Treatment of squamous cell skin cancer. Radiation therapy for skin cancer Radiation therapy for skin cancer

As shown by radiometric and morphological research, the degree of radiation damage to the skin, and therefore the possibility of its restoration, are directly related to the distribution of energy in depth. Therefore, the absolute value of the incident dose measured on the skin surface cannot characterize the expected effect under the influence of radiation of different energies. It is known that large doses of soft radiation cause less biological effect than small doses of hard radiation [Osanov D. P. et al., 1976; Dvornikov V.K., 1975]. At the same time, soft radiation, which has lower energy, in comparable doses, more quickly causes local manifestations of radiation damage to the skin than hard X-rays, y-rays and neutrons, which have greater penetrating ability [Ivanovsky B. D., 1958; Borzov M.V. et al., 1972].

Pathogenesis structural changes skin varies significantly depending on where the energy is primarily absorbed - in the epidermis, superficial or deep layers of the dermis, or in the underlying tissues. Therefore, calculations of the magnitude and depth of distribution of absorbed energy doses show that primary changes in the epidermis become less pronounced as the severity of the radiation energy increases and, conversely, the severity of damage to the deep layers of the dermis and underlying soft tissue increases accordingly. For example, when irradiated with an energy of 7 keV at the level of the basal layer of the epidermis, the absorbed dose is 2 times higher than when irradiated with an energy of 18 keV [Dvornikov V.K., 1975; Samsonova T.V., 1975]. After external exposure to β-radiation at a dose of 5000 R, complete restoration of the epidermis is possible, while with γ-irradiation with megavolt energy, damage to the epidermis may be absent, but fibrosis of the subcutaneous tissue develops in the long term [Dzhelif A.M., 1963].

L. A. Afrikanova(1975) distinguishes 3 zones of structural disturbances when the skin is irradiated with soft X-ray radiation: the actual zone of necrosis, the reserve zone of necrosis and the zone of reactive changes. At the same time, the author notes that necrotic changes in the papillary and other layers of the dermis occur (reserve zone of necrosis) only after the death of the epidermis due to the cessation of physiological regeneration of the latter under the influence of radiation. However, such a clear division into zones and such a sequence are characteristic only of skin lesions caused by soft radiation in a dose of up to 5000-10,000 R, when the main amount of energy is absorbed by the surface layers of the skin.

When in action hard radiation due to the geometry of the distribution of the maximum dose of absorbed energy morphological changes in irradiated skin have their own characteristics. They appear most clearly in places of maximum direct exposure to gamma rays or fast neutrons with uneven irradiation of the body. This type of radiation damage to the skin, judging by the literature, is possible during accidents at nuclear installations in industrial or laboratory conditions, which deserves from the practical side special attention. It should be noted that in this case, along with the early changes in the epidermis described above, significant disturbances simultaneously occur in the deep layers of the dermis, subcutaneous tissue and skeletal muscles.

Moreover, if the radiation does not cause immediate death epidermis, then morphological changes in the integumentary epithelium are less severe than disturbances of the dermis and underlying soft tissues. In the first days of the disease, significant swelling of the dermis and physicochemical changes in collagen fibers are noticeable, which is especially clearly revealed by their metachromatic violet coloring using the Mallory method. In addition, gross changes in elastic fibers are detected, which, as is known, is not typical for the early stage of skin damage by X-rays [Afrikanova L.L.. 1975].

In subcutaneous tissue and skeletal muscles are also observed signs massive edema, accumulation of acidic mucopolysaccharides (glycosaminoglycans) in the ground substance of the interstitial tissue and walls of blood vessels, dystrophic changes in fibrous structures and striated muscles. In the following days, these changes increase and spread from the deep layers of the skin to the superficial ones. Microscopically visible voids or gaps are formed between the basal layer of epidermal cells and the basement membrane due to vacuolization of cells and rejection of the epidermis due to swelling of the reticular layer. Thus, the death of the epidermis and the formation of necrotic-ulcerative defects when damaged by gamma-neutron or neutron radiation are primarily due to severe circulatory disorders and degenerative changes in the subcutaneous tissue and dermis. This corresponds to the deep distribution of absorbed energy and the peculiarities of the interaction of fast neutrons with tissues.

As is known, 85% of the energy of a beam of fast neutrons is spent on education recoil protons during the interaction of neutral particles with hydrogen atoms. Therefore, the maximum exchange of energy occurs in the subcutaneous tissue, which contains 15-20% more hydrogen than other tissues [Dzhelif A., 1964; Grammaticati V.S. et al., 1978].

All methods treatment squamous cell carcinoma skin are aimed at radical removal of the tumor focus and obtaining a lasting clinical cure. The choice of treatment method depends on the shape of the tumor, stage, localization, extent of the process, the presence of metastases, age and general condition of the patient. Thus, solar-induced squamous cell carcinoma of the skin has a lower level of metastasis compared to squamous cell carcinoma that developed against the background of foci chronic inflammation, scars or chronic radiation dermatitis, which should be taken into account when performing surgery. Tumors of the lips, ears and nose have a higher level of metastasis, however, such localization does not allow for wide excision of the formations, so they must be treated with methods that allow microscopic control of the marginal zone of the removed tumor. Recurrent tumors are also aggressive and often localized. Regarding the size of the tumor, it is known that squamous cell skin cancer, the diameter of which exceeds 2 cm, recurs and metastasizes more often and therefore requires treatment with more radical methods.

To histological features that determine tactics treatment of patients with squamous cell skin cancer, include the degree of differentiation, depth of invasion and the presence of perineural spread of the tumor. Patients with well-differentiated squamous cell carcinoma have a better prognosis than with poorly differentiated ones, because low-grade cancer is more aggressive and has a higher rate of recurrence and metastasis. Tumors with a lower level of invasion, growing only into the papillary layer of the dermis, have a significantly lower frequency of recurrence and metastasis than tumors that deeply invade the dermis, subcutaneous fatty tissue or having perineural invasion. Squamous cell skin cancer also occurs more aggressively in patients with immunosuppression (recipients of internal organ transplants, patients with lymphoma, AIDS, etc.), with a higher risk of recurrence, metastasis and death. Their treatment should be carried out with radical methods, as well as patients with palpable lymph nodes, since this may be a sign of metastasis.

The oldest, but which has not lost its significance up to the present time, is surgical treatment for squamous cell skin cancer, which for small tumors is based on excision of the tumor within healthy skin, retreating 1-2 cm from the edge of the tumor, with or without subsequent plastic surgery. This gives not only a good cosmetic result, but also the opportunity to obtain adequate material for pathomorphological examination. Larger and more aggressive tumors are removed more widely. Large tumors require the removal of a significant amount of tissue and sometimes amputation, for example of a finger or penis. If tumor removal is performed adequately, the cure rate within 5 years is 98%.

Exclusively important for surgical treatment of squamous cell skin cancer has the Mohs method with microscopic control of the marginal zone of the removed tumor at the time of surgery, which allows to achieve a high cure rate (up to 99%) and preserve a maximum of normal skin around the lesion. The lowest level of recurrence while maintaining a good cosmetic effect is achieved by removing tumors within a 4 mm zone of apparently healthy skin. This method is also advisable to use for poorly differentiated and metastatic skin cancers.

Surgical treatment methods also include electrocoagulation and juoretage, which are used for small tumor diameters (up to 2 cm) and minor invasion. More often, electrocoagulation is used for squamous cell skin cancer with a diameter of less than 1 cm, located on smooth surfaces of the skin (forehead, cheek, torso) and having a depth of invasion within the dermis or upper subcutaneous tissue. Electrocoagulation is also indicated for the treatment of small-diameter squamous cell skin cancer that develops against the background of foci of chronic radiation dermatitis. When performing electrocoagulation, it is necessary to capture 5-6 mm of healthy skin adjacent to the tumor. Sometimes electrocoagulation and curettage are combined with cryotherapy. The advantages of the method include a high cure rate, simplicity of the method, as well as the formation of a cosmetically satisfactory scar due to the rapid and complete subsequent healing of the skin. The method does not allow obtaining adequate material for histological control of the edges of the removed tumor and therefore requires careful monitoring of patients over a long period of time.

Cryodestruction of squamous cell skin cancer It is performed only for small superficial and highly differentiated tumors located on the body. It is carried out using a cryoprobe (but in no case with a cotton swab) or using the aerosol method; exposure time - 5 minutes with repeated thawing from 2 to 5 times and capturing healthy skin by 2-2.5 cm. Due to the fact that with this method histological control of the edges of the removed tumor is impossible, the procedure must be preceded by a biopsy confirming that the tumor is superficial and highly differentiated. In hand experienced doctor If you carefully observe the indications and contraindications for cryodestruction, treatment with this method can be very effective, providing a cure in 95% of cases. However, it should be taken into account that the healing period during cryodestruction ranges from 2 to 4 weeks, and after treatment an atrophic hypopigmented scar is formed.

Application of laser radiation in the treatment of squamous cell skin cancer carried out by two methods: by photothermal destruction (coagulation, excision) of the tumor and in the form of photodynamic therapy.

For excision of squamous cell skin cancer A carbon dioxide laser can be used in a focused mode, which reduces the likelihood of bleeding (due to coagulation of small vessels during treatment) and scar formation, thereby providing a good cosmetic result. The use of a focused laser beam to remove this tumor is especially indicated for patients receiving anticoagulant therapy or suffering from bleeding diseases.

In order to reduce the intensity of exposure laser coagulation, as a rule, use neodymium and carbon dioxide lasers in defocused mode. Laser coagulation is especially indicated for squamous cell cancer of the nail bed and penis.

Photodynamic therapy for squamous cell skin cancer is a combination of exposure to light radiation (wavelength from 454 to 514 nm) with drug therapy with photosensitizers (for example, hematoporphyrins), which leads to necrosis of tumor cells. However, the effectiveness of its use in squamous cell skin cancer has not yet been studied sufficiently.

Squamous cell skin cancer small lesions can be successfully treated with close-focus X-rays, although, in general, radiation therapy is rarely used in the treatment of primary squamous cell carcinoma of the skin. It is an alternative treatment method, and with appropriate selection of patients, it ensures their cure in more than 90% of cases. The method is most effective in the treatment of deeply invasive skin tumors located along the closure lines of the embryonic ectoderm (nasolabial folds, parotid areas, etc.); when the tumor is localized near natural openings (eyes, nose, ears, etc.). Radiation therapy also used to suppress metastases. It is indicated in some cases after surgery in patients with a high risk of metastasis; for recurrent tumors that have arisen after the use of other treatment methods, as well as as a palliative method of treatment in patients with inoperable tumors. It is the method of choice in the treatment of elderly patients and in the presence of severe concomitant pathology.

Usually for older people radiation therapy for squamous cell skin cancer carried out with a tumor diameter of up to 20 mm. One of the conditions that ensures the effectiveness of treatment is the preservation of the viability of healthy tissues located in the area of ​​radiation exposure. In this regard, the dose of radiation exposure must be tolerable (tolerable). The irradiation regimen depends on the location and size of the tumor, as well as the degree of cellular differentiation. It should be taken into account that highly differentiated squamous cell skin cancer requires higher doses of radiation than poorly differentiated ones. The radiation dose varies from 3 to 5 Gy/day; per course - from 50 to 80 Gy. Before X-ray therapy, exophytic lesions are cut off using a scalpel or by electrodissection. An electron beam is used to treat large superficial skin tumors. A significant disadvantage of radiation therapy is the development local complications(radiation dermatitis, conjunctivitis, cataracts, perichondritis). which are observed in approximately 18% of cases. Although the immediate cosmetic outcome after radiation therapy may be good, it sometimes worsens over time, including the development of chronic radiation dermatitis. In this case, at the site of previous irradiation, the skin becomes atrophic, hypopigmented with the presence of telangiectasia. For recurrent tumors, repeated radiation therapy is not performed.

