16 August 2022

Check Up #5 - What is the difference between adjuvant cancer treatments and neoadjuvant cancer treatments?

It's a matter of before or after.

Check Up #5 - What is the difference between adjuvant cancer treatments and neoadjuvant cancer treatments?

Adjuvant cancer treatments are the most conventional, most classic therapeutic approach to cancer. Here, the first step is usually surgery to remove the tumour, followed by chemotherapy, radiotherapy or other additional treatments to consolidate the surgery’s results.

Neoadjuvant cancer treatments emerged in contrast to adjuvant treatments. In neoadjuvant cancer therapy the treatment is initiated with chemotherapy or radiotherapy (or both), for instance, in order to reduce the tumour’s volume and its metastizing/spreading potential. Surgery comes afterwards. Sometimes, neoadjuvant treatments are necessary before and after surgery.

Adjuvant chemotherapy, radiotherapy or other treatments are often given following surgery for many types of cancer, including colon and rectal cancer, lung cancer, pancreatic cancer, breast cancer, prostate cancer, and some gynaecological cancers. There are some cancers, however, that do not benefit from adjuvant therapy, including renal cell carcinoma, and certain forms of brain cancer.

At the CCC, the Radiotherapy Department has been implementing a new, non-invasive approach to treating patients with rectal cancer, called Watch & Wait (W&W), which involves initiating treatment with radiochemotherapy (i.e. neoadjuvant radiochemotherapy). In some cases, when the patients show no clinical signs of cancer after this treatment, it is possible to stringently watch them, and only resort to surgery in case of recurrence of their tumour. Radical surgery used to be the only approach to rectal cancer, but today, there is a growing mass of evidence suggesting that a large portion of patients eligible for W&W could thus avoid surgery altogether.

The Radiotherapy Department is also applying new radiotherapy techniques to optimize the dose of neoadjuvant radiation delivered to rectal cancer patients – including upping the dose of radiation for maximum effect and delivering the radiation only where it is needed, thus leaving adjacent tissues and organs untouched.   

By Ana Gerschenfeld, Health & Science Writer of the Champalimaud Foundation.
Reviewed by: Professor António Parreira, Clinical Director of the Champalimaud Clinical Center.
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