Radiotherapy for cancer: the treatment of tumors, reconstruction after
Radiation therapy occupies one of the main places in the treatment of malignant tumors of different organs and tissues. This method allows to significantly improve patient survival as well as relieve their condition in the case of far advanced stage of the disease.
The discovery of x-rays was a breakthrough in medical science, because the ability to «see» the body from the inside, to learn how to «look» already known diseases of different organs and systems. Inspired by the possibilities of application of x-ray radiation and having experienced the feeling, akin to euphoria, scientists began to use it not only for diagnosis but also for treatment. So become aware of the harmful impact of x-rays on tumors that decreased in size, and patients have felt a substantial relief.
However, the flip side of the coin were numerous complications and radiation reaction, inevitably pursuing irradiated patients. Information about negative influence of ionizing radiation on healthy tissue was accumulated, and the criticism to the method is growing. For some time the use of radiation therapy was significantly reduced, but the ability to deal with malignant tumors, the number of which every year increased, did not fully abandon the exposure. Fighting for the possibility of safe radiation therapy in Oncology, physicists, radiologists together with doctors to develop new devices and methods for irradiation, which would reduce radiation exposure, and, hence, the likelihood of side effects, making treatment both effective and safe.
Today, radiation therapy is considered to be one of the main methods of cancer treatment, and in some cases it allows you to refuse surgical intervention, leading to a complete cure. The number of side effects decreased significantly, thanks to the possibility of sighting of radiation effect on tumor tissue, as well as using x-rays, but also strictly aimed at the tumor beams of elementary particles. In most cases, such treatment was well tolerated, but some rules and peculiarities of lifestyle, and we will look at next.
Types of radiation therapy and their characteristics
Radiotherapy involves the influence of various types of ionizing radiation on tumor tissue. Because cancer cells divide very quickly, they are very sensitive to various physical influences. Radiation causes damage to the main unit cell DNA, resulting in not only it’s their loss, but and that is extremely important in the case of cancer, the violation of the fission process. The result of irradiation becomes reducing the size of the tumor due to the death (necrosis) of its constituent elements, as well as stop the growth of the neoplasia. Healthy cells suffer to a much lesser extent, but focusing strictly on the tumor helps to avoid unwanted effects. Together with chemotherapy and surgery radiotherapy contributes to the early improvement of patients, and in favorable cases complete removal of the tumor from the body.
Radiation for cancer is possible as independently, especially in the case of superficial tumours (skin, for example), or in combination with chemotherapy and surgery. Conducted before the surgical intervention, radiotherapy reduces tumor size, reduce the risk of separation and penetration of cancer cells into blood and lymphatic vessels, and, hence, the effectiveness of treatment in General will be much higher. In the case of advanced forms of cancer, in the presence of metastases the use of radiation energy makes possible not only the improvement of life of patients and reducing the severity of pain, but also prevents further separation of cancer cells throughout the body and the existing metastatic nodes are subjected to regression.
Often radiotherapy is performed after surgery, when there is the likelihood of leaving tumor cells in the site of cancer growth. This approach allows you to destroy all the cells and avoid relapse in the future.
The type and method of radiotherapy, in each case, the doctor chooses based on the characteristics of the tumor, its location, stage and General condition of the patient. Since the radiation can damage healthy tissue, the dose is determined individually, splitting into several sessions, in contrast to chemotherapy, which most commonly used standard treatment regimens.
Types of radiation therapy vary depending on radiation:
- the x-ray.
X-rays were used first, later, through the efforts of physicists were setting that allows you to generate a beam of elementary particles in special accelerators.
Methods of radiation therapy depend on the method of impact on tumor tissue:
Deserves special attention as a very promising and effective way of treating tumors with proton beams. Dispersed in special accelerators the protons reach their destination and give a maximum radiation in the last millimeters of its mileage. In other words, on the way to the tumor scatters only a small amount of radiation energy, and the tissue behind the tumor node, it does not apply at all. This feature allows you to minimize the damaging effects of radiation on healthy organs and tissues with high efficiency inside the tumors.
The ability to focus the proton beam strictly to tumor tissue and the low likelihood of side effects gives you a great advantage in the treatment of children with secondary tumors after conventional radiation can be a real problem. In addition, prior to the use of proton therapy, such as tumor melanoma of the retina inevitably ended with the removal of the entire eye, which significantly worsened the quality of life after surgery. With the advent of proton therapy, it became possible to treat the tumor while preserving the organ of vision, and the patient not experiencing the severe consequences of adaptation after surgical treatment.
