What are the treatment options for cancer in clinical oncology?

Treatment Options for Cancer in Clinical Oncology

The optimal treatment approach for cancer in clinical oncology includes surgery, radiation therapy, systemic therapy (chemotherapy, immunotherapy, targeted therapy), or combinations of these modalities, with treatment selection based on cancer type, stage, molecular characteristics, and patient factors. 1

Multidisciplinary Treatment Approach

• Cancer care requires a multidisciplinary team approach involving surgical oncologists, radiation oncologists, and medical oncologists to determine the best treatment strategy 1, 2
• Treatment decisions should be made through multidisciplinary tumor board consultations, especially for complex cases such as locally advanced or metastatic disease 1, 3
• The goal of cancer treatment is to improve morbidity, mortality, and quality of life through disease control or cure 4, 1

Surgery

• Surgical resection is often the primary treatment for early-stage solid tumors and remains a cornerstone of curative treatment 1
• For resectable tumors, complete surgical excision with appropriate margins is the standard approach 1
• In some cases, neoadjuvant therapy (chemotherapy, radiation) may be given before surgery to downstage tumors and improve resectability 1
• Surgical approaches may include:
  • Wide local excision for small, accessible tumors 1
  • Organ-preserving surgery when possible 1
  • Radical resection for more advanced disease 1
  • Lymph node dissection for staging and local control 1

Radiation Therapy

• Approximately 50% of all cancer patients receive radiation therapy during their course of illness, contributing to about 40% of curative cancer treatments 5

• Radiation therapy can be delivered as:

  • Definitive treatment (primary therapy) 1
  • Adjuvant therapy (after surgery) 1
  • Neoadjuvant therapy (before surgery) 1
  • Palliative treatment for symptom control 1

• Common radiation techniques include:

  • External beam radiation therapy (EBRT) using photons or electrons 6
  • Three-dimensional conformal radiation therapy (3D-CRT) 1, 6
  • Intensity-modulated radiation therapy (IMRT) 1, 6
  • Volumetric modulated arc therapy (VMAT) 1, 6
  • Particle therapy (protons, carbon ions) for selected cases 6
  • Brachytherapy (internal radiation) 6

• Radiation dosing depends on:

  • Intent of treatment (curative vs. palliative) 1
  • Tumor type and location 1
  • Presence of gross disease vs. microscopic disease 1
  • Proximity to critical organs at risk 1, 6

Systemic Therapy

Chemotherapy

• Used in various settings:

  • Adjuvant therapy to eliminate micrometastatic disease after surgery 1
  • Neoadjuvant therapy to downstage tumors before local treatment 1
  • Definitive therapy for certain cancer types 1
  • Palliative therapy for metastatic disease 1

• Common chemotherapy regimens include:

  • Platinum-based combinations (cisplatin, carboplatin) 1
  • Anthracycline-based regimens (doxorubicin, epirubicin) 1
  • Taxanes (paclitaxel, docetaxel) 1
  • Alkylating agents (cyclophosphamide, ifosfamide) 1

Immunotherapy

• Checkpoint inhibitors have revolutionized treatment for many cancer types 1, 3
• Key immunotherapy agents include:
  • PD-1/PD-L1 inhibitors (pembrolizumab, nivolumab, avelumab) 1, 3
  • CTLA-4 inhibitors (ipilimumab) 3
  • Can be used as monotherapy or in combination with other treatments 1, 3

Targeted Therapy

• Directed at specific molecular alterations in cancer cells 1, 4
• Examples include:
  • HER2-targeted therapies (trastuzumab) for HER2-positive breast cancer 1
  • Tyrosine kinase inhibitors for various molecular targets 1, 4
  • Hormone therapy for hormone-responsive cancers 1

Treatment Strategies by Disease Stage

Early-Stage Disease

• Often treated with surgery alone or surgery plus adjuvant therapy 1
• Adjuvant radiation may be indicated based on risk factors 1
• Adjuvant systemic therapy decisions based on pathologic features and molecular characteristics 1

Locally Advanced Disease

• Typically requires multimodality treatment 1, 3
• May include:
  • Neoadjuvant therapy followed by surgery 1, 3
  • Definitive chemoradiation 1, 3
  • Surgery followed by adjuvant therapy 1, 3

Metastatic Disease

• Primary goals are prolonging survival and maintaining quality of life 1, 4
• Treatment options include:
  • Systemic therapy (chemotherapy, immunotherapy, targeted therapy) 1
  • Palliative radiation for symptomatic lesions 1
  • Surgery for oligometastatic disease in selected cases 1
  • Best supportive care when appropriate 1

Special Considerations

• Clinical trials should be considered at all stages of disease 1
• Treatment decisions should balance efficacy against toxicity 1, 4
• Early integration of palliative care improves outcomes in advanced disease 1
• Genetic and molecular testing increasingly guides personalized treatment selection 1, 4
• Regular assessment of response to therapy and adjustment of treatment plans as needed 1, 3