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Contraindications for radiation therapy

Despite the effectiveness radiotherapy ( radiation therapy) in the treatment of tumor diseases, there are a number of contraindications that limit the use of this technique.

Radiotherapy is contraindicated:

• In case of dysfunction of vital organs. During radiation therapy, the body will be exposed to a certain dose of radiation, which can negatively affect the functions of various organs and systems. If the patient already has severe diseases of the cardiovascular, respiratory, nervous, hormonal or other body systems, radiotherapy may aggravate his condition and lead to the development of complications.

• With severe exhaustion of the body. Even with highly precise radiation therapy, a certain dose of radiation reaches and damages healthy cells. To recover from such damage, cells need energy. If the patient’s body is exhausted ( for example, due to damage to internal organs by tumor metastases), radiotherapy may cause more harm than good.
• For anemia. Anemia – pathological condition, characterized by a decrease in the concentration of red blood cells ( red blood cells). When exposed to ionizing radiation, red blood cells can also be destroyed, which will lead to the progression of anemia and may cause complications.
• If radiotherapy has already been performed recently. In this case, we are not talking about repeated courses of radiation treatment for the same tumor, but about the treatment of a different tumor. In other words, if a patient has been diagnosed with cancer of any organ, and radiotherapy was prescribed for its treatment, if another cancer is detected in another organ, radiotherapy cannot be used for at least 6 months after the end of the previous course of treatment. This is explained by the fact that in this case the total radiation exposure to the body will be too high, which can lead to the development of serious complications.
• In the presence of radioresistant tumors. If the first courses of radiation therapy did not give absolutely no positive effect ( that is, the tumor did not decrease in size or even continued to grow), further irradiation of the body is inappropriate.
• If complications develop during treatment. If during a course of radiotherapy the patient experiences complications that pose an immediate danger to his life ( for example bleeding), treatment should be discontinued.
• If there are system inflammatory diseases (for example, systemic lupus erythematosus). The essence of these diseases is the increased activity of immune system cells against their own tissues, which leads to the development of chronic inflammatory processes in them. Exposure of such tissues to ionizing radiation increases the risk of complications, the most dangerous of which may be the formation of a new malignant tumor.
• If the patient refuses treatment. According to current legislation, no radiation procedure can be performed until the patient gives written consent.

Compatibility of radiation therapy and alcohol

During radiation therapy, it is recommended to refrain from drinking alcohol, as this can negatively affect the general condition of the patient.

There is a popular belief that ethanol ( ethyl alcohol, which is the active component of all alcoholic beverages) is able to protect the body from the damaging effects of ionizing radiation, and therefore it should be used during radiotherapy. Indeed, a number of studies have found that the introduction of high doses of ethanol into the body increases tissue resistance to radiation by approximately 13%. This is due to the fact that ethyl alcohol disrupts the flow of oxygen into the cell, which is accompanied by a slowdown in processes cell division. And the slower a cell divides, the higher its resistance to radiation.

At the same time, it is important to note that in addition to minor positive effects, ethanol also has a number of negative effects. For example, an increase in its concentration in the blood leads to the destruction of many vitamins, which themselves were radioprotectors ( that is, they protected healthy cells from the damaging effects of ionizing radiation). Moreover, many studies have shown that chronic consumption of alcohol in large quantities also increases the risk of developing malignant neoplasms (in particular tumors of the respiratory system and gastrointestinal tract). Considering the above, it follows that drinking alcoholic beverages during radiation therapy causes more harm to the body than good.

Is it possible to smoke during radiation therapy?

Smoking is strictly prohibited during radiation therapy. The fact is that tobacco smoke contains many toxic substances ( ethers, alcohols, resins and so on). Many of them have a carcinogenic effect, that is, upon contact with the cells of the human body, they contribute to the occurrence of mutations, the outcome of which can be the development of a malignant tumor. It has been scientifically proven that smokers have a significantly increased risk of developing lung cancer, pancreatic cancer, esophageal cancer and bladder cancer.

Taking into account the above, it follows that patients undergoing radiation therapy for cancer of any organ are strictly prohibited not only from smoking, but also from being near people who smoke, since carcinogens inhaled during this process can reduce the effectiveness of the treatment and contribute to the development of the tumor.

Is it possible to perform radiation therapy during pregnancy?

Radiation therapy during pregnancy can cause intrauterine damage to the fetus. The fact is that the effect of ionizing radiation on any tissue depends on the speed at which cell division occurs in this tissue. The faster the cells divide, the more pronounced the damaging effects of radiation will be. During intrauterine development, maximum intensive growth absolutely all tissues and organs of the human body, which is due to the high rate of cell division in them. Consequently, even when exposed to relatively low doses of radiation, the tissues of a growing fetus can be damaged, which will lead to disruption of the structure and functions of internal organs. The outcome depends on the stage of pregnancy at which radiation therapy was performed.

During the first trimester of pregnancy, the laying and formation of all internal organs and tissues occurs. If at this stage the developing fetus is irradiated, this will lead to the appearance of pronounced anomalies, which are often incompatible with further existence. This triggers a natural “protective” mechanism, which leads to the cessation of fetal activity and to spontaneous abortion (I'll have a miscarriage).

During the second trimester of pregnancy, most internal organs are already formed, so intrauterine fetal death after irradiation is not always observed. At the same time, ionizing radiation can provoke developmental anomalies of various internal organs ( brain, bones, liver, heart, genitourinary system and so on). Such a child may die immediately after birth if the resulting anomalies turn out to be incompatible with life outside the womb.

If exposure occurs during the third trimester of pregnancy, the baby may be born with certain developmental abnormalities that may persist throughout life.

Considering the above, it follows that it is not recommended to perform radiation therapy during pregnancy. If a patient is diagnosed with cancer early in pregnancy ( up to 24 weeks) and radiotherapy is required, the woman is offered an abortion ( abortion) for medical reasons, after which treatment is prescribed. If cancer is detected at a later stage, further tactics determined depending on the type and rate of tumor development, as well as the wishes of the mother. Most often, such women undergo surgical removal of the tumor ( if possible - for example, for skin cancer). If the treatment does not give positive results, you can induce labor or perform a delivery operation at an earlier date ( after 30 – 32 weeks of pregnancy), and then begin radiation therapy.

Is it possible to sunbathe after radiation therapy?

Sunbathing in the sun or in a solarium is not recommended for at least six months after completing a course of radiotherapy, as this can lead to the development of a number of complications. The fact is that when exposed to solar radiation, many mutations occur in skin cells, which can potentially lead to the development of cancer. However, as soon as a cell mutates, the body's immune system immediately notices this and destroys it, as a result of which cancer does not develop.

During radiation therapy, the number of mutations in healthy cells ( including in the skin through which ionizing radiation passes) can increase significantly, which is due to the negative effect of radiation on the genetic apparatus of the cell. At the same time, the load on the immune system increases significantly ( she has to deal with a large number of mutated cells at the same time). If a person begins to tan in the sun, the number of mutations may increase so much that the immune system cannot cope with its function, as a result of which the patient may develop a new tumor ( for example skin cancer).

What are the dangers of radiation therapy? consequences, complications and side effects)?

During radiotherapy, a number of complications may develop, which may be associated with the effect of ionizing radiation on the tumor itself or on healthy tissues of the body.

Hair loss

Hair loss in the scalp area is observed in most patients who have undergone radiation treatment for tumors in the head or neck area. The cause of hair loss is damage to the cells of the hair follicle. Under normal conditions, it is division ( reproduction) of these cells and determines hair growth in length.
When exposed to radiotherapy, cell division of the hair follicle slows down, as a result of which the hair stops growing, its root weakens and it falls out.

It is worth noting that when other parts of the body are irradiated ( such as legs, chest, back and so on) hair may fall out of the area of ​​the skin through which a large dose of radiation is delivered. After the end of radiation therapy, hair growth resumes on average within a few weeks to months ( if no irreversible damage to the hair follicles occurred during treatment).

Burns after radiation therapy ( radiation dermatitis, radiation ulcer)

When exposed to high doses of radiation, certain changes occur in the skin, which in appearance resemble a burn clinic. In fact, there is no thermal damage to tissues ( like a real burn) is not observed in this case. The mechanism of burn development after radiotherapy is as follows. When skin is irradiated, small blood vessels are damaged, resulting in disruption of microcirculation of blood and lymph in the skin. The delivery of oxygen to the tissues is reduced, which leads to the death of some cells and their replacement with scar tissue. This, in turn, further disrupts the oxygen delivery process, thereby supporting development pathological process.

Skin burns may appear:

• Erythema. This is the least dangerous manifestation of radiation damage to the skin, in which there is dilation of superficial blood vessels and redness of the affected area.
• Dry radiation dermatitis. In this case, an inflammatory process develops in the affected skin. At the same time, many biologically active substances enter the tissues from the dilated blood vessels, which act on special nerve receptors, causing a sensation of itching ( burning, irritation). In this case, scales may form on the surface of the skin.
• Wet radiation dermatitis. With this form of the disease, the skin swells and may become covered with small blisters filled with clear or cloudy liquid. After opening the blisters, small ulcerations form that do not heal for a long time.
• Radiation ulcer. Characterized by necrosis ( death) parts of the skin and deeper tissues. The skin in the area of ​​the ulcer is extremely painful, and the ulcer itself does not heal for a long time, which is due to impaired microcirculation in it.
• Radiation skin cancer. The most severe complication after radiation burn. The formation of cancer is facilitated by cellular mutations resulting from radiation exposure, as well as prolonged hypoxia ( lack of oxygen), developing against the background of microcirculation disorders.
• Skin atrophy. It is characterized by thinning and dry skin, hair loss, impaired sweating and other changes in the affected area of ​​the skin. The protective properties of atrophied skin are sharply reduced, resulting in an increased risk of developing infections.

Itchy skin

As mentioned earlier, exposure to radiation therapy leads to disruption of blood microcirculation in the skin area. At the same time, blood vessels dilate, and permeability vascular wall increases significantly. As a result of these phenomena, the liquid part of the blood passes from the bloodstream into the surrounding tissues, as well as many biologically active substances, which include histamine and serotonin. These substances irritate specific nerve endings located in the skin, resulting in an itching or burning sensation.

To eliminate skin itching, antihistamines can be used, which block the effects of histamine at the tissue level.

Edema

The occurrence of edema in the legs can be caused by the effects of radiation on the tissues of the human body, especially when irradiating abdominal tumors. The fact is that during irradiation, damage to the lymphatic vessels can be observed, through which, under normal conditions, lymph flows from the tissues and flows into the bloodstream. Impaired lymph outflow can lead to the accumulation of fluid in the tissues of the legs, which will be the direct cause of the development of edema.

