 cGy each to Point A daily
Teletherapy

• Radiation is directed towards tumor tissue from

external sources like Cobalt 60, Caesium 137 or
Linear accelerators
• Usual dosage is 900 cGy / week in 5 fractions of
180 cGy each, given with or without central shield-
ing
• Teletherapy is usually given by parallel opposing
fields or multiple external fields to decrease dam-
age to normal tissues