What Is Chemoradiotherapy and How Does It Work?

Chemoradiotherapy combines chemotherapy and radiation therapy to treat cancer. Chemotherapy uses drugs to destroy cancer cells, while radiation uses high-energy X-rays. This combination enhances radiation’s effects, making cancer cells more sensitive. It’s used for locally advanced cancers like gastrointestinal, gynecological, head and neck, and lung cancers. Chemoradiotherapy can be given sequentially or concurrently, with concurrent treatment offering a more condensed schedule but more side effects. It can also be used as adjuvant or neoadjuvant therapy, depending on the cancer’s stage and treatment plan.

How Does Chemoradiotherapy Work?

Chemoradiotherapy works by combining chemotherapy and radiation therapy to treat cancer. The chemotherapy drugs act as sensitizing agents, making the cancer cells more vulnerable to the effects of radiation. This combination allows for a stronger attack on cancer cells, improving the effectiveness of radiation treatment. Chemotherapy targets cancer cells throughout the body, while radiation therapy focuses on localized tumors. This approach is particularly useful for treating cancers that are confined to a specific area and helps increase the chances of destroying the tumor.

source: www.promedskin.com 

Comparison with other treatment modalities

Chemoradiotherapy differs from other treatment modalities in that it combines chemotherapy and radiation therapy, which targets cancer both locally and systemically. Unlike surgery, which physically removes tumors, chemoradiotherapy works by enhancing the sensitivity of cancer cells to radiation. It also differs from chemotherapy alone, as radiation adds a localized treatment approach that can improve outcomes. Compared to radiation therapy alone, CRT can be more effective but may lead to more side effects due to the combination of treatments. It is often used for specific cancer types and stages, offering a targeted yet comprehensive treatment option.

Benefits of Chemoradiotherapy

Chemoradiotherapy offers several benefits, including enhanced tumor sensitivity to radiation, leading to more effective cancer cell destruction. It can shrink tumors before surgery, making them easier to remove, or be used as an adjuvant treatment to eliminate remaining cancer cells after surgery. This combined approach is particularly effective for cancers in areas where surgery is difficult or not an option. Additionally, CRT can improve survival rates, especially for certain cancers like head and neck, lung, and gynecological cancers. It may also provide better local control of the disease compared to using either chemotherapy or radiation alone.

What Is Success Rate for Chemoradiation?

The success rate of chemoradiation depends on factors such as the type and stage of cancer, the patient’s overall health, and how well the cancer responds to treatment. For localized cancers, chemoradiation can be very effective, with high success rates, particularly in cancers like head and neck, lung, and cervical cancers. However, success rates vary widely, and it is important to consult with a medical professional to understand the expected outcomes based on individual circumstances.

A study by Law et al., published in 2003 in Annals of Oncology, identified improved survival in esophageal cancer patients with the introduction of chemoradiation. The study analyzed 639 patients from 1990-2000, comparing two periods: period I (1990-1995) and period II (1995-2000), when chemoradiation was introduced. Hospital mortality after resection decreased from 7.8% to 1.2%. Median survival improved from 15.8 months in period I to 25.6 months in period II. Chemoradiation enabled better patient selection and increased R0 resections, leading to better outcomes, even in nonsurgical patients, where survival rose from 3 to 5.8 months.

Who Is a Good Candidate for Chemoradiotherapy?

A good candidate for CRT is typically a patient with localized cancer, such as stage I or II disease, where the cancer has not spread extensively. It is often used for cancers that can be treated with radiation, like those in the chest, head, neck, or gynecological areas. Patients with stage IV cancers may also benefit from CRT, especially in combination with other treatments like immune checkpoint inhibitors pr target therapy. However, those with multiple tumors or advanced cancer spread may not be ideal candidates. The decision depends on individual factors like overall health and cancer type.

When Chemoradiotheray Is Used?

Chemoradiotherapy is used for treating locally advanced cancers, where the cancer has not spread extensively, such as gastrointestinal, gynecological, head and neck, lung cancers, and certain sarcomas and brain cancers. It is often employed when radiation therapy alone is insufficient, and chemotherapy is used to sensitize tumors to radiation. It may be administered sequentially or concurrently, depending on the cancer type and patient needs. Chemoradiotherapy can also be used as an adjuvant or neoadjuvant treatment to shrink tumors before surgery or eliminate remaining cancer cells after surgery.

A study by R. Glynne-Jones, J. Dunst, and D. Sebag-Montefiore, published in 2006 in Annals of Oncology, reviewed capecitabine-based chemoradiation for preoperative treatment of locally advanced rectal cancer (LARC). Phase I/II studies showed that capecitabine (825 mg/m² twice daily) is effective and well-tolerated with preoperative radiotherapy, with similar tolerability to intermittent regimens. It is associated with a low rate of grade 3/4 adverse events and simplifies chemoradiation. Combining capecitabine with agents like oxaliplatin and irinotecan could enhance efficacy. The study supports replacing infusional 5-FU with oral capecitabine for LARC treatment.

What Are the Side Effects of Chemoradiotherapy?