Skin swelling during radiotherapy can also be caused by exposure to ionizing radiation. In this case, there is an expansion of the blood vessels of the skin and sweating of the liquid part of the blood into the surrounding tissue, as well as a violation of the outflow of lymph from the irradiated tissue, as a result of which edema develops.

At the same time, it is worth noting that the occurrence of edema may not be associated with the effects of radiotherapy. For example, in advanced cases of cancer, metastases may occur ( distant tumor foci) V various organs and fabrics. These metastases ( or the tumor itself) can compress blood and lymphatic vessels, thereby disrupting the outflow of blood and lymph from tissues and provoking the development of edema.

Pain

Pain during radiation therapy can occur in case of radiation damage to the skin. At the same time, in the area of ​​the affected areas there is a violation of blood microcirculation, which leads to oxygen starvation of cells and damage to nerve tissue. All this is accompanied by the occurrence of severe pain, which patients describe as “burning”, “unbearable” pain. The pain syndrome cannot be eliminated with conventional painkillers, and therefore patients are prescribed other treatment procedures ( medicinal and non-medicinal). Their goal is to reduce swelling of affected tissues, as well as restore the patency of blood vessels and normalize microcirculation in the skin. This will help improve the delivery of oxygen to the tissues, which will reduce the severity or completely eliminate pain.

Damage to the stomach and intestines ( nausea, vomiting, diarrhea, diarrhea, constipation)

The cause of dysfunction of the gastrointestinal tract ( Gastrointestinal tract) there may be too much radiation dose ( especially when irradiating tumors of internal organs). In this case, there is damage to the mucous membrane of the stomach and intestines, as well as a violation of nervous regulation intestinal peristalsis (motor skills). In more severe cases, inflammatory processes may develop in the gastrointestinal tract ( gastritis - inflammation of the stomach, enteritis - inflammation small intestine, colitis - inflammation of the large intestine, and so on) or even ulcers form. The process of moving intestinal contents and digesting food will be disrupted, which can cause the development of various clinical manifestations.

Damage to the gastrointestinal tract during radiation therapy can manifest itself:

• Nausea and vomiting– associated with delayed gastric emptying due to impaired gastrointestinal motility.
• Diarrhea ( diarrhea) – occurs due to inadequate digestion of food in the stomach and intestines.
• Constipation– can occur with severe damage to the mucous membrane of the large intestine.
• Tenesmus– frequent, painful urge to defecate, during which nothing is released from the intestines ( or a small amount of mucus is produced without stool).
• The appearance of blood in the stool– this symptom may be associated with damage to the blood vessels of the inflamed mucous membranes.
• Abdominal pain– occur due to inflammation of the mucous membrane of the stomach or intestines.

Cystitis

Cystitis is an inflammatory lesion of the mucous membrane of the bladder. The cause of the disease may be radiation therapy performed to treat a tumor of the bladder itself or other pelvic organs. At the initial stage of development of radiation cystitis, the mucous membrane becomes inflamed and swollen, but later ( as the radiation dose increases) it atrophies, that is, it becomes thinner and wrinkles. Its protective properties are thereby violated, which contributes to the development infectious complications.

Clinically, radiation cystitis may manifest itself as a frequent urge to urinate ( during which a small amount of urine is released), the appearance of a small amount of blood in the urine, periodic increases in body temperature, and so on. In severe cases, ulceration or necrosis of the mucous membrane may occur, which may lead to the development of a new cancerous tumor.

Treatment of radiation cystitis involves the use of anti-inflammatory drugs ( to eliminate symptoms of the disease) and antibiotics ( to combat infectious complications).

Fistulas

Fistulas are pathological channels through which various hollow organs can communicate with each other or with the environment. The causes of fistula formation can be inflammatory lesions of the mucous membranes of internal organs that develop during radiation therapy. If such lesions are not treated, over time deep ulcers form in the tissues, which gradually destroy the entire wall of the affected organ. The inflammatory process can spread to the tissue of a neighboring organ. Ultimately, the tissues of the two affected organs are “soldered” together, and a hole is formed between them through which their cavities can communicate.

During radiation therapy, fistulas can form:

• between the esophagus and trachea ( or large bronchi);
• between the rectum and vagina;
• honey of the rectum and bladder;
• between intestinal loops;
• between the intestines and the skin;
• between the bladder and the skin and so on.

Lung damage after radiation therapy ( pneumonia, fibrosis)

With prolonged exposure to ionizing radiation, inflammatory processes can develop in the lungs ( pneumonia, pneumonitis). In this case, ventilation of the affected areas of the lungs will be disrupted and fluid will begin to accumulate in them. This will manifest itself as a cough, a feeling of shortness of breath, chest pain, and sometimes hemoptysis ( producing a small amount of blood in sputum when coughing).

If these pathologies are not treated, over time this will lead to the development of complications, in particular to the replacement of normal lung tissue with scar or fibrous tissue ( that is, to the development of fibrosis). Fibrous tissue is impermeable to oxygen, as a result of which its growth will be accompanied by the development of oxygen deficiency in the body. The patient will begin to experience a feeling of lack of air, and the frequency and depth of his breathing will increase ( that is, shortness of breath will appear).

If pneumonia develops, anti-inflammatory and antibacterial drugs are prescribed, as well as agents that improve blood circulation in the lung tissue and thereby prevent the development of fibrosis.

Cough

Cough is a common complication of radiation therapy in cases where the chest is exposed to radiation. In this case, ionizing radiation affects the mucous membrane of the bronchial tree, as a result of which it becomes thinner and dry. At the same time, its protective functions are significantly weakened, which increases the risk of developing infectious complications. During the process of breathing, dust particles, which usually settle on the surface of the moist mucous membrane of the upper respiratory tract, can penetrate into the smaller bronchi and get stuck there. At the same time, they will irritate special nerve endings, which will activate the cough reflex.

Expectorants may be prescribed to treat cough during radiation therapy ( increasing mucus production in the bronchi) or procedures that promote hydration of the bronchial tree ( for example, inhalations).

Bleeding

Bleeding can develop as a result of the effect of radiotherapy on a malignant tumor growing into large blood vessels. During radiation therapy, the size of the tumor may decrease, which may be accompanied by thinning and a decrease in the strength of the wall of the affected vessel. A rupture of this wall will lead to bleeding, the location and volume of which will depend on the location of the tumor itself.

At the same time, it is worth noting that the cause of bleeding can also be the effect of radiation on healthy tissue. As mentioned earlier, when healthy tissues are irradiated, blood microcirculation is disrupted. As a result, blood vessels can dilate or even become damaged, and certain part blood will be released into the environment, which may cause bleeding. According to the described mechanism, bleeding can develop due to radiation damage to the lungs, mucous membranes of the oral cavity or nose, gastrointestinal tract, genitourinary organs, and so on.

Dry mouth

This symptom develops when tumors located in the head and neck area are irradiated. In this case, ionizing radiation affects the salivary glands ( parotid, sublingual and submandibular). This is accompanied by a disruption in the production and release of saliva into the oral cavity, as a result of which its mucous membrane becomes dry and hard.

Due to lack of saliva, taste perception is also impaired. This is explained by the fact that in order to determine the taste of a particular product, particles of the substance must be dissolved and delivered to the taste buds located deep in the papillae of the tongue. If there is no saliva in the oral cavity, the food product cannot reach the taste buds, as a result of which a person’s taste perception is disrupted or even distorted ( the patient may constantly experience a bitter feeling or a metallic taste in the mouth).

Dental damage

During radiation therapy for oral tumors, teeth darken and their strength is impaired, as a result of which they begin to crumble or even break. Also due to impaired blood supply to the dental pulp ( the inner tissue of the tooth, consisting of blood vessels and nerves) the metabolism in the teeth is disrupted, which increases their fragility. Moreover, disruption of saliva production and blood supply to the oral mucosa and gums leads to the development of oral infections, which also adversely affects dental tissue, contributing to the development and progression of caries.

Temperature increase

An increase in body temperature can be observed in many patients both during the course of radiation therapy and for several weeks after its completion, which is considered absolutely normal occurrence. At the same time, sometimes an increase in temperature may indicate the development severe complications Therefore, if this symptom appears, it is recommended to consult with your doctor.

An increase in temperature during radiation therapy may be due to:

• The effectiveness of treatment. During the destruction of tumor cells, various biologically active substances are released from them, which enter the blood and reach the central nervous system, where they stimulate the thermoregulation center. The temperature can rise to 37.5 - 38 degrees.
• The effects of ionizing radiation on the body. When tissues are irradiated, a large amount of energy is transferred to them, which can also be accompanied by a temporary increase in body temperature. Moreover, a local increase in skin temperature may be due to the expansion of blood vessels in the area of ​​irradiation and the influx of “hot” blood into them.
• The main disease. With a majority malignant tumors Patients experience a constant increase in temperature to 37 - 37.5 degrees. This phenomenon may persist throughout the course of radiotherapy, as well as for several weeks after the end of treatment.
• Development of infectious complications. When the body is irradiated, its protective properties are significantly weakened, resulting in an increased risk of infections. The development of infection in any organ or tissue may be accompanied by an increase in body temperature to 38 - 39 degrees and above.

Decrease in leukocytes and hemoglobin in the blood

After radiation therapy, there may be a decrease in the concentration of leukocytes and hemoglobin in the patient’s blood, which is associated with the effect of ionizing radiation on the red bone marrow and other organs.

Under normal conditions, leukocytes ( cells of the immune system that protect the body from infections) are formed in the red bone marrow and lymph nodes, after which they are released into the peripheral bloodstream and perform their functions there. Red blood cells are also produced in the red bone marrow ( red blood cells), which contain the substance hemoglobin. It is hemoglobin that has the ability to bind oxygen and transport it to all tissues of the body.

Radiation therapy may expose the red bone marrow to radiation, causing cell division to slow down. In this case, the rate of formation of leukocytes and red blood cells may be disrupted, as a result of which the concentration of these cells and the level of hemoglobin in the blood will decrease. After cessation of radiation exposure, normalization of peripheral blood parameters can occur within several weeks or even months, which depends on the received dose of radiation and the general condition of the patient’s body.

Menstruation during radiation therapy

The regularity of the menstrual cycle may be disrupted during radiation therapy, depending on the area and intensity of radiation.

The period may be affected by:

• Irradiation of the uterus. In this case, there may be a violation of blood circulation in the area of ​​the uterine mucosa, as well as increased bleeding. This may be accompanied by the release of large amounts of blood during menstruation, the duration of which may also be increased.
• Irradiation of the ovaries. Under normal conditions, the course of the menstrual cycle, as well as the appearance of menstruation, is controlled by female sex hormones produced in the ovaries. When these organs are irradiated, their hormone-producing function may be disrupted, as a result of which various menstrual cycle disorders may occur ( until the disappearance of menstruation).
• Irradiation of the head. In the head area is the pituitary gland, a gland that controls the activity of all other glands of the body, including the ovaries. When the pituitary gland is irradiated, its hormone-producing function may be disrupted, which will lead to dysfunction of the ovaries and disruption of the menstrual cycle.

Can cancer recur after radiation therapy?

Relapse ( re-development of the disease) can be observed during radiation therapy for any form of cancer. The fact is that during radiotherapy, doctors irradiate various tissues of the patient’s body, trying to destroy all the tumor cells that could be located in them. At the same time, it is worth remembering that it is never possible to exclude the possibility of metastasis 100%. Even with radical radiation therapy performed according to all the rules, 1 single tumor cell can survive, as a result of which, over time, it will again turn into a malignant tumor. That is why, after completing the treatment course, all patients should be regularly examined by a doctor. This will allow a possible relapse to be identified in time and promptly treated, thereby prolonging a person’s life.

