What is the difference between Adjuvant and Neoadjuvant?

Every case of a person seeking a consultation at a radiotherapy centre is somewhat unique, and as a result, the treatment pathway will often be designed and tweaked based on their individual needs and the complexities of each treatment.

However, whilst there are hundreds of different types of cancer, each of which can progress in different ways and at varying speeds, there are typically four particular scenarios where radiotherapy is used.

The first and most directly effective treatment is radiosurgery, where radiation is carefully targeted to destroy lesions and tumours. This was initially primarily used for brain tumours but can be used for tumours in any part of the body if the treatment is suitable.

The final type of treatment is palliative radiotherapy, used for the opposite purpose of radiosurgery.

In cases where a tumour cannot be safely operated on or where treatment would be ineffective, radiotherapy can help to reduce the size of tumours and as a result, also reduce pain and other symptoms.

However, there are two other types of treatment that are both in the middle of this treatment pathway, known as adjuvant and neoadjuvant.

Both are used alongside conventional surgery to cut tumours away from the body, but both are used at different times and for very different purposes.

Adjuvant Radiotherapy

An adjuvant treatment is a type of care used to enhance the effect of a surgery or other primary care pathway.

In the case of adjuvant radiotherapy, it is used after a surgical treatment has cut out a cancer to destroy any remaining cancer cells to stop the cancer from growing back from just a few cells.

It is not always used, and if it is a recommended treatment, it will typically be carefully considered by an oncologist before it is recommended.

Neoadjuvant Radiotherapy

A neoadjuvant treatment also works to enhance the effect of an existing primary therapy, but instead of taking place after this main treatment, it is undertaken before the main intervention.

Because of this, the motivation behind neoadjuvant treatments is to make the surgery or other primary care easier to execute, more likely to be completed successfully and with fewer side effects.

In neoadjuvant radiotherapy, this is used to shrink the tumour down in size, making it far easier to excise in surgery and often shortening the procedure’s length.

In some cases, neoadjuvant radiotherapy can turn an inoperable tumour into one that can be treated without significant harm to surrounding organs, tissue or structures.

Much like adjuvant radiotherapy, it is not always an option and would be discussed carefully by an oncologist and specialist radiotherapist, detailing the clear details of the treatment before progressing further.

Can You Have Both?

In some cases, a patient may have both neoadjuvant and adjuvant radiotherapy during the same course of treatment.

Often, this is done based on the response to the neoadjuvant therapy, tailored based on the response of the cancer to ensure that the overall treatment is as effective as possible and this effectiveness outweighs the effects of the triple treatment.