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Skin cancer and its treatment by radiotherapy
Radiation Oncology
64
??Biology ??Physics
October 1984, Volume 10, Sup. 2
306 CHEMOTHERAPY Stephen
FOR RADIATION
ONCOLOGISTS
K. Carter
Pharmaceutical
Research
and Development
Division,
Bristol-Myers
Company
Cancer Chemotherapy is a modality which can be curative or palliative depending upon the tumor in One of the major hopes for increasing the curative question, its stage and prior therapeutic history. potential of chemotherapy has been combining it with irradiation and/or surgery to attack micrometastatic This has been called adjuvant chemotherapy. Despite initial enthusiasm and excitement adjuvant disease. chemotherapy has been generally disappointing. The best data exist for Wilms' tumors, Ewing's sarcoma and The data for breast cancer and osteosarcoma are controversial and clearly at embryonal rhabdomyosarcoma. this time do not represent a major improvement in therapy. The data for gastrointestinal and lung cancer In the malignant lymphomas, where chemotherapy against microscopic indicate no meaningful benefit. disease is highly positive, adjuvant chemotherapy for early stage disease after curative intent irradiation has been equivocal at best. It therefore appears time to reevaluate the basic tenets of adjuvant chemotherapy as well as the design of future trials. New developments in cancer chemotherapy involve the search for new drugs, superior analogs of existing drugs, and ways of improving the therapeutic index. The preclinical evaluation of new drugs needs to be improved and systems developed which are more clinically relevant than the murine transplantable systems currently in use. One approach is to use human tumor related models in a related mixture of in vitro and in vivo systems. The clinical evaluation of new drugs is made difficult by the very success of chemotherapy which precludes utilizing the responsive tumors for new drug evaluation until after they have been heavily pretreated. Improving effects. monoclonal modifiers tolerable
the therapeutic index involves increasing the dose of chemotherapy and/or diminishing the side Approaches to increasing the dose include: bone marrow transplantation, targeting with antibodies and regional drug delivery. The blocking of specific toxicities with biologic of drug action offer another opportunity for increasing drug dosage or at least making more the existing drug dosages.
307 SKIN
CANCER AND ITS
Peter J. Fitzpatrick, Princess
Margaret
TREATMENT
BY RADIOTHERAPY
M.D.
Hospital,
University
of
Toronto,
Ontario
The purpose of this refresher course is to provide the basic and clinical information necessary for the successful treatment of skin cancer by radiotherapy. Carcinomas of the skin are the commonest of all cancers. They are disfiguring but rarely fatal and can be managed in a variety of ways. Al ternat ives include surgery, radiation therapy, chemosurgery, cryotherapy, electrodesiccation and chemotherapy. The selection of optimal treatment is best made by a multidisciplinary oncologic team with decisions based on the probability of cure, cosmesis, function and relative comfort, time and cost of treatment. Basal and squamous cell carcinomas, melanoma, keratoacanthoma, Bowen’s disease and pre-malignant lesions will be reviewed . Special attention will be given to turnout-s at particular sites such as the eyelid, ear, nose and lip. The clinical aspects, technical details of radiotherapy, reactions, complications and results of treatment based on over 15,000 patients followed for a minimum of 8 years will be presented. For basal and squamous cell carcinomas treated by radiotherapy, the control rate is 95% and the cosmetic and functional results usually excellent.
64
??Biology ??Physics
October 1984, Volume 10, Sup. 2
306 CHEMOTHERAPY Stephen
FOR RADIATION
ONCOLOGISTS
K. Carter
Pharmaceutical
Research
and Development
Division,
Bristol-Myers
Company
Cancer Chemotherapy is a modality which can be curative or palliative depending upon the tumor in One of the major hopes for increasing the curative question, its stage and prior therapeutic history. potential of chemotherapy has been combining it with irradiation and/or surgery to attack micrometastatic This has been called adjuvant chemotherapy. Despite initial enthusiasm and excitement adjuvant disease. chemotherapy has been generally disappointing. The best data exist for Wilms' tumors, Ewing's sarcoma and The data for breast cancer and osteosarcoma are controversial and clearly at embryonal rhabdomyosarcoma. this time do not represent a major improvement in therapy. The data for gastrointestinal and lung cancer In the malignant lymphomas, where chemotherapy against microscopic indicate no meaningful benefit. disease is highly positive, adjuvant chemotherapy for early stage disease after curative intent irradiation has been equivocal at best. It therefore appears time to reevaluate the basic tenets of adjuvant chemotherapy as well as the design of future trials. New developments in cancer chemotherapy involve the search for new drugs, superior analogs of existing drugs, and ways of improving the therapeutic index. The preclinical evaluation of new drugs needs to be improved and systems developed which are more clinically relevant than the murine transplantable systems currently in use. One approach is to use human tumor related models in a related mixture of in vitro and in vivo systems. The clinical evaluation of new drugs is made difficult by the very success of chemotherapy which precludes utilizing the responsive tumors for new drug evaluation until after they have been heavily pretreated. Improving effects. monoclonal modifiers tolerable
the therapeutic index involves increasing the dose of chemotherapy and/or diminishing the side Approaches to increasing the dose include: bone marrow transplantation, targeting with antibodies and regional drug delivery. The blocking of specific toxicities with biologic of drug action offer another opportunity for increasing drug dosage or at least making more the existing drug dosages.
307 SKIN
CANCER AND ITS
Peter J. Fitzpatrick, Princess
Margaret
TREATMENT
BY RADIOTHERAPY
M.D.
Hospital,
University
of
Toronto,
Ontario
The purpose of this refresher course is to provide the basic and clinical information necessary for the successful treatment of skin cancer by radiotherapy. Carcinomas of the skin are the commonest of all cancers. They are disfiguring but rarely fatal and can be managed in a variety of ways. Al ternat ives include surgery, radiation therapy, chemosurgery, cryotherapy, electrodesiccation and chemotherapy. The selection of optimal treatment is best made by a multidisciplinary oncologic team with decisions based on the probability of cure, cosmesis, function and relative comfort, time and cost of treatment. Basal and squamous cell carcinomas, melanoma, keratoacanthoma, Bowen’s disease and pre-malignant lesions will be reviewed . Special attention will be given to turnout-s at particular sites such as the eyelid, ear, nose and lip. The clinical aspects, technical details of radiotherapy, reactions, complications and results of treatment based on over 15,000 patients followed for a minimum of 8 years will be presented. For basal and squamous cell carcinomas treated by radiotherapy, the control rate is 95% and the cosmetic and functional results usually excellent.