A high likelihood of relapse may be indicated by:

• presence of metastases;
• tumor growth into neighboring tissues;
• low efficiency of radiotherapy;
• late start of treatment;
• incorrect treatment;
• exhaustion of the body;
• presence of relapses after previous courses of treatment;
• patient's failure to comply with doctor's recommendations ( If the patient continues to smoke, drink alcohol or be exposed to direct sunlight during treatment, the risk of cancer recurrence increases several times).

Is it possible to get pregnant and have children after radiation therapy?

The effect of radiation therapy on the possibility of bearing a fetus in the future depends on the type and location of the tumor, as well as on the dose of radiation received by the body.

The possibility of bearing and giving birth to a child may be affected by:

• Irradiation of the uterus. If the purpose of radiotherapy was to treat a large tumor of the body or cervix, at the end of treatment the organ itself may be so deformed that pregnancy cannot develop.
• Irradiation of the ovaries. As mentioned earlier, with tumor or radiation damage to the ovaries, the production of female sex hormones may be disrupted, as a result of which a woman will not be able to become pregnant and/or bear a fetus on her own. At the same time, carrying out replacement hormone therapy may help solve this problem.
• Pelvic irradiation. Irradiation of a tumor that is not associated with the uterus or ovaries, but is located in the pelvic cavity, can also create difficulties when planning a pregnancy in the future. The fact is that as a result of radiation exposure, the mucous membrane of the fallopian tubes can be damaged. As a result of this, the process of fertilization of the egg ( female reproductive cell) sperm ( male reproductive cell) will become impossible. The problem can be solved by in vitro fertilization, during which germ cells are combined in a laboratory outside the woman’s body and then placed in her uterus, where they continue to develop.
• Irradiation of the head. When irradiating the head, the pituitary gland may be damaged, which will disrupt the hormonal activity of the ovaries and other glands of the body. You can also try to solve the problem with hormone replacement therapy.
• Disruption of vital organs and systems. If during radiation therapy the functions of the heart are impaired or the lungs are damaged ( for example, severe fibrosis has developed), a woman may experience difficulties during pregnancy. The fact is that during pregnancy ( especially in the 3rd trimester) the load on the cardiovascular and respiratory system the expectant mother, that in the presence of severe concomitant diseases may cause the development of dangerous complications. Such women should be constantly monitored by an obstetrician-gynecologist and take supportive therapy. They are also not recommended to give birth through the birth canal ( The method of choice is delivery via cesarean section at 36–37 weeks of pregnancy).

It is also worth noting that the time elapsed from the end of radiation therapy to the onset of pregnancy is of no small importance. The fact is that the tumor itself, as well as the treatment carried out, significantly deplete the female body, as a result of which it needs time to restore energy reserves. That is why it is recommended to plan pregnancy no earlier than six months after treatment and only in the absence of signs of metastasis or relapse ( re-development) cancer.

Is radiation therapy dangerous for others?

During radiation therapy, a person does not pose a danger to others. Even after irradiation of tissues with large doses of ionizing radiation, they ( fabrics) do not emit this radiation into the environment. Exception from of this rule is contact interstitial radiotherapy, during which radioactive elements can be installed in human tissue ( in the form of small balls, needles, staples or threads). This procedure is performed only in a specially equipped room. After installation of radioactive elements, the patient is placed in a special room, the walls and doors of which are covered with radioprotective screens. He must remain in this ward throughout the entire course of treatment, that is, until the radioactive substances are removed from the affected organ ( the procedure usually takes several days or weeks).

Access of medical personnel to such a patient will be strictly limited in time. Relatives can visit the patient, but before doing so they will need to wear special protective suits that will prevent radiation from affecting them. internal organs. At the same time, children or pregnant women, as well as patients with existing tumor diseases of any organs, will not be allowed into the ward, since even minimal exposure to radiation can negatively affect their condition.

After removing sources of radiation from the body, the patient can return to Everyday life on the same day. It will not pose any radioactive threat to others.

Recovery and rehabilitation after radiation therapy

During radiation therapy, a number of recommendations should be followed that will save the body's strength and ensure maximum effectiveness of the treatment.

Diet ( nutrition) during and after radiation therapy

When drawing up a menu during radiation therapy, one should take into account the peculiarities of the influence of ionizing radiation on the tissues and organs of the digestive system.

During radiation therapy you should:

• Eat well processed foods. During radiotherapy ( especially when irradiating the gastrointestinal tract) damage occurs to the mucous membranes of the gastrointestinal tract - the oral cavity, esophagus, stomach, intestines. They can become thinner, inflamed, and become extremely sensitive to damage. That is why one of the main conditions for preparing food is its high-quality mechanical processing. It is recommended to avoid hard, coarse or tough foods that could damage the oral mucosa during chewing, as well as the esophageal or gastric mucosa when swallowing a bolus. Instead, it is recommended to consume all foods in the form of cereals, purees, and so on. Also, the food consumed should not be too hot, as this can easily cause a burn to the mucous membrane.
• Consume high-calorie foods. During radiation therapy, many patients complain of nausea and vomiting that occurs immediately after eating. That is why such patients are recommended to consume small amounts of food at a time. The products themselves must contain all the necessary nutrients to provide the body with energy.
• Eat 5-7 times a day. As mentioned earlier, patients are advised to eat small meals every 3 to 4 hours, which will reduce the likelihood of vomiting.
• Drink enough water. In the absence of contraindications ( for example, severe heart disease or edema caused by a tumor or radiation therapy) the patient is recommended to drink at least 2.5 - 3 liters of water per day. This will help cleanse the body and remove byproducts of tumor decay from the tissues.
• Eliminate carcinogens from your diet. Carcinogens are substances that can increase the risk of developing cancer. During radiation therapy, they should be excluded from the diet, which will increase the effectiveness of the treatment.

Nutrition during radiation therapy

What can you use?
cooked meat; wheat porridge; oatmeal; rice porridge; buckwheat porridge; mashed potatoes; boiled chicken eggs ( 1 – 2 per day); cottage cheese; fresh milk ; butter ( about 50 grams per day); baked apples ; walnuts ( 3 – 4 per day); natural honey; mineral water ( without gases); jelly.	fried food ( carcinogen); fatty foods ( carcinogen); smoked food ( carcinogen); spicy food ( carcinogen); salty food; strong coffee ; alcoholic drinks ( carcinogen); carbonated drinks; fast food ( including porridge and instant noodles); vegetables and fruits containing a large amount of dietary fiber ( mushrooms, dried fruits, beans and so on).

Vitamins for radiation therapy

When exposed to ionizing radiation, certain changes can also occur in the cells of healthy tissues ( their genetic apparatus may be destroyed). Also, the mechanism of cell damage is due to the formation of so-called free oxygen radicals, which aggressively affect all intracellular structures, leading to their destruction. The cell dies.

Over the course of many years of research, it was found that some vitamins have so-called antioxidant properties. This means that they can bind free radicals inside cells, thereby blocking their destructive effect. The use of such vitamins during radiation therapy ( in moderate doses) increases the body's resistance to radiation, without compromising the quality of the treatment provided.

They have antioxidant properties:

• some trace elements ( for example, selenium).

Is it possible to drink red wine during radiation therapy?

Red wine contains a number of vitamins, minerals and trace elements necessary for the normal functioning of many body systems. It has been scientifically proven that drinking 1 glass ( 200 ml) red wine per day helps normalize metabolism and also improves the removal of toxic products from the body. All this undoubtedly has a positive effect on the condition of the patient undergoing radiation therapy.

At the same time, it is worth remembering that abuse of this drink can negatively affect cardiovascular system and on many internal organs, increasing the risk of complications during and after radiation therapy.

Why are antibiotics prescribed during radiation therapy?

When irradiation is carried out, cells of the immune system are affected, as a result of which the body's defenses are weakened. Along with damage to the mucous membranes of the gastrointestinal tract, as well as the respiratory and genitourinary systems, this can contribute to the emergence and development of many bacterial infections. Antibacterial therapy may be necessary to treat them. At the same time, it is worth remembering that antibiotics destroy not only pathogenic, but also normal microorganisms that live, for example, in the intestines healthy person and take an active part in the digestion process. That is why, after completing a course of radiotherapy and antibiotic therapy, it is recommended to take drugs that restore intestinal microflora.

Why are CT and MRI prescribed after radiation therapy?

CT ( CT scan) and MRI ( Magnetic resonance imaging) are diagnostic procedures that allow detailed examination of certain areas human body. Using these techniques, you can not only identify a tumor, determine its size and shape, but also monitor the process of treatment, noting weekly certain changes in the tumor tissue. For example, with the help of CT and MRI, it is possible to detect an increase or decrease in the size of a tumor, its growth into neighboring organs and tissues, the appearance or disappearance of distant metastases, and so on.

It is worth considering that during a CT scan, the human body is exposed to a small amount of X-ray radiation. This introduces certain restrictions on the use of this technique, especially during radiation therapy, when the radiation load on the body must be strictly dosed. At the same time, MRI is not accompanied by irradiation of tissues and does not cause any changes in them, as a result of which it can be performed daily ( or even more often), presenting absolutely no danger to the patient's health.

Before use, you should consult a specialist.

Doctor of Medical Sciences, Professor Afanasyev Maxim Stanislavovich, oncologist, surgeon, expert in photodynamic therapy of basal cell carcinoma.

Basalioma, or basal cell skin cancer, is a complex disease. Medicine offers many treatment methods, but all of them are traumatic, fraught with the formation of serious cosmetic defects, the development of long-term complications, and none of them eliminates relapses in the future.

Even Hollywood stars, who have access to the most high-tech and expensive treatments, have to undergo treatment for basal cell skin cancer for years. Most famous example- Hugh Jackman. The actor has been fighting the disease since 2013 to save his nose. And so far he has succeeded. But against the backdrop of his sixth relapse, Jackman has a serious risk of losing it.

Unfortunately, they do not guarantee getting rid of basal cell carcinoma forever.

And even if Hugh Jackman, who has access to the most modern medical care, cannot get rid of the problem, then a logical question arises: is this disease treatable? Is it possible to cure basal cell carcinoma?

Is it necessary to remove basal cell carcinoma?, if she doesn't bother?

Many people treat basal cell carcinoma treatment too leniently. Because this form of cancer grows slowly and almost never metastasizes, doctors rarely insist on treatment and usually do not warn about the consequences of failure.

And if for elderly patients such tactics can be considered justified with a stretch, then for young people - and over the past 10 years basal cell carcinoma has become very “younger” - it does not stand up to criticism.

With this approach, the patient does not take his seemingly insignificant disease seriously and decides not to do anything about it. Very often, treatment is limited to the use of so-called “green stuff”.

But I believe that Hugh Jackman is right in his persistent desire to get rid of basal cell carcinoma. And not only because of an aesthetic defect.

Treatment is necessary. Basalioma is a tumor that, although slowly, is constantly growing. It never goes away on its own. Sooner or later, it overcomes the skin, grows into muscles and nerves, penetrates cartilage and irreversibly disrupts the functioning of organs. If basal cell carcinoma is located on the face, it literally destroys it. Basalioma in the area of ​​the eye or nose, growing, can lead to their loss. Over time, basalioma of the head can destroy the skull and grow to the brain.