For many years this technique was available only in specialized centers conducting research in the field of physics, but in recent years in North America and Europe there has been considerable progress in the use of this type of treatment, as evidenced by the operation of the proton therapy clinics. In Russia and other countries of the former Soviet Union, unfortunately, still such methods are of limited use, and the proton therapy centers under construction. This is due to the high cost of equipment, necessity of arrangement of structures, providing reliable radiation protection, where the thickness of the walls can reach 5 meters or more. Only 1% of patients in Russia have the opportunity to undergo such treatment, but the centers with appropriate equipment, encouraging the accessibility of proton therapy in the future for the majority of oncological patients.
Other modern and highly effective method of radiation therapy is the use of radiosurgery when the radiation beam is focused at a certain place, causing cell death and destruction of tumors. Radiosurgery has been successfully used for treating not only malignant but also benign brain tumors (meningioma, pituitary adenoma etc.), especially, are difficult for conventional surgery. Stereotactic radiosurgery (aka «gamma knife», «CyberKnife») allows you to remove the tumors without craniotomy and other surgical procedures, but its effect does not occur immediately, it takes several months or even a year, as in the case of benign tumors. The patient at this time under observation of specialists.
Stages of radiation therapy
Given the complexity of the techniques and equipment, as well as the possibility of radiation reactions and other complications, radiotherapy should be strictly shown to the patient and the scheme of its implementation accurate. The whole set of procedures consists of three stages:
- Of pre-treatment.
The patient’s behavior at each stage has its own characteristics, which may affect how effective the treatment will be, and the observance of simple rules will help to avoid unwanted side effects.
Pre-treatment period is perhaps the most important, because the correct planning procedures, calculation of dose and method of exposure on the tumor and determine the final result. It is important to take care of as healthy tissues that are somehow unable to experience the effects of radiation.
Radiotherapy planning is carried out simultaneously by multiple specialists, radiation therapist, oncologist, medical physicist, radiation monitor, which is necessary to calculate the required radiation dose, to choose the optimal way of introducing it into the tissue with brachytherapy (in this case the doctor connects brachytherapie), determine the maximum radial load and backup the ability of the surrounding tissues that may be exposed to radiation.
Planning in the pre-treatment period may require not only efforts of experts and a few days of their hard work. For the precise determination of all parameters of radiation therapy without additional research and the help of modern computer technology can not do, so as soon as the unit millimeter precision to calculate the entire path of the radioactive beam to tumor cells using a three-dimensional image of the affected organs or tissues obtained by the imager.
The important point is the marking on the body of the patient, which is carried out according to the results of CT, MRI, radiography. Doctor special marker marks on the body of the tumor and the irradiated area, and if necessary, go to another irradiating apparatus «ranging» is performed automatically according to the available marks. The patient must know that the mark to be kept until the end of the treatment, so it is best to avoid rinsing in the shower, and if that happens, then you need to inform the nurse or doctor who will fix the situation.
What are the main rules of conduct in the pre-treatment period? First, you need to try to keep the marking in place of radiation. Secondly, no need to sunbathe or use different creams, irritants, perfumes, iodine in the area of the intended exposure. Finally, if the skin there is damage, dermatitis, diaper rash, or a rash, you should inform the doctor who will help to get rid of existing problems. If necessary, the irradiation of the head, throat need to be concerned about the condition of the teeth, cure cavities and tidy mouth.
By following these simple recommendations, doctor’s appointments and positive Outlook on the result, treatment needs to go safely and efficiently.
Radiation period include the actual irradiation according to the scheme developed earlier. Radiation therapy usually lasts no more than 4-7 weeks, and for preoperative reduction of tumor size is enough for 2-3 weeks. Sessions are conducted daily, five days a week, with a break for two days to restore the skin and tissues involved in the radiation exposure. If the daily radiation dose is large, it can be divided into several sessions.
The treatment is carried out in specially equipped rooms that have protection from radiation, and the staff at the time of the procedure of its leaves, and the patient has a relationship with the doctor through a speaker. The patient is placed on a table or chair, set the source radiation to the desired area and surrounding tissue impose protective blocks. At the time of the procedure, the table or the emitter can travel through space or to create a noise that should not scare you, what will usually warn the nurse.