After chemoradiotherapy, the patient enters a period of recovery and monitoring. The immediate effects of the treatment may continue to be felt, but the body begins to heal over time. One of the first things that happens is the management of side effects, which may still be present. Patients may continue to experience fatigue, nausea, or other symptoms related to chemotherapy and radiation therapy. Depending on the location of the cancer, some long-term effects may also become apparent, such as changes in organ function or ongoing tissue damage.

In the weeks following treatment, regular follow-up visits with the medical team are essential. These visits typically include physical exams, imaging tests, and blood tests to monitor for any recurrence of cancer, evaluate the healing process, and manage ongoing side effects. Doctors assess the success of the treatment by looking for signs that the tumor has shrunk or been eradicated, and whether there is any evidence of new cancer development.

Who is Radiation Oncologist, and what to know about your doctor: Article by OncoDaily

How Much Does Chemoradiotherapy Cost?

The cost of chemoradiotherapy can vary significantly based on several factors, including the type of cancer, the treatment plan, location, and healthcare provider. On average, the cost can range from a few thousand to tens of thousands of dollars. This includes the costs of chemotherapy drugs, radiation therapy sessions, diagnostic tests, medical consultations, hospital stays, and follow-up care. Insurance coverage can help reduce out-of-pocket expenses, but the exact cost to the patient will depend on their specific insurance plan, deductible, and co-pays. It’s important to discuss treatment costs with the healthcare provider and insurance company beforehand to better understand the financial implications.

Recovery of the Body After Chemoradiotherapy

Recovery after chemoradiotherapy varies from person to person, depending on factors such as overall health, cancer type, and treatment specifics. It involves healing from the combined effects of chemotherapy and radiation therapy, which can take time and require ongoing support.

Recovery After Chemoradiotherapy

Chemoradiotherapy is an intensive treatment approach, and recovery can vary widely among patients depending on their overall health, cancer type, and the specific treatments they received. The recovery process involves the body healing from the side effects of both chemotherapy and radiation therapy.

Initial Recovery Phase

In the first few weeks following chemoradiotherapy, patients may experience fatigue, which is one of the most common side effects. The body requires time to recover from the strain of the treatments. Fatigue often improves gradually, but some patients may continue to feel tired for a few months. Managing fatigue may involve rest, proper nutrition, and pacing daily activities.

Bone Marrow Recovery

Chemoradiotherapy can affect the bone marrow, which is responsible for producing blood cells. This may lead to a drop in white blood cells, red blood cells, and platelets, putting patients at risk of infection, anemia, and bleeding. The recovery of bone marrow function is a gradual process, and patients may need regular blood tests to monitor their blood counts. The healthcare team may also manage these effects with medications or blood transfusions if necessary.

Skin and Tissue Healing

Radiation therapy can cause skin irritation or damage to the area being treated, leading to redness, dryness, or peeling. This usually heals over time, but the skin may remain more sensitive for some months or even longer. Similarly, radiation may cause changes in internal tissues, which may take time to recover, especially in areas like the lungs, esophagus, or gastrointestinal system. Patients may experience swallowing difficulties, pain, or digestive issues during this period.

Long-Term Recovery

Over the long term, the recovery process may continue as the body works to repair any lasting damage. Some patients may experience permanent changes in the treated area, such as fibrosis, which involves the thickening or scarring of tissue. For example, if the treatment was for head and neck cancers, some patients might face difficulty with speech or swallowing due to scar tissue development. Long-term recovery may also involve addressing mental health challenges, as many patients experience emotional distress or anxiety following treatment.

What Research is Being Done on Chemoradiotherapy?

A phase 3 trial by Leong et al. (2024) in NEJM compared preoperative chemoradiotherapy plus perioperative chemotherapy to perioperative chemotherapy alone in resectable adenocarcinoma of the stomach or gastroesophageal junction. Among 574 patients, pathological complete response was higher in the chemoradiotherapy group (17% vs. 8%). However, at a median follow-up of 67 months, overall survival (46 vs. 49 months; HR 1.05) and progression-free survival (31 vs. 32 months) showed no significant difference between groups. Treatment-related toxic effects were similar in both groups.

A phase 3 trial by Cheng et al. (2024) found that durvalumab significantly improved survival compared to placebo in patients with stage I–III disease. Among 264 patients receiving durvalumab and 266 receiving placebo, median overall survival was 55.9 vs. 33.4 months (HR 0.73; P=0.01), and median progression-free survival was 16.6 vs. 9.2 months (HR 0.76; P=0.02). Grade 3–4 adverse events occurred in 24.4% (durvalumab) vs. 24.2% (placebo), with treatment discontinuation in 16.4% vs. 10.6%. Pneumonitis (grade 3–4) was observed in 3.1% vs. 2.6%.

How Can Patients Support Their Health During Chemradiotherapy?

During chemoradiotherapy, patients can support their health by maintaining a balanced diet, staying hydrated, and managing side effects. Proper nutrition helps keep the body strong and supports the immune system. Regular, gentle exercise may help reduce fatigue and improve overall well-being. It’s also essential to follow the healthcare provider’s advice regarding medications, rest, and physical activity. Patients should also monitor and manage side effects like nausea, fatigue, or skin irritation with the guidance of their healthcare team. Regular follow-ups are important for adjusting treatment plans and addressing any concerns.

Written by Aren Karapetyan, MD