Need I say that these processes are also extremely painful?

In this stage basal cell carcinoma It is practically impossible to treat, because along with basal cell carcinoma it will be necessary to remove part of the organ or the entire organ.

You need to know the enemy by sight

Before continuing our conversation, I must tell you about one type of basal cell carcinoma that cannot be recognized at the diagnostic stage.

In approximately 6% of cases, treatment of basal cell carcinoma does not have any effect - removal of the basal cell carcinoma ends in relapse, and it reappears in the same place. And after the next removal, the whole process repeats... This form of basal cell carcinoma is called persistently recurrent basal cell carcinoma.

Unfortunately, modern medicine does not have a single effective means of combating persistently recurrent basal cell carcinoma. The mechanism why it returns has not yet been figured out.

However, even for such a head start on basal cell carcinoma, the founder of PDT in Russia, Professor Evgeniy Fillipovich Stranadko, recommends using exclusively photodynamic therapy as the method of choice. Indeed, in case of manifestation of persistently recurrent basal cell carcinoma, it is necessary to repeated treatment, the cosmetic effect of which will depend entirely on the method of its removal chosen at an early stage.

We must understand that any surgical treatment is always a “minus tissue” treatment, a mutilating treatment. Only PDT allows effective treatment without removing healthy tissue and obtaining an aesthetic result even against the background of persistently recurrent basal cell carcinoma.

Surgery for basal cell carcinoma

Surgical removal of basal cell carcinoma usually performed with a laser, scalpel or radio wave scalpel with the obligatory capture of 5 mm of healthy tissue. Surgical techniques also include the cryodestruction method - removal of basal cell carcinoma with nitrogen, and the Mohs method.

I strongly advise you not to agree to remove basal cell carcinoma with a scalpel - this method usually leaves behind a rough scar.

In the early stages, surgical removal of basal cell carcinoma gives good effect. Therefore, it makes sense to remove very small and accessible formations up to 2-3 millimeters surgically. I myself prefer this method: the procedure is simple, quick and does not require special rehabilitation.

Disadvantages of the surgical method:

• High percentage of basal cell carcinoma recurrence after excision. Advanced basal cell carcinomas, which have managed to grow beyond the skin, recur especially often.

You should not trust information that surgery to remove basal cell carcinoma has a low recurrence rate. This figure is relevant only for small entities. When basaliomas larger than 2-3 mm are removed, usually more than half of them recur.

• Difficulty and impossibility of re-treatment due to severe tissue loss.

Recurrence of basal cell carcinoma requires repeated surgery. But after the second or third relapse, surgery is usually impossible: imagine what happens to the area in which, with each removal of the basal cell carcinoma, an additional 6 mm of healthy tissue is removed.

• Relapse after surgery occurs in the scar area. This area is almost impossible to treat with PDT. Therefore, in case of relapse of basal cell carcinoma after surgical treatment you will have practically no alternative method left - only repeated surgery or irradiation.
• If the tumor is located on the wings of the nose, on the auricle or in the corners of the lips, if multiple basal cell carcinoma is to be treated, then the surgical method literally turns into a mutilating operation. In these areas, every millimeter of tissue is important, but often, along with the tumor, it may be necessary to remove up to half of the nose or ear, and the lack of tissue cannot be compensated for by plastic surgery methods.
• A contraindication to surgery is the location of the basal cell carcinoma in close proximity to the eye - there is a high risk of its loss.

Laser removal of basal cell carcinoma: features of the method and its disadvantages

Laser treatment of basal cell carcinoma is a surgical operation.

Laser removal of basal cell carcinoma has one significant drawback. The fact is that the laser beam does not cut the tissue, but evaporates it, layer by layer. After the laser, only a charred crust remains from the tumor. Thus, “cauterization” with a laser does not make it possible to send the removed tumor for histological examination. Only histology allows one to assess the completeness of basal cell carcinoma removal and exclude a more serious form of cancer, which in rare cases is hidden or adjacent to basal cell carcinoma.

This method also has one more drawback. Laser treatment of basal cell carcinoma thermally damages tissue, and such a wound heals with the formation of a scar.

Removal of basal cell carcinoma using Surgitron: features of the method and its disadvantages

Radio wave removal of basal cell carcinoma, or electrocoagulation, or treatment with electric knife,

- another surgical method. In this case, a tip with a thin wire is used to remove the formation. When an electric current of a certain frequency is passed through a wire, it acquires the properties of a scalpel.

Most often, treatment of basal cell carcinoma with radio waves is performed using medical equipment from the American company Surgitron, which gave the method its second name.

This method is good because after its use, tissue remains for biopsy - the pathologist will be able to assess the completeness of basal cell carcinoma removal and rule out a more aggressive form of cancer. The disadvantage of electrocoagulation is the same as everyone else's surgical techniques– high percentage of relapses for all tumors exceeding 2 mm.

You also need to be mentally prepared for the fact that excision of skin basal cell carcinoma using radio waves leaves behind a scar.

Cryodestruction of basalioma: features of the method and its disadvantages

Cryodestruction, or cryotherapy, is the cauterization of basal cell carcinoma with liquid nitrogen.

The method is cheap and quite widespread. However, you shouldn’t count on a miracle. Removing basal cell carcinoma by cryodestruction has a very serious drawback: the depth of exposure of liquid nitrogen to tissue cannot be controlled. That is, after treating basal cell carcinoma with nitrogen, there is a risk of both leaving lesions in the skin and, conversely, affecting too large areas of healthy tissue. In the latter case, after cauterization of basal cell carcinoma, there is a high probability of developing an extensive scar.

Treatment of basal cell carcinoma with cryodestruction has another drawback. Since the method does not make it possible to assess whether the tumor has been completely removed or not, basal cell carcinoma after cryodestruction may well resume its growth and eventually require repeated removal.

Mohs method: features of the method and its disadvantages

This is a high-tech and expensive treatment method that requires special equipment, special training of the surgeon and the presence of the clinic’s own pathology laboratory. It is designed to achieve high aesthetic results in the treatment of tumors on the face, neck, legs and arms, and genitals.

This is probably the method used to treat Hugh Jackman.

The Mohs operation can be compared (very loosely, of course) to using a slicer: tissue is removed in thin layers, layer by layer, and immediately sent to the laboratory. The procedure is repeated until tumor cells are no longer detectable in the section.

Since the entire operation is carried out under the supervision of a pathologist, there is no need to remove the basal cell carcinoma “involving” 6 mm of healthy tissue.

The operation is highly aesthetic, and if there is a lack of skin in the operated area, it is replaced with implants.

Irradiation of basal cell carcinoma: features of the method and consequences after irradiation of basal cell carcinoma

Radiation, or radiation, treatment methods are used only if there are contraindications to alternative methods. This is the method of choice for complexly located (for example, on the face), deep or too large tumors up to 5 cm that cannot be treated surgically. They are also prescribed to elderly patients with contraindications to surgical treatment.

Since the use of the method is always accompanied by complications, it is used mainly for elderly people over 65 years of age.

Irradiation of skin basalioma is carried out:

• using close-focus X-ray therapy,
• using gamma rays,
• using beta rays (electrons).

The use of a particular method is not always determined by rationality. Close-focus X-ray therapy is presented in every oncology clinic, so most often patients are referred to it. Electronic installations are expensive and complex, so literally only a few clinics are equipped with them.

Let's look at how radiation therapy works on basalioma.

It is believed that treatment of basal cell carcinoma with radiation therapy negatively affects the DNA of tumor cells. Ionizing radiation makes their further division impossible; after radiation therapy, basal cell carcinoma stops growing and is destroyed over time.

There is often information that radiation treatment of basal cell carcinoma does not have any serious consequences. Unfortunately, this is not true. Irradiation of skin basalioma causes a lot of complications, which impossible to avoid. Therefore, treating basal cell carcinoma with radiation is often comparable to shooting sparrows with a cannon, since the side effects of such treatment often exceed the severity of the disease itself.

This is what a radiation ulcer looks like

If at the beginning of treatment the skin in the training area only turns red and itches, then by the third week of therapy a non-healing bright red ulcer develops. It becomes very easily infected, has an extremely unpleasant odor, and heals with great difficulty only 1.5 months after the end of treatment.

2. A radiation ulcer always heals with the formation of a scar. This creates not only a defect in facial expressions, but also makes it very difficult to treat basal cell carcinoma in case of relapse.

3. It is impossible to predict in advance how radioactive particles will act. On the one hand, therapeutic radiation is aimed at rapidly dividing cells, and this is the main property of malignant neoplasms: radiation damages basal cell carcinoma cells and makes them non-viable.

But on the other hand, radiation exposure itself has high mutagenic properties. Healthy tissue is also exposed to radiation, and the DNA of healthy cells is damaged.

Thus, an initially safe basal cell carcinoma is highly likely to “degenerate” into metastatic forms of cancer – for example, squamous cell skin cancer.

The risk of developing this complication persists for the rest of your life after basal cell carcinoma irradiation. It is for this reason that radiation treatment is not given to patients under 50 years of age. Due to the high risks of complications, radiation treatment is not used for recurrent basal cell carcinoma.

4. If basal cell carcinoma occurs on the head, irradiation leads to hair loss in the affected area, which grows brittle and dull after treatment.

5. The risk of complications increases in proportion to the depth of penetration of basal cell carcinoma and the intensity of irradiation.

6. When treating tumors located near the eyes, cataracts may occur.

7. Treatment of basal cell carcinoma with irradiation leads to changes in the functioning of the sebaceous and sweat glands in the area of ​​radiation exposure.

8. Anatomically difficult areas are not treated with any of the methods of radiation therapy.

9. When radiation treatment Basalioma on the face has a higher risk of recurrence than on other areas of the skin.

This is what a device for close-focus X-ray therapy looks like.

Since the depth of exposure to this radiation ranges from a few millimeters to 7–8 cm, the dosage and number of sessions are calculated individually.

Close-focus X-ray therapy is effective only in the initial stages of basal cell carcinoma and is used only on accessible areas of the skin. For example, the corner of the nose is considered difficult to treat.

This method also has its drawback. X-ray radiation is well absorbed dense fabrics- for example, bones. Therefore, when basal cell carcinoma is located close to the bone - in the area of ​​the ears and on the head - electron radiation therapy is recommended.

Electronic therapy for basal cell carcinoma: features of the method and its disadvantages

Beta rays are called electrons. Accordingly, beta ray treatment is called electron therapy.

Compared to X-rays, electron radiation is considered more gentle, selective and highly targeted. Electrons are absorbed by tissues equally and regardless of their density. Unlike X-rays, whose energy is lost with increasing depth, uh The energy of the electron beam increases to a peak at a certain depth and then drops sharply.

All this means that with the correct dose calculation, radiation minimally injures healthy tissue around the tumor. Electronic therapy also allows irradiation of large areas of skin for multiple basal cell carcinomas.

But electronic therapy treatment also has limitations. On the one hand, this is the high cost of equipment. On the other hand, the technique is indicated in advanced stages - the size of the basal cell carcinoma should be no less than 4 cm2, since the device is quite labor-intensive to set up and does not allow focusing the flow onto a smaller area.

