Adjuvant therapy is treatment administered after surgical resection to remove residual tumor cells from the body and reduce the risk of tumor recurrence after surgery.
Adjuvant therapy mainly includes adjuvant radiotherapy and adjuvant chemotherapy.
Specific treatment options can be divided into sequential therapy, combined radiotherapy, and adjuvant radiotherapy alone.
1. Sequential therapy
Patients who need adjuvant radiotherapy are usually treated in a sequential fashion (also called sequential radiotherapy), i.e., chemotherapy followed by radiation followed by chemotherapy (e.g., “sandwich therapy”: 2 weeks of chemotherapy + radiation + 2 weeks of chemotherapy).
Why do we need this type of treatment? This is because there is a limit to how much the body can tolerate, and it is more demanding to have chemotherapy and radiation at the same time. Sequential radiotherapy can balance the pros and cons between antitumor efficacy and adverse effects.
However, in patients who are “not cut clean” (tumor remains at the cut edge), adjuvant chemotherapy and radiotherapy need to be given simultaneously, i.e., combined radiotherapy and chemotherapy.
During sequential radiotherapy, you will need to have regular reviews of your chest CT, blood work, and liver and kidney function to evaluate adverse effects. You can also watch for signs of discomfort and talk to your doctor about them, rather than stopping treatment without permission.
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2. Combined radiotherapy
Combined radiotherapy, also called synchronized radiotherapy, is chemotherapy given at the same time as radiotherapy, usually weekly or every 3 weeks.
Synchronous radiotherapy is not just an overlay of radiotherapy and chemotherapy, but combines the benefits of both treatments to make “1+1 better than 2.
We know that chemotherapy is a systemic treatment that is administered by infusion or orally, allowing chemotherapy drugs to enter the body in a “war of all people” to destroy cancer cells. The first thing you need to do is to take a look at the results of the study.
Some chemotherapy drugs can act as “radiation sensitizers,” that is, they can enhance the killing effect of radiation therapy on tumors and attack enemy positions where there are “air defenses” (insensitive to radiation therapy) to supplement the “air force” strike. The air force” strikes. This is a very good example of the synergistic effect of simultaneous radiotherapy.
Synchronous radiotherapy for esophageal cancer is commonly used with platinum in combination with fluorouracil and purple shirt in combination with platinum. Your doctor will choose the chemotherapy regimen that is best for you based on your disease.
However, simultaneous radiotherapy increases the risk of adverse effects, such as radiation esophagitis and hematologic toxicity. A multidisciplinary esophageal cancer team will develop the best treatment plan for you.
There are a number of test results that need to be completed before synchronous radiotherapy: upper gastrointestinal tract imaging, chest and abdominal CT, and neck ultrasound or CT. Your doctor will also evaluate your heart and lung function and nutritional status, among other things.
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3. Adjuvant radiotherapy alone
Postoperative adjuvant radiotherapy has the potential to control local residual cancer, lymph nodes outside the surgically resected area, or distant micrometastases, thereby improving long-term survival.
However, several randomized controlled studies abroad, comparing the surgery alone group with the surgery combined with radiotherapy group, found that postoperative radiotherapy was associated with only a reduction in local recurrence in the irradiated area and did not increase survival. Thus, there is little evidence to support that radical resection should be followed by adjuvant radiotherapy alone.
If you have had chemotherapy in the past and are estimated to be physically unable to tolerate chemotherapy, adjuvant radiotherapy alone may be indicated. A course of treatment with adjuvant radiotherapy often takes 5 to 6 weeks.
Co-written by: Dr. Rong Yu Dr. Jing You, Peking University Cancer Hospital