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Comparison Between Concurrent Administration of Both Radiation and Chemotherapy

Standard therapies for cancer primarily include surgery, radiation therapy and chemotherapy. Your doctor may also use other treatments — including alcohol injections, electric current therapy or surgery to freeze the tumor (cryosurgery).The goal of any treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or spreading. In some cases palliative care only is appropriate. Palliative care refers to treatment aimed not at removing or slowing the disease but at helping relieve symptoms and making you as comfortable as possible.

Surgery can be very successful in treating some kinds of cancer, but it isn't an option for all people. If the cancer is in the form of a malignant tumor and the tumor is in one place (localized), it may be possible to safely "cut out" the tumor and any surrounding affected tissue. Surgery may not be possible if the cancer has spread to other areas of the body or if the tumor cannot be removed without damaging vital organs, such as the liver or brain.

Radiation therapy will help shrink your tumor. This therapy uses a form of high energy x-rays which are carefully directed at your tumor and the surrounding tissue which is at high risk for local spread. The high-energy beams can kill cells and keep them from dividing and spreading. This helps destroy the tumor, because cancer cells divide and grow faster than normal cells. Normal cells usually recover successfully from radiation, but the high-energy beams will be carefully aimed to target your tumor and lymph nodes and minimize the amount of normal tissue affected.

Chemotherapy refers to medications that are used to treat cancer. There are many different types of chemotherapy. Most of the drugs used in the treatment of lung cancer either directly kill cancer cells or stop them from dividing into new cells. Your Medical Oncologist will make recommendations for the specific chemotherapy medication you will receive based on your stage of disease, overall physical health and any prior treatments. The exact doses will be calculated using your weight, height and lab values. You will see the doctor or nurse practitioner in the clinic on 9B. You will receive your chemotherapy as an outpatient on 13 West in a unit specifically dedicated to outpatient chemotherapy. You will be given medicine to prevent nausea and allergic reactions before your chemotherapy. A specially trained nurse will remain with you while your chemotherapy is infusing.

Chemotherapy is usually used when the cancer has spread to other areas in the body. Chemotherapy can also be used in combination with surgery and radiation. Sometimes the tumor is surgically removed and then chemotherapy is used to make sure all the cancer cells are killed.

Hormone therapy is sometimes used to treat breast or prostate cancer. The hormone estrogen can make breast cancer tumors grow faster. Similarly, the hormone testosterone can make cancerous tumors in the prostate grow faster. Drugs that contain other hormones may be used to block the effects of estrogen and testosterone. In other cases, surgery to remove the ovaries or the testicles may be used. Removing these organs reduces the amount of estrogen or testosterone in the body.

Hormone therapy is often used in addition to chemotherapy or radiotherapy.

Following surgery, treatment with chemotherapy and radiation at the same time, rather than at different times, seems to improve the odds that a breast cancer won't return, according to a report in the International Journal of Radiation Oncology Biology Physics.

Dr. Bruce Haffty, of the Robert Wood Johnson Medical School-UMDNJ in New Brunswick, New Jersey, and colleagues studied 535 women with breast cancer who underwent lumpectomy, plus radiation and chemotherapy at a major medical center. Chemotherapy and radiation were administered concurrently or in various sequences.

The overall survival rate at 10 years was 78 percent, and 75 percent of the women had no evidence of cancer in distant organs.

Despite experiencing more side effects, 92 percent of patients who received concurrent radiation and chemotherapy showed no signs that their cancer had returned. When radiation and chemotherapy were given at different times, the percentage was significantly lower, 83 percent.

The researchers note that although there have been concerns about more side effects with simultaneous treatment, the approach had acceptable cosmetic results, severity of side effects, and long-term complication rates.

Still, because outcomes are generally good with sequential therapy, the researchers do not currently recommend the use of concomitant therapy outside of clinical studies.

"The challenge over the next few years," Haffty points out, "is to identify those patients who would best benefit from this strategy." This, he concluded, can best be accomplished by forward-looking) clinical trials.