Electron irradiation is also not used to treat basal cell carcinoma in the eye area: modern radiology does not effectively protect the organ of vision.

The main disadvantage of all existing treatment methods is high risk relapses. As a result, you have to cut or irradiate again and again. Moreover, each stage of treatment is accompanied by significant loss of healthy tissue and scarring.

The need for deep tissue excision is a critical moment in the treatment of basal cell carcinomas on the face - especially on the nose, ears and corners of the lips, when each recurrence of basal cell carcinoma is accompanied by irreversible loss of a significant part of the organ.

Relapsebasal cell carcinomasin the scar - perhaps the most terrible consequence of treating basal cell carcinoma using classical methods

You need to understand that almost all existing treatment methods lead to the formation of a scar, which is a dense connective tissue, poorly penetrated by vessels and poorly supplied with blood. In this case, relapse of basal cell carcinoma occurs in the area of ​​its original localization - that is, always in the scar area.

Unfortunately, in this case, PDT loses its effectiveness - the microcirculation of the rumen does not allow the photosensitizer to accumulate in sufficient concentration. Accordingly, recurrence of basal cell carcinoma in the scar is poorly amenable to any alternative treatment methods other than surgery.

So, having performed an operation to remove basal cell carcinoma just once, you become a hostage to the surgical method.

How to treat basaliomato cure. Treatment of basal cell carcinoma using PDT

PDT is an effective method of relapse-free treatment of basal cell carcinoma in one procedure.

Big personal experience treatment of basal cell carcinoma using PDT allows me to confidently say that:

• PDT in 96% of cases forever eliminates basal cell carcinoma in one procedure,
• Photodynamic treatment of basal cell carcinoma shows the highest efficiency among all existing techniques. The method targets cancer cells and fully eliminates them. The risk of recurrence of even large basal cell carcinoma after correct and fully performed PDT is several times lower than from other treatment methods and is only a few percent.
• Only the photodynamic method of treating basal cell carcinoma provides the highest aesthetic result: either no scar remains or it is almost invisible.
• The method is suitable for the most complex basal cell carcinomas in the nose and eyelids.
• PDT shows very good results in the treatment of large basal cell carcinomas.
• Almost none side effects, since healthy cells are not harmed during PDT.

What is the essence of the technique

Photodynamic removal of skin basalioma begins with a dropper - a photosensitizer drug is injected into the patient’s blood, which increases the photosensitivity of tissues. The photosensitizer has the special property of being retained only in old, atypical, damaged and cancer cells.

2-3 hours after injection, the tissues are irradiated with a laser according to a special scheme. The photosensitizer is activated by light and enters into a complex photochemical reaction, which results in the release of toxic compounds and reactive oxygen species that destroy cancer cells.

The duration of the procedure depends on the size and number of tumors and takes from 20 minutes to 2.5 hours.

It is this targeted effect on cancer cells that ensures complete tumor removal and an excellent aesthetic result after the procedure.

Is it that simple?

Of course, the PDT procedure is not at all as simple as it might seem at first glance. To obtain a guaranteed result, it requires very high-quality equipment, the highest craftsmanship, jewelry precision and strictly individual developed treatment plan.

For every patient I I am developing my own treatment protocol, which depends on age, medical history, size and location of the tumor, and concomitant diseases.

I make sure to diagnose and differentiate the tumor:

• visual examination with dermatoscopy;
• collection of material for cytological evaluation;
• taking a fingerprint-smear in the case of an ulcerated form;
• taking a biopsy for tumors larger than 5 cm2.

This procedure allows you to accurately diagnose basal cell skin cancer and exclude the more aggressive squamous cell cancer.

Before the procedure, I carefully calculate the dosage of the photosensitizer, as well as the intensity and time of laser exposure. I carefully control the power of laser radiation during the procedure.

Compliance with the PDT protocol and individual approach allows me to achieve good treatment results of 96% the first time.

By the way, not all specialists trained in PDT are able to trigger the necessary photochemical reaction and achieve a cure.

The photograph shows hyperthermia - a tissue burn that should not occur after a correctly performed PDT procedure. From the reaction of the tissues, I understand that no photochemical reaction occurred in this case, even if before the procedure the patient was injected with a photosensitizer and a laser was used. The treatment result shown in the photograph does not give the right to call it PDT. Therefore, after completion of treatment, the patient will not receive the benefits of the technique that I spoke about above.

The photochemical reaction may be accompanied by whitening of the tissue in the affected area, as shown in the photograph.

On days 14-20, a crust forms, under which epithelization occurs.

Rehabilitation

After the procedure, cyanosis appears at the site of treatment, which becomes covered with a black crust on days 14-20.

If the patient carefully follows the doctor’s requirements in the postoperative period for 4–6 weeks, after the PDT procedure a small and almost invisible scar remains on the skin. If a small basal cell carcinoma is removed, the tumor often disappears without a trace after PDT.

Why is the PDT method poorly represented in Europe and the USA?

The degree of skin response to radiation largely depends on the source and dose of ionizing radiation, and on the size of the area of ​​skin irradiation of a cancer patient.

Manifestations radiation reaction skin: itching, slight burning and redness of the skin.

Changes in the skin of a cancer patient after radiation can vary: from slight redness, discoloration (pigmentation) and peeling to swelling and the development of dry or wet inflammation with detachment of the upper layer (epidermis). Recent changes may resemble in appearance a burn from boiling water. Very deep burns cancer treatment are rarely observed.

In order to minimize the damaging effects of radiation on the skin, you need to remember the following.

1. During the period of radiation therapy for cancer, you should not use body creams and other perfumes for the skin, as they can increase the sensitivity of the skin to radiation that destroys cancer;

2. From the moment redness of the skin of a cancer patient appears, the damaged area of ​​the skin must be lubricated with a rich cream. Fish oil, sea buckthorn oil or Fleur-enzyme cream are good for this purpose. Fleur-enzyme cream contains the antioxidant (anti-oxidant) enzyme superoxide dismutase, the latter ensures a reduction in the degree of inflammatory reactions in the skin after cancer therapy;

3. For radiation dermatitis, accompanied by swelling and pain, textile napkins “Coletex” with propolis, urea, chlorhexidine or dimexide can be applied to the area affected during cancer treatment. The material from which the napkin is made is designed in such a way that the medicine contained in it gradually moves into the skin over the course of two days. cancer patient, providing therapeutic effect. And if there is a wound that is devoid of the upper epithelial layer, the napkin also absorbs tissue breakdown products, helping to cleanse and heal the damaged surface.

Propolis effectively promotes the healing of irradiated skin surfaces and stimulates the restoration of the skin of a patient treating cancer.

Urea is good at relieving swelling and pain at the radiation site effects on cancer.

Dimexide not only relieves pain and swelling, but also promotes rapid healing of damaged skin and recovery of cancer patients.

Chlorhexidine disinfects and promotes healing.

The napkins are very easy to use. You need to open the sterile packaging and moisten plain water the top (working) layer of the napkin, and then fix it (wet layer to the skin) on the affected area. The napkin can remain in the affected area for up to 3 days. During this time, the healing process takes place.

It is necessary to inform your cancer doctor about any changes that occur on the skin during radiation exposure. The doctor treating your cancer will tell you what measures will help avoid unpleasant consequences.

In addition to the skin, the mucous membranes of organs entering the area are also involved in radiation reactions. cancer radiation.

How to reduce the radiation reaction of mucous membranes

The sensitivity of mucous membranes to cancer-killing radiation varies. The most vulnerable is the mucous membrane small intestine, and the most stable ones are the rectum and uterus.

Manifestations of a radiation reaction of the mucous membrane during radiation therapy for cancer: swelling and redness, increasing with increasing dose of radiation exposure to cancer. In the future, a filmy coating and erosion may appear on the mucous membrane (areas without an upper protective layer).

Typically, restoration of damaged mucous membrane after radiation cancer therapy takes 10-15 days, but redness and swelling can be observed for a longer time, since ionizing radiation damages the germinal layer of the mucous epithelium. This significantly slows down its update.

Radiation reactions of the mucous membranes during cancer treatment can be prevented or significantly reduced.

If you are to undergo irradiation of the abdominal area, you may experience frequent loose stools, often mixed with mucus, and the urge to defecate. These unpleasant consequences Radiation treatment of cancer is caused by damage to the mucous membrane of the small intestine and the death of intestinal microflora.

A number of measures can help reduce the severity of these manifestations: cancer patient can independently undertake other than the treatment prescribed by the cancer doctor. These measures are as follows.

1. It is necessary to significantly reduce the amount of carbohydrates in the food of a cancer survivor. Food should be high-calorie, rich in protein (for example, soy, boiled fish or meat, eggs). In addition, during periods of severe diarrhea in a cancer patient (frequent loose stools), it is necessary to limit the intake of fresh vegetables and fruits (with the exception of bananas);

2. The locking effect can be achieved with the help of enveloping agents that have anti-inflammatory and protective effect on the intestinal mucosa cancer survivor. Such agents include attapulgite (kaopectate, neointestopan, reabagg) and smecta (diosmectite). These drugs envelop the intestinal wall and form a protective barrier, precipitate and remove microbes, viruses, toxic substances (including bile acids) and gases from the intestine. The drugs are not absorbed from the digestive tract and have no side effects. The antidiarrheal effect manifests itself quite quickly - already within 24 hours and lasts for several hours. Intestinal bloating and associated pain are eliminated.

Attapulgite cancer patients take 1.5 grams after the first bowel movement, and then in the same dose after each subsequent one. The daily dose is no more than 9 grams. Smecta is a natural preparation obtained from clay. Diosmectite is pre-diluted in water until a homogeneous suspension is obtained. The contents of one sachet are used for one dose. Diosmectite is taken 2-3 times a day.

It must be remembered that when taking these drugs, the absorption of other drugs taken after cancer therapy is significantly impaired. Therefore, after taking adsorbents, other drugs cancer survivor can be taken no earlier than 1.5-2 hours later.

Dies when the abdominal area is irradiated normal microflora intestines, which is one of the reasons for the development intestinal problems in a cancer patient. Therefore, after a decrease in stool frequency, it is necessary to begin restoring the intestinal flora of a cancer patient. You need to start a week before the end of the course of radiation therapy for cancer. The main drug is bifidumbacterin or bificol. Bifidumbacterin is a dried mass of living bifidobacteria. Bifikol is a dried mass of living bifidobacteria and E. coli. If there is a deficiency or absence of bifid flora in the patient’s intestines, cancer survivor, taking these drugs normalizes its microbial composition, prevents the development of harmful microbes, promotes the synthesis of a number of vitamins, restores the function of the gastrointestinal tract, increases local intestinal immunity and the general defenses of the body of a cancer survivor. Any of the drugs (bifidumbacterin or bificol) for radiation treatment of cancer must be taken for 30-45 days, 5 doses three times a day. The combination of taking bifidumbacterin (or bificol) with the nutritional supplement fervital (analogs of BioSorb, Recicen-RD) promotes better engraftment of bacteria and also regulates stool well. Fervital for cancer radiation therapy is added to food (soup, porridge, kefir) 1 tablespoon 3 times a day.

