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Concurrent Chemoradiation
➤ Some chemotherapeutic agents when given concurrently with
radiation can potentiate the antitumor effects of radiation and
thereby act as "radiation sensitizers." This therapeutic advantage
may be at the cost of increased toxicity, and in some regimens
may require a reduction of the radiation dose. The principal aim of
chemotherapy given concurrently with radiation is to increase the
chance of local control of the tumor, and also with the intentions to
affect more rapid tumor cytoreduction (assuming that the systemic
therapy involved may be active in ATC) and, aspirationally, in parallel
to control systemic micrometastatic disease if present.
Chemotherapy
➤ Chemotherapy, for the purposes of these guidelines, denotes
cytotoxic agents that target basic cellular components and processes
that are commonly altered in cancers. Examples include agents
targeted toward cell division machinery (e.g., antimicrotubule
inhibitors, paclitaxel and docetaxel), DNA repair pathways (e.g.,
topoisomerase inhibitors and poly-ADP ribose polymerase inhibitors),
or DNA structure (e.g., platins).
Genomic Tumor Assessment
➤ Genomic tumor assessment denotes rigorous analysis of tumor DNA
for the purposes of defining altered genes of potential or actual
relevance to cancer growth and/or survival. Various platforms are
available for this assessment, each with their own strengths and
weakness as discussed in the Pathology section.
Genetically-informed Targeted Therapy
➤ "Targeted therapy" denotes systemic treatment intended to be
specifically directed toward an actually or presumed altered molecule
or pathway relevant to cancer growth or survival. In general, an agent
or agents are selected to target a specifically identified "driver"
mutation.
Bridging Therapy
➤ "Bridging therapy" is used to denote interim approaches to the
treatment of general applicability in ATC intended to contain disease
while information is being attained that may better inform subsequent
individualization of systemic therapy such as via targeted approaches.