The procedure is painless, lasts 5-10 minutes, during which time the patient should keep the adopted body position, not moving, quiet and smooth breathing.
Throughout the course of treatment must adhere to the following rules:
Irradiation with different forms of cancer has its own characteristics, which usually warn patients in advance. In breast cancer, often resorting to remote postoperative radiotherapy designed to destroy cancer cells that may remain after removal of neoplasia. In the presence of metastases the aim of reducing their size and reducing the severity of pain. During treatment may develop fatigue and tiredness, which should disappear after the course of irradiation.
In the case of colorectal cancer the most effective is radiation therapy before surgery, and in some cases is enough for the healing chemoradiotherapy even without surgical removal of the tumor. In addition to distance effects, there are methods with the introduction of the radiation source directly into the rectum. For the overlying divisions of the colon radiation therapy is not performed.
Of prostate tumors are successfully treated by brachytherapy, when containing radioactive isotope capsules or needles are injected directly into the tumor tissue. This approach allows you to avoid unwanted reactions on the part of adjacent organs (diarrhea, urination disorder, etc.).
Neoplasms of female genital organs involve external beam radiation of pelvic, and cervical cancer radiation therapy is often of paramount importance. So, if in the case of microinvasive cancer radiation therapy in the postoperative period, at II-III stages of the disease it is the primary and often only method of treatment. In the fourth stage of cervical cancer radiotherapy is palliative, helping only to ease the condition of patients.
Postradiation period starts after the end of treatment. As a rule, most patients feel well and side effects are either completely absent or expressed only slightly. However, some effects are still there and they need to know so you don’t lose and time to seek the necessary help.
Recovery after radiation therapy begins immediately after the radiation sessions and is in compliance with gentle treatment, ensuring adequate sleep, rest during the day. Equally important is diet, and emotional state of the patient. At the stage of rehabilitation may need not only medical help, but also relatives and friends whose participation and support is very important during this period.
Because of the presence of a tumor and have to undergo all kinds of studies and treatments are not always pleasant for the patient, you may experience disorders of the emotional sphere. It may be apathy, feelings of sadness or anxiety, and sometimes depression. It is very important not to withdraw into themselves, try to communicate more with friends and family, to keep the rhythm of life, but reducing the overall activity to such an extent to avoid feeling tired. Do not abandon household chores, Hobbies, hobby, and if you have any desire to go to rest, then plans can be postponed for some time. Walk and chat help many patients to return to the old way of life and improve mood.
Fatigue is often accompanied by radiation therapy, as the body burden associated with the procedures, as well as the destruction of tumors require large inputs of energy and may be accompanied by metabolic changes. It is recommended more rest, have a short NAP, but if the patient continues to work, it makes sense to talk to the leadership about the possibility of switching to an easier labor. Many patients do prefer at the time of treatment to go on vacation.
After treatment you need to see your doctor regularly to monitor the status and results of treatment. Supervision is usually exercised by the Oncology clinic or cancer centre, which determines the frequency of inspections. In case of sudden deterioration, development of pain syndrome, disorders of the gastrointestinal tract, fever and other symptoms should consult the doctor without waiting for the next scheduled visit.
An important place in rehabilitation after radiotherapy is skin care, which in most cases turns out to be involved in the irradiation with external beam radiotherapy suffer almost always. At least a year after completing the course of irradiation it is necessary to protect the skin from the sun and various injuries. Skin areas that were in the area of radiation, you need to lubricate a nourishing cream, even if signs of inflammation or burn anymore. The lovers of baths or baths is better to refuse these procedures, replacing them with a shower, annoying the skin and harsh scourers should be put away.
Sometimes patients may experience communication difficulties related to a lack of awareness of others about the cancer and its treatment. So, some believe that persons subjected to radiation therapy, are able to emit radiation, therefore it is better to stay away from them. This view is mistaken: patients at all stages, including rehabilitation, are not dangerous to others, but the tumor itself is not contagious. If possible, it is not necessary to abandon an intimate relationship, it’s part of a full life. If there are changes in the mucous membranes of the genital tract or discomfort, the doctor will tell you how to deal with it.