Sometimes it is necessary to add another drug - lactobacterin - to the food of a cancer survivor for a short period of time. This is a dried mass of live lactobacilli that play no less important role in normal intestinal function and are also sensitive to radiation exposure, destroying cancer. It is advisable for cancer patients to take Lactobacterin 5 doses 2-3 times a day for 14 days. If you are taking bifidumbacterin, lactobacterin can be taken after or during meals on the days you are taking the bifid drug. If bificol is used to restore the intestinal microflora of a person suffering from cancer, then Lactobacterin should be taken only after finishing taking it, i.e. after a month and a half.

Skin cancer

Skin cancer is a malignant tumor with a relatively favorable course, since, due to its localization, it is available for radical treatment - radiation and surgery. It is detected in relatively early stages of its development, which is explained by its slow growth rate, as well as ease of detection.

Based on the histological structure, they mainly distinguish between squamous cell keratinizing, squamous cell non-keratinizing and basal cell skin cancer. The most common is basal cell carcinoma or so-called cutaneous basal cell carcinoma.

When treating skin tumors in the early stages, localized on the trunk and extremities, where the cosmetic side is of less importance, a lasting clinical effect is achieved using surgery or cryodestruction (freezing the tumor with liquid nitrogen). For tumors of the scalp and especially the face, short-distance radiotherapy is mainly used.

Short-distance radiotherapy is carried out taking into account the size and depth of tumor spread. The magnitude of the focal dose is planned so that the relative depth dose in the area of ​​the tumor bed is 80%.

The latter is achieved by varying the radiation energy in the range of 30 - 100 keV and using various filters.

Short-distance radiotherapy for skin cancer.

Basalioma of the left corner of the mouth

a - before treatment; b - 2 1/2 years after radiation therapy;

c - isodose distribution under different irradiation conditions depending on the depth.

Irradiation is carried out, as a rule, from one field, and the irradiation zone must include surrounding healthy tissue at a distance of at least 5 mm from the edge of the tumor. During irradiation, as the tumor is reabsorbed, the field size may be slightly reduced.

A single exposure dose is 400 R with an irradiation rhythm of 5 fractions per week, the total focal dose for basal cell carcinoma is increased to 50 - 55 Gy, for squamous cell skin cancer - up to 65 - 70 Gy.

A good clinical effect in the form of complete resorption of the tumor and its replacement with a cosmetically satisfactory scar, and sometimes complete epithelialization is observed mainly in superficially located skin tumors (95%), while in infiltrative forms the percentage of permanent cure is noticeably reduced.

When the tumor is localized on the skin of the eyelids, in the area of ​​the inner corner of the eye, certain difficulties are created due to the risk of damage to the eye and the unevenness of the irradiated surface. In these cases, it is sometimes advisable to use interstitial gama therapy, and for very superficially located neoplasms (basal cell carcinoma) - applications with beta-emitting nuclides (32РХ, 90Y, etc.).

On the skin of the scalp, auricle, forehead, and bridge of the nose, radiation treatment is complicated by the proximity of bone and cartilage tissue. However, if the tumor is small and there is no infiltration of the underlying tissues, short-distance radiotherapy can be quite effective for skin cancer in these localizations.

For more common malignant skin tumors that deeply infiltrate the underlying tissue (stages III - IV), the use of remote gamma therapy is indicated.

Directories, encyclopedias, scientific works, public domain books.

Radiation therapy for skin cancer

Skin cancer is one of the most common cancer diseases. There are several types of malignant skin tumors:

Basalioma or basal cell carcinoma (develops from the basal cells of the skin epithelium),

Cancer developing from skin appendages.

Popular foreign oncology clinics and centers

Cancer Center Nord, operating as part of the German clinic Vivantes Clinicum Spandau, is one of largest centers Berlin, providing services in the field of oncology and hematology. Along with good technical equipment, the center is known for its team of well-trained oncologists. Go to page >>

The German outpatient clinic "Munich Oncology" is classified as medical institutions day hospital. The priority area of ​​activity is the diagnosis and treatment of a wide range of malignant tumors, various forms of leukemia, as well as diseases of the autoimmune system. Go to page >>

The multidisciplinary cancer center of the University of Münster in Germany offers its patients highly accurate diagnosis and treatment of almost all oncological diseases. The main areas of focus are the treatment of breast cancer, gastrointestinal tract cancer, lung cancer, leukemia and lymphoma. Go to page >>

The Oncology Center at the University Hospital Hamburg-Eppendorf in Germany diagnoses and treats almost all known oncological diseases, having an excellent diagnostic and treatment base that allows for fast and highly accurate examination of patients. Go to page >>

The Oncology Center operating at the University Hospital of Ulm in Germany is rightfully considered by the medical community as one of the most advanced. The center is part of the International Society for the Treatment of Cancer, and is also a member of the Unified Cancer Center of the city of Ulm. Go to page >>

The Eastern Hospital of the National Cancer Research Center in Japan carries out diagnosis and effective treatment of cancer using the most modern equipment; it is here that the cyclotron accelerator is located, the only one in the country at the moment. Go to page >>

The Central Vienna Clinical Hospital in Austria has an Oncology Department in its division, which successfully treats many oncological diseases. The department has the most modern equipment and technology at its disposal, and is staffed by experienced oncologists. Go to page >>

Clinic named after Johann Wolfgang Goethe in Germany, among other services, provides its patients with highly accurate diagnostics and effective treatment of oncological diseases. The Clinic successfully operates one of the largest oncology centers in Europe, Rhein-Main, headed by Professor Mitrou. Go to page >>

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Herbal medicine in oncology

Herbal medicine can provide significant assistance not only in the treatment of cancer, but also in their prevention.

Heredity and cancer

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Cancer Prevention

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Palliative treatment of cancer

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New cancer treatments

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About “folk” medicine

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Stress and cancer

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Radiation therapy for skin cancer

Of all the existing treatments for skin cancer, radiation therapy provides the best results. This primarily applies to facial skin tumors. Considering that there are basal cell cancers on the skin of the face, radiation therapy provides a high percentage of cures with a good cosmetic effect.

Indications for radiation therapy for skin cancer

1) for primary skin cancers;

2) for metastatic skin cancers;

3) for prophylactic purposes after surgery;

4) in case of relapses.

Radiation therapy methods for skin cancer

Fractionated irradiation method. Its essence is this. that over 10-12 days treatment is carried out in relatively fractional doses, and the total dose is brought to 4000 rads.

The fractionated irradiation method has the advantage that tumor tissues are more damaged and healthy tissues are spared more than with older methods; on the other hand, the reactive ability of the tissues surrounding the tumor is preserved, which largely determines the therapeutic effect.

The positive features of the fractionated irradiation method include the influence of the time factor. Extending treatment to 12-15 days ensures that all cancer cells are exposed to x-rays, since during this period all cells go through the mitosis phase and, therefore, are exposed to radiation.

In the literature we have collected on the treatment of skin cancer, a common thread is the idea that all efforts should be aimed at achieving a cure after one course of radiotherapy.

The currently accepted principle for the treatment of malignant neoplasms is to give in one course the maximum dose compatible with the need to spare healthy tissue. Repeated irradiations due to the cumulative effect of X-rays are dangerous - they entail changes in vascularization, damage to surrounding healthy tissue, and cause necrotic changes.

Based on this, fractionated irradiation using a high total dose is recognized as the most effective method that guarantees the elimination of a cancer focus in one course of treatment.

Concentrated short-focus irradiation method according to Shaul. The short-focus irradiation method is based on the principle of creating conditions for the distribution of X-ray energy similar to those found when using radium, despite the fact that the wavelength of these two types of radiation is not the same. From the point of view of modern X-ray biology, the therapeutic and biological effect depends only on the amount of energy absorbed, be it the energy of y-rays or the energy of X-rays. The qualitative side of radiation is not given significant importance.

Based on the equivalence of y- and x-rays, Shaul believes that the greater effectiveness of radium therapy is due only to a more appropriate distribution of 7-rays. It is appropriate to note here that the issue of spatial dose distribution during radiation therapy is extremely relevant, especially in the treatment of malignant neoplasms. The relationship between the energy absorbed by the tumor and adjacent tissues becomes extremely important.

The difficulty with radiation therapy for skin cancer is that the sensitivity differences between tumor cells and surrounding tissue cells are often insufficient. That is why the currently accepted principle of using radiation therapy for malignant neoplasms is based on the desire not only to destroy the tumor as much as possible, but also to spare the surrounding tissue as much as possible.

When radium is applied directly to the affected area, the greatest impact of rays on the site of application of radium and minimal impact on surrounding tissues is achieved, since the intensity of the radiation action to the depth and to the periphery sharply decreases.

In this regard, the method of concentrated close-focus irradiation is aimed at creating the same conditions.

According to Shaul, the method he proposed should be an imitation of radium therapy; and indeed it began to be successfully used instead of radiation therapy for some localizations of skin cancer, cancer of the lower lip, oral cavity, as well as for malignant melanomas and hemangiomas. Treatment is carried out using a special X-ray tube, in which the anode in the form of a hollow cylinder is brought out.

Radiation therapy for skin cancer with this method is carried out with a single dose of 400 - 800 rads, and a total dose of 6000 - 8000 rads.

Results of radiation therapy for skin cancer

Results depend on:

1) morphological picture;

2) localization and soil on which cancer develops;

3) treatment methods.

Basal cell carcinoma is most successfully treated with radiotherapy. The mixed form is more resistant than the purely basocellular form. Squamous cell carcinoma is the most dangerous form skin cancer. The success of treatment for this form depends on the timeliness of diagnosis.

In some locations (corner of the eye, ear), the effectiveness of radiation therapy for skin cancer is reduced.

The prognosis sharply worsens with damage to bone and cartilage tissue. This is explained by the fact that bone and cartilage tissue, due to their anatomical and physiological properties, cannot respond to X-ray irradiation with an appropriate reaction.

The soil on which the neoplasm developed also matters. The reason for the worse treatment results for cancer caused by lupus and scars is that the surrounding tissue, being weakened by the underlying disease, is unable to respond with the desired reaction to x-ray irradiation.

The reason radiation therapy for skin cancer fails is that sometimes the proliferation of epithelial tissue in the deeper parts of the tumor stops for a very short time and then resumes again. This may be a result of inappropriate selection of beam quality, inappropriate filtration and dose. To select a carcinicidal dose in relation to deep-lying cells, it is necessary to use filtered beams, appropriate voltage and cross-irradiation. Large doses should be used without damaging normal tissue.

Failure is rare due to the presence of resistant cells, especially in basocellular epitheliomas. It is also necessary to remember that not all cells that make up a malignant neoplasm have the same degree of sensitivity; some cells in the same tumor may be very resistant.

Patients after radiation therapy for skin cancer should be monitored every six months for 5 years. Failure to comply with this rule often leads to serious consequences.

For stages 1 and 2, radiation therapy for skin cancer is carried out under short-focus radiotherapy conditions. A single dose is 300 - 400 rad, the total dose is 5000 - 7000 rad. Doses of 500 - 600 rads per session significantly reduce the treatment time, but leave large changes on the skin, which gives worse results from a cosmetic point of view. Cure in stage 1 is observed in 95-98%, and in stage 2 - in 85-87% of cases.

At stage 3, radiation therapy should be carried out under conditions of deep radiotherapy, on a cesium installation, and in some cases, on a telegamma installation. A single dose should not exceed 250 rads. The question of the total dose is decided in each individual case, depending on the size of the lesion. If radiation therapy alone raises doubts about the possibility of achieving good results, then after the radiation reaction has subsided, surgical or electrosurgical treatment methods may be recommended. At stage 4, treatment (if it can be carried out) must begin with radiation (deep radiotherapy or telegammatherapy).

