Chemotherapy curative

In the veterinary as in the human patient, neoplasms are often metastatic and widely disseminated throughout the body. Surgery and irradiation are limited in use to weU-defined neoplastic areas and, therefore, chemotherapy is becoming more prevalent in the management of the veterinary cancer victim (see Chemotherapeutics, anticancer). Because of the expense and time involved, such management must be restricted to individual animals for which a favorable risk—benefit evaluation can be made and treatment seems appropriate to the practitioner and the owner. In general, treatment must be viewed not as curative, but as palliative. 

Cancer or neoplastic disease is a genomic disorder of the body s own cells which start to proliferate and metastasize in an uncontrolled fashion that is ultimately detrimental to the individual. Antineoplastic agents are used in conjunction with surgery and radiotherapy to restrain that growth with curative or palliative intention. The domain of antineoplastic chemotherapy is cancer that is disseminated and therefore not amenable to local treatment modalities such as surgery and radiotherapy. 

The goal of adjuvant chemotherapy is curative, whereas the goal of chemotherapy in the metastatic setting is palliative. 

Early breast cancer is resected completely with curative intent, and adjuvant chemotherapy and hormonal therapy are initiated to prevent recurrence. During adjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy. After completion of adjuvant therapy, patients are monitored every 3 months for the first few years after diagnosis, with intervals between exams extended as time from diagnosis lengthens. 

The treatment aim for patients with aggressive histologies is cure of the malignancy. There are some histologic subtypes that exhibit an aggressive clinical course that are not considered to be curable. These patients are still treated with curative-intent chemotherapy or may be considered for a clinical trial. 

Health care providers use a multimodality approach including surgery and chemotherapy in the initial treatment of ovarian cancer with a curative intent. Although most patients will achieve a complete response initially, more than 50% of cancers will recur within the first 2 years,2,35 Complete response to treatment is defined as no evidence of disease can be detected by physical examination or diagnostic tests, and patient has a normalized CA-125 value. 

Radiation therapy is the standard treatment and is usually curative. Chemotherapy is not recommended, unless the patient has high-risk, stage II disease. 

Porschen, R. et al., Fluorouracil plus leucovorin as effective adjuvant chemotherapy in curatively resected stage III colon cancer Results of the trial adjCCA- 01, J Clin. Oncol., 19, 1787, 2001. 

Kaiser MH, Ellenberg S S. Pancreatic cancer adj uvant combined radiation and chemotherapy following curative resection. Arch Surg 1985 120 899-903. 

Earle CC, Maroun A. Adjuvant chemotherapy after curative resection for gastric cancer Revisiting a meta-analysis of randomized trials (abstract). Proc Am Soc Clin Oncol 1998. 

GITSG, Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumor Study Group. Cancer 1987 59(12) 2006-2010. 

Farah R, Chodak GW, Vogelzang NJ, et al. Curative radiotherapy following chemotherapy for invasive bladder carcinoma (a preliminary report). Int J Rad Oncol Biol Phys 1991 20 413 117. 

Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA 2007 297 267-77. 

Methotrexate is part of curative combination chemotherapy for acute lymphoblastic leukemias, Burkitt s lymphoma, and trophoblastic choriocarcinoma. It is also useful in adjuvant therapy of breast carcinoma in the palliation of metastatic breast, head, neck, cervical, and lung carcinomas and in mycosis fungoides. 

Bleomycin, in combination with cisplatin or etopo-side, is important as part of the potentially curative combination chemotherapy of advanced testicular carcinomas. Bleomycin is used in some standard regimens for the treatment of Hodgkin s and non-Hodgkin s lymphomas, and it is useful against squamous cell carcinomas of the head and neck, cervix, and skin. 

The first demonstration of the curative potential of chemotherapy in human cancer was the use of which agent in trophoblastic choriocarcinoma in women ... 

---