Which Treatment For Which Patient?

In cancer, classic treatments are chemotherapy, radiotherapy and surgery. In some types of cancer, only one of these treatments may be sufficient, but in others, it may be necessary to use various combinations of these treatments concomitantly or one after another.

Interventional radiologic treatments have had an ever increasing role in cancer management in the last decade. These treatments can be divided into two main groups: ablation (destroying a tumor via needles inserted from the skin) and transarterial treatments (killing a tumor via a catheter placed into the feeding vessels). These treatments have a local or regional effect on tumors, like radiotherapy and surgery, and thus, they may provide an alternative to these therapies. However, in a chronic disease like cancer, it may be frequently necessary to use interventional treatments in combination with radiotherapy or surgery concomitantly or at different times.

Recently, it has been shown that cancer is a very heterogenous disease with many subgroups that respond to different therapies. These subgroups may be identified with pathologic, genetic and receptor analysis of the biopsy specimen. This may allow doctors to predict which treatment will be most beneficial for which patient. Besides, other factors spesific to the patient, such as age, sex, heart and lung problems may also dictate doctors to change the treatment of the patient. Therefore, the old concept “one drug fits all” has today completely changed to the “patient-specific treatment” concept in cancer management.

In conclusion, today, the cancer management is much more different and complicated than it was in the past. The rapid development of new diagnostic and therapeutic methods, increasing identification of disease subgroups, longer lifespan of cancer patients and occurrence of previously unknown problems during this increased lifespan make it impossible for the cancer disease to be managed by only one doctor. Today, modern cancer centers have a team of doctors including surgeons, medical oncologists, radiation oncologists, radiologists, nuclear medicine specialists and interventional radiologists, and the decision to use which treatment for which patient is made by this group of doctors in cancer patients.