After radiation therapy, in some cases it is possible to excise the tumor with or without plastic surgery, depending on the condition and location of the pathological process. For x-ray cancer that has developed due to scars and relapses of skin cancer after radiation treatment, it is indicated surgical treatment. The scope of the operation should not confuse the surgeon, since tumor growth does not spare the patient and leads to severe disability.

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What you should not and should be afraid of after irradiation of basal cell carcinoma

The treatment method for one of the most common forms of skin cancer, basal cell carcinoma, is determined by several factors. This is the location of the tumor, its size and the extent of spread to the tissues of cartilage, muscles, tendons and bones located under the epidermis. Radiation therapy is suitable for older people, patients with contraindications to removing the tumor by other means, or its size is too large. The disadvantages of this method of therapy include side effects and complications that arise after irradiation.

Indications for testing

Basalioma belongs to the so-called borderline types of cancer. The growth of the tumor occurs due to its growth deep into the skin. Initially, the neoplasm forms on the lowest layer of the epidermis - the basal layer. However, over time it affects subcutaneous tissue, and then cartilage or even bones. The “favorite” place for localization of basal cell carcinoma is the face, neck, and less often other open areas of the body. Considering the peculiarities of the course of this type of cancer, tumors located on the wings of the nose, near the eyes or ears are especially dangerous.

Radiation therapy for basal cell carcinoma is possible at almost any stage of the disease. However, with the development of laser and radio wave techniques for tumor removal, this method of treatment faded into the background. In addition, doctors emphasize that the growth of basal cell carcinoma occurs slowly, so when undergoing regular preventive examinations there is a high chance of detecting the disease at an early stage. In the initial stages of basal cell skin cancer, you can do without drug treatment or minimally invasive surgery. But oncologists recommend radiation therapy in such cases:

• large size of basal cell carcinoma;
• spread of malignant cells deep under the skin;
• patient age over 65 years;
• the presence of diseases that serve as contraindications to other treatments;
• features of the localization of basal cell carcinoma that prevent its surgical removal.

Irradiation is also widely used as part of complex therapy. For example, sessions ionizing effects are necessary after surgery if complete elimination of pathological cells is impossible. In addition, radiation exposure is a variant of the so-called palliative care. This means that therapy sessions help relieve pain and other symptoms of the disease in inoperable cases.

Methods of radiation therapy for basal cell carcinoma, their advantages and disadvantages

The effectiveness of ionizing radiation lies in its effect on cellular DNA. Under the influence of γ-irradiation, it begins to collapse, which makes further proliferation of malignant structures impossible. First of all, therapeutic radiation is aimed at rapidly dividing cells, and this is the main property of malignant neoplasms. But healthy tissue is also exposed to radiation, which causes the effects of therapy.

When contact γ-irradiation with isotopes of cobalt Co60, radium Ra226, iridium Ir192, the dose must be selected so as to achieve the death of malignant cells or a permanent cessation of their division. The procedure is carried out using special applicators, made individually for each patient from plastic material. The plate is 1 cm thick; it is dipped in boiling water and then applied to the skin of the nose or other area of ​​the face, neck and body. The applicator is then molded to follow each curve. Radioactive elements and protective lead plates are applied to it. The advantage of this method is that the radiation intensity decreases as it passes through the tissue. This is why it is widely used to treat skin cancer.

The effect of close-focus X-ray therapy from a distance of up to 7.5 cm is achieved by irradiation with a power of 10 to 250 W. Depending on this, the depth of exposure changes - from a few millimeters to 7 - 8 cm. To focus the rays, a special tube is put on the device, and the area of ​​influence is limited using filters made of aluminum or brass up to 3 mm thick. The degree of radiation absorption by tissues depends on the stage of basal cell carcinoma and the general condition of the patient. Therefore, the dosage and frequency of sessions is calculated individually for each patient.

How does basal cell carcinoma differ from papilloma? Basalioma is

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This video has How to treat and cure skin cancer - This video has How to t

Interstitial β-irradiation is carried out using radioactive isotopes of phosphorus P32 or thallium Tl204. Before this, colloidal solutions of gold Au188, silver Ag111 in the form of granules, treated with catgut threads are injected into the basal cell carcinoma tissue. According to oncologists, this method of radiation therapy is more complex than others, and the equipment for its implementation is not available in every clinic due to its high cost. It is used to treat forms of basal cell skin cancer that are resistant to other methods of radiation exposure.

Side effects that develop directly during therapy

Radiation treatment of basal cell carcinoma is always accompanied by damage to the surrounding tissues. This cannot be avoided even if you follow the rules of this method of therapy. The sensitivity of the skin to radiation depends on many factors. This:

• localization of the tumor, the anterior surface of the neck is more susceptible to radiation exposure than the skin of the wings of the nose and other areas of the face and back of the head;
• air temperature, in hot weather the blood supply to the epidermis improves, which increases the risk of developing the consequences of treatment; in cold weather this probability decreases;
• excess weight, it has been proven that the skin of obese people is more susceptible to the effects of radiation;
• cracks and scratches increase the permeability of the epidermis;
• age-related changes.

In most cases, radiation treatment of basal cell carcinoma does not cause systemic consequences. Most of the side effects are due to a skin reaction, which manifests itself in the form of epidermatitis. First, during each session, swelling, redness, and itching occur. As treatment continues, symptoms become more pronounced and reach a maximum by the third week of therapy and disappear 1 - 1.5 months after its completion.

Blisters filled with exudate form on the affected area of ​​the skin. They burst, revealing an inflamed, bright red epidermis. This serves as a gateway for pathogenic flora, and if the doctor’s recommendations are not followed, the development of bacterial infection. The appearance of wounds covered with crusts is also noted.

A dangerous consequence of such treatment for basal cell carcinoma is a radiation ulcer. Under the influence of radioactive isotopes, microcirculation in the blood vessels located under the skin is disrupted. The risk of complications increases in proportion to the depth of penetration of the pathological process and the strength of radiation. The onset of ulcerative changes in the skin is indicated by the following symptoms:

• dryness and flaking;
• disappearance of the surface pattern of the epidermis;
• the appearance of spider veins;
• pigmentation disorder.

If basal cell carcinoma is located near the mucous membranes of the nose or mouth, inflammation may occur - mucositis. It is characterized by dry epithelium, burning and pain when touched. However, such consequences are rare. During radiation treatment of a tumor in the eye area, recurrent conjunctivitis is noted.

Long-term complications of radiation therapy

Over time, the skin exposed to radiation becomes thinner, and the vascular network is visible underneath. A year to a year and a half after the end of treatment, lighter or, conversely, darker areas of the epidermis may appear. The severity of these signs depends on the duration of treatment, the radiation dose received as a result of therapy, and the area of ​​exposure. It is worth noting that the radiation ulcer discussed above may also appear several months after the end of treatment.

The most dangerous consequence There is a high risk of developing a more severe, malignant form of skin cancer – squamous cell cancer. For this reason, irradiation of basal cell carcinoma is not advisable for patients under 50 years of age. Also, due to the risk of complications, this method of treatment is not used for relapses of basal cell carcinoma. After exposure to radiation on the scalp, hair loss is observed. Over time, they grow back, but become brittle, dull, and their color becomes more faded.

When treating tumors located on the facial skin near the eyes, cataracts may occur. How high the risk of such a disease is is unknown, since today the threshold dose of radiation to the lens has not been established. Due to tissue scarring after the destruction of neoplasm cells, their mobility is limited, which affects facial expressions. There are also changes in the functioning of the sebaceous and sweat glands in the area of ​​exposure to radiation.

Prevention of complications

The basic rule of radiation treatment for basal cell carcinoma is a preliminary examination of the patient, collection of anamnesis, and identification of concomitant pathologies. This information will help you correctly calculate the dose, frequency and duration of therapy. Depending on the size of the tumor, the procedure involves 1–2 cm of surrounding healthy tissue. This is done to prevent relapse of the disease.

Lead plates are used to protect other nearby cells. A hole is cut out in them, which exactly follows the shape of the basal cell carcinoma, and is applied during each radiation therapy session. The patient is warned that before starting the course of treatment (as well as during it) the skin should be protected from damage. In addition, doctors recommend adhering to the following rules:

• protect yourself from direct sunlight, do not visit the solarium, go outside in long sleeves, cover your face with a wide-brimmed hat, apply a special cream to exposed skin;
• You cannot rub the skin that has been exposed to irradiation, massage it, apply cupping, apply mustard plasters, treat it with antiseptics and alcohol solutions (iodine, brilliant green, peroxide) without a doctor’s prescription;
• hygienic procedures should be carried out with care so as not to wash off the marks made by the doctor that define the area of ​​radiation exposure;
• It is forbidden to make compresses or use a heating pad;
• before using scented soap or shower gel, bath foam, deodorant, cream, you should definitely consult a doctor; decorative cosmetics (if allowed) should be washed off 4 hours before the radiation treatment session for basal cell carcinoma;
• To prevent bacterial infection, it is worth limiting visits to public places such as swimming pools or baths.

Doctors emphasize that radiation therapy is a serious burden on the body. Therefore, if any disturbing symptoms appear, you should seek advice from your doctor or nurse. It is also better to coordinate changes in diet and climate with them. It is worth remembering that the danger of the consequences of radiation treatment for basal cell carcinoma remains for the rest of your life.

Medicines used to relieve side effects

To prevent radiation dermatitis, the skin around the basal cell carcinoma is regularly lubricated with Vaseline, metacil emulsion, or treated with a cotton swab moistened with a mixture of Shostakovsky Balsam and vegetable oil (prepared in a ratio of 1:4). Moreover, this should be done from the first irradiation session. If, despite the measures taken, ulcers form, it is necessary to prevent bacterial inflammation. To do this, lotions with solutions of silver or dioxidine are applied to the affected areas of the skin; gels Solcoseryl, Actovegin, Iruksol, and methyluracil ointment are used for speedy healing.

To prevent damage to the mucous membrane, rinsing or washing with chlorhexidine, chamomile or sage decoction is prescribed. Antibacterial drops are indicated for the treatment of conjunctivitis. If it is not possible to avoid exposure to sunlight on the skin of the face or other area of ​​the body where the basal cell carcinoma is located, so-called indurative edema may appear. Its treatment consists of prescribing antibiotics, anti-inflammatory prednisolone and drugs to strengthen the vascular wall. To prevent pigmentation, vitamin P (100 mg daily) and ascorbic acid are prescribed.

It is worth noting that with radiation treatment of basal cell carcinomas located on the face, the risk of relapse is higher than in other areas of the skin. According to oncology clinics in Russia and foreign countries this probability is up to 30%. It is particularly difficult to target tumors localized on a textured surface, since radiation is unevenly absorbed by cells. Severe consequences of radiation therapy are noted in almost 17% of cases. Therefore, a timely visit to the clinic is of great importance, when the area and depth of the lesion allows for the removal of basal cell carcinoma without significant complications.

Good afternoon Please tell me that my friend was prescribed 12 radiation treatments for basal cell carcinoma. But she can't drive every day. Is it possible to carry out this procedure 2 days after 2 days? Is this so important?

All information on the site is presented for informational purposes. Before using any recommendations, be sure to consult your doctor.