For coping is to diversify your leisure. It can be a visit to the theater, exhibitions, occupation, favorite Hobbies, walking and meeting friends. It is important to escape from painful thoughts that can accompany all stages of treatment of malignant tumors.
A little bit about the complications and side effects of radiation therapy
Like any other kind of treatment, radiotherapy may cause a variety of adverse reactions, both local and General. Common side effects of radiation therapy can be considered the feeling of tiredness, weakness, changes in emotional state, as well as abnormalities in the bone marrow, occurring under the action of radiation. If you need to irradiate large areas of the body suffer constantly renewed red blood cells, impaired their maturation in the bone marrow, which is manifested by decrease in the number of leukocytes, erythrocytes, thrombocytes. The patient regularly conduct blood tests to monitor its components and, if necessary, is assigned to the appropriate treatment or course of radiation is suspended for a week.
The common consequences of radiation therapy, one can observe loss of hair, deterioration of the nails, loss of appetite, nausea, and even vomiting. These changes are associated most often with exposure of the head, the organs of the gastrointestinal tract, as well as with the collapse of the tumor tissue under the action of radiation. After the end of treatment the patient’s condition gradually returns to normal.
Special attention should be paid to nutrition of patients undergoing radiotherapy. Change of appetite, nausea are not conducive to eating, and, meanwhile, the need for nutrients is quite high. If feelings of hunger do not occur, then there is a need, as they say, «I do not want». Since the list of recommended products is quite large, there is no need to limit yourself to sweets, meat and fish dishes, fruit, juices. The diet should be high calorie and full of all necessary nutrients.
When cooking you need to follow some rules:
- Meals should be high-calorie. If you want ice cream you need to eat it at Breakfast if the patient likes the porridge, it’s worth it to add a little more butter;
- Daily volume of food should be divided in several techniques, it is better to eat more often but smaller portions so as not to burden the digestive organs;
- Diet should contain plenty of fluids (if not contraindicated due to pathology of the kidneys, edema, etc.), and preference should be given fruit juices, milk beverages, yoghurt;
- Well, you will always be favorite products permitted for storage in the clinic (cookies, chocolate, etc.), so it will be possible to eat them when there is a desire;
- Eating better to make nice with the music, watching TV or even books;
- In some hospitals, doctors allow patients to even drink a glass of beer during a meal to improve the appetite, therefore, you should not hesitate to discuss all the features of diet with your doctor.
The most frequently observed local complications of radiation therapy in the form of skin reactions. After a few sessions of exposure possible reddening of the skin, which eventually passes, leaving behind pigmentation. Some patients complain of a feeling of dryness, itching, burning, peeling of the skin in the irradiation zone. With proper care and attention the skin is restored within 4-6 weeks after treatment.
Among the complications can be and burns, sometimes severe, with ulceration or infection radiation wounds. The likelihood of this scenario increases with increasing radiation dose, the presence of individual sensitivity to radiation, comorbidity, for example diabetes.
To avoid such trouble, you should after the procedure to treat the place of irradiation with moisturizer oils to protect the skin from sun rays. In the case of severe damage to the skin, the doctor may recommend medicines that contain corticosteroids, so if any changes in health should inform the doctor.
The irradiation of organs of the head or neck may damage the effect of radiation on the mucous membrane of the mouth, throat, so, again, you must follow some recommendations:
- Quitting Smoking, alcohol, irritating food;
- Use a soft toothbrush and gentle cleaning of teeth;
- Rinse the mouth with decoction of chamomile or other solutions which recommend attending.
In radiotherapy of the chest possible cough, shortness of breath, pain and swelling in the area of the breast. In the treatment of tumors of the rectum may receive a tendency to constipation, blood in the stool, abdominal pain, so it is important to diet, preventing the delay content in the gut.
About any deterioration of health, the emergence of these changes, you must inform the attending physician, which will help with the appointment of additional treatment.
Radiation therapy is an integral part of treatment of most malignancies, the effect of which can be recovery. With all the guidelines and rules it is usually well tolerated and improved patients can feel after a few sessions of radiation.
Thus, even taking into account possible adverse reactions from radiotherapy should not give up, because it gives a chance for a favorable outcome of the disease that dooms man to destruction. For successful treatment should be the right way of life, to fulfil the above recommendations and inform you of any changes in health to your doctor.