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4.3 Radio immunotherapy (RIT) 79

4.2.4 Clinical examinations
Norton et al. compared the use of chemotherapy and chemotherapy associated with
trastuzumab as a treatment for her2-positive breast cancer patients. By examining
the serum of patients before and after treatment, they observed that before treatment,
all patients had the same mean anti-HER2 IgG levels; but after treatment, the mean
levels of antibodies in the group receiving chemotherapy with trastuzumab has been
significantly higher. Whereas in the group that has just been chemotherapy, there has
been no change in the level of antibodies [24].
In the other clinical research Chari et al. have evaluated safety and tolerability
of daratumumab in combination with pomalidomide/dexamethasone (pom-dex) in
patients with multiple myeloma. They have found that compared to other therapies,
as with the use of pom-dex alone and without combining whit daratumumab, there
is no significant increase in the rate of infection, despite the high rate of neutropenia
seen. They also found that the use of daratumumab together with pom-dex induces
rapid, perdurable and definite response in patients who received this treatment [25].

4.3 Radio immunotherapy (RIT)
4.3.1 Radiotherapy
Radiotherapy is one of the major therapies for cancer treatment. Radiation therapy
or oncology radiation is the use of ionized rays (these rays are ionized by passage of
matter and produce positive and negative ions in the material) as an agent for treat-
ing cancer and controlling or killing malignant cells. Radiotherapy can treat some
of cancers that limited to part of the body. It can also be treated as part of the treat-
ment and prevent tumor recurrence after surgery by removing malignant tumors,
for example, prostate carcinomas, cervix carcinomas, lung carcinomas (nonsmall
cell) and lymphomas (Hodgkin’s and low grade non-Hodgkin’s) are considered to
be cancers that can be treated with radiotherapy alone. And breast carcinomas, rectal
and anal carcinomas, advanced lymphomas and CNS tumors are among the many
cancers that are curable with radiotherapy in combination with other treatment such
as surgery, chemotherapy, hormone therapy, and immune therapy. The mechanism
of radiotherapy as a treatment for cancer is to damage the DNA of tumor cells. The
damage can directly or indirectly affect the DNA chain; more clearly, radiation can
directly affect DNA inside the cell and cause it to degrade or that radiation can cause
ionization of intracellular components and cause free radicals and thus indirectly
damages DNA (Fig. 4.4). On the other hand, this damage can be entered into a DNA
strand or entered into two strands of DNA. And since the cells have a mechanism
for repairing single strand DNA breaks (SSDB), it has been seen that double strand
DNA breaks (DSDB) is the most important technique that results in cell death [26].
Radiotherapy as a treatment for cancer induces different types of cell death.
Apoptosis and mitotic cell death or mitotic catastrophe are the major cell deaths
which happens after radiotherapy. In addition, radiation may cause other types of