Chemotherapy palliative

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. 

Chemotherapy may be given to cure cancers that are curable, or it may be given to help control the symptoms of an incurable cancer, which is referred to as palliative therapy. 

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

Currently, most MCRCs are incurable. Initial chemotherapy (Table 62-2) is administered with palliative intent to reduce symptoms, improve quality-of-life, and extend survival. In general, treatment options are similar for metastatic cancer of the colon and rectum. 

Palliative radiation therapy with chemotherapy may help control local and systemic disease and reduce disease-related symptoms. The optimal delivery method, schedule and radiation therapy dosages when used with chemotherapy are yet to be determined. 

Obviously, this broad range of tumor extent requires an equally broad array of treatment approaches, ranging from surgery, with or without adjuvant radiation therapy (RT) or chemotherapy (ChT), to definitive chemoradiation combinations, to palliative... 

IIIB Palliative chemotherapy, radiotherapy +/- surgery, neoadjuvant chemoradiation... 

Chemotherapy as a single modality still has a role as palliative treatment in recurrent or metastatic disease. However, the median survival for patients with... 

In metastatic or loco-regional recurrent disease palliative chemotherapy can be effective but usually for relatively short periods. Occasionally prolonged remissions are seen in patients with limited extent distant metastatic disease. The most effective combinations are cisplatin-based regimens... 

Metastatic osteosarcoma has a poor prognosis unless the disease is confined to the lungs and is resectable. Palliative chemotherapy can be employed with a number of drugs including doxorubicin, cisplatin, carboplatin, methotrexate, ifosfamide and etoposide. 

The nodular follicular lymphomas are low-grade, indolent tumors that tend to present in an advanced stage and are usually confined to lymph nodes, bone marrow, and spleen. This form of non-Hodgkin s lymphomas, when presenting at an advanced stage, is considered incurable, and treatment is generally palliative. To date, there is no evidence that immediate treatment with combination chemotherapy offers clinical benefit over close observation and "watchful waiting" with initiation of chemotherapy at the time of disease symptoms. 

Surgery can cure lung cancer, but only one in five patients are suitable for this treatment. If the tumor has not spread outside the chest and does not involve vital structures such as the liver, then surgical removal may be possible, but only if the patient does not also have severe bronchitis, heart disease, or other illnesses. Small cell lung cancer is treated with chemotherapy. Non-small cell cancer may be treated with radiotherapy and chemotherapy (as part of a research trial) or with supportive care. Radiotherapy is either radical or palliative. ... 

Where expectation is confined to palliation in terms of modest life prolongation of less certain quality, then the benefits and costs of treatment must be considered carefully. Preferably, palliative treatments should involve low risk of serious side effects, e.g. 5-fluorouracil-based chemotherapy for advanced colorectal cancer is well tolerated by most patients while improving survival by around 6-9 months. 

Systemic chemotherapy is usually not indicated in non-colorectal liver metastases due to lack of response. The systemic administration of cytostatics (also in combination) possesses the status of palliative therapy. However, in metastatic neuroendocrine tumours, a combination of octreotide -i- IFN had a positive effect on the survival time. Systemic chemotherapy produced remission rates of up to 60%. (320) In metastatic breast cancer, systemic chemotherapy is indicated, usually in combination with hormonal and immune therapy. (316, 342) In metastatic gastric carcinoma, palliative chemotherapy can achieve a remission rate of up to 40%, with a slight extension of survival time. 

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