In combined modality treatment (CMT), antineoplastic agents are delivered at specific, prescribed intervals with radiation treatment to elicit a targeted response.50, 51 The treatment approaches may be termed:52
- Neoadjuvant chemotherapy (administered before local radiation to shrink a tumour)
- Concomitant therapy (administered during radiation to enhance or increase radiation cell kill)
- Adjuvant therapy (administered after a course of radiation to control micrometastases and subclinical disease).
The goal of CMT is to achieve a greater therapeutic gain than can be obtained by using either therapy alone. Improved 'cell kill' in the oesophagus, rectum, lung and head and neck have been reported with CMT.4, 53-55 Radiation effects are augmented in normal tissue when an antineoplastic agent is added to the treatment regime, causing normal tissues to become increasingly vulnerable to both acute reactions and chronic late sequelae. The inclusion of the antineoplastic agent(s):54
- creates a synergism with the local effects of the radiation therapy and sensitises the cells to the radiation cell kill
- improves tumour oxygenation and cell kill
- protects normal tissues in the radiation pathway, therefore allowing an increase in radiation dose
- plays a role in eradicating micrometastases due to systemic effects.
The impact and complexity of effects for people receiving this treatment may be increased, requiring targeted education and a range of specific supportive care interventions.4, 56
Discuss occupational health and safety considerations and the SCN responses to ensure safety for staff and the person undergoing treatment during concomitant therapy.
Identify a CMT regimen, and:
- Identify the treatment approach
- Outline the therapeutic effects of CMT regimen
- Outline the acute and chronic effects related to the combined effects of radiation and the antineoplastic agent(s).