TAILIEUCHUNG - Chapter 081. Principles of Cancer Treatment

The goal of cancer treatment is first to eradicate the cancer. If this primary goal cannot be accomplished, the goal of cancer treatment shifts to palliation, the amelioration of symptoms, and preservation of quality of life while striving to extend life. The dictum primum non nocere is not the guiding principle of cancer therapy. When cure of cancer is possible, cancer treatments may be undertaken despite the certainty of severe and perhaps life-threatening toxicities. Every cancer treatment has the potential to cause harm, and treatment may be given that produces toxicity with no benefit. The therapeutic index of many interventions. | Chapter 081. Principles of Cancer Treatment The goal of cancer treatment is first to eradicate the cancer. If this primary goal cannot be accomplished the goal of cancer treatment shifts to palliation the amelioration of symptoms and preservation of quality of life while striving to extend life. The dictum primum non nocere is not the guiding principle of cancer therapy. When cure of cancer is possible cancer treatments may be undertaken despite the certainty of severe and perhaps life-threatening toxicities. Every cancer treatment has the potential to cause harm and treatment may be given that produces toxicity with no benefit. The therapeutic index of many interventions is quite narrow and most treatments are given to the point of toxicity. Conversely when the clinical goal is palliation careful attention to minimizing the toxicity of potentially toxic treatments becomes a significant goal. Irrespective of the clinical scenario the guiding principle of cancer treatment should be primum succerrere quot first hasten to help. quot Radical surgical procedures large-field hyperfractionated radiation therapy high-dose chemotherapy and maximum tolerable doses of cytokines such as interleukin IL 2 are all used in certain settings where 100 of the patients will experience toxicity and side effects from the intervention and only a fraction of the patients will experience benefit. One of the challenges of cancer treatment is to use the various treatment modalities alone and together in a fashion that maximizes the chances for patient benefit. Cancer treatments are divided into four main types surgery radiation therapy including photodynamic therapy chemotherapy including hormonal therapy and molecularly targeted therapy and biologic therapy including immunotherapy and gene therapy . The modalities are often used in combination and agents in one category can act by several mechanisms. For example cancer chemotherapy agents can induce differentiation and antibodies a form of

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