X-ray therapy a skin cancer

Histological forms – squamous cell carcinoma, basal cell carcinoma – basalioma is more often.

Classification of a skin cancer in TNM system :

Т - a primary tumor, N - metastases into the regional lymph nodes, M - the distant metastases.

Т₀ — the tumor is not defined;

Т_{is (in situ)} — carcinoma in situ;

Т₁ — the tumor in diameter until 2 cm is located superficially;

Т₂ — a tumor from 2 to 5 cm in diameter or it is minimal dermal involvement;

Т₃ — the tumor is more then 5 cm in diameter or is deep dermal involvement;

Т₄ — the tumor spreads into cartilage, muscles or a bone.

N₀ — lymph nodes don’t palpate;

N₁ — lymph nodes near the primary tumor are not fixed;

N₂ — lymph nodes on the opposite side or on the both sides are not fixed;

N₃ — lymph nodes on one side or both the sides are not fixed.

М₀ — the distant metastases are not defined;

М₁ — there are distant metastases.

The 1-2 stages of skin cancer are the most effective treated with superficial or short-distance X-ray therapy. The field of radiation exposure includes the tumor and surrounding healthy tissues on its perimeter in width of 5-10 mm. The SBD is within the limits of 4 - 6 Gy, TBD for basalioma is about 60 Gy, TBD for squamous cell carcinoma is about 70 Gy.

The 3-4 stages of skin cancer are treated with gamma-therapy; TBD is about 20-30 Gy with external beam gamma-therapy and then interstitial gamma-therapy. Both methods TBD is 60-70 Gy; better results are reached with help of electrontherapy.

Inoperable metastases in lymph nodes are treated by electrontherapy (energy of electrons 15-25 MeV, the SBD 6 Gy to TBD 60 Gy).

The long-term results of treatment of a skin cancer are (according to a five years' survival):

for 1 stage - 97,9 %, for 2 stages of 82,2 %, for 3 and 4 stages- less than 34 %.

X-ray therapy cancer of lower lip

The cancer of lower lip is mainly diagnosed at old age smokers. Disease develops gradually, arises mainly from long-lasting nonhealing labial fissures, leukoplakia and others precancerous lesions. The cancer of a upper lip arises rarely.

Histological form of cancer of a lower lip: approximately 80% is basal cell carcinoma (BCC) and 20% is squamous cell carcinoma (SCC).

Metastases are usually diagnosed in submental and submandibular lymph nodes, rarely in lymph nodes of a neck.

Classification cancer of a lip TNM:

Т₀ — the tumor is not defined;

Т₁ — the tumor is diameter up to 2 cm, superficial;

Т₂ — the tumor in diameter up to 2 cm with insignificant hypodermal infiltration;

Т₃ — the tumor diameter more than 2 cm with deep hypodermal infiltration;

Т₄ — the tumor spread to bone;

N₀ — lymph nodes do not palpate;

N₁ — unfixed lymph nodes on the side of tumor are palpated;

N₂ — palpate mobile lymph nodules on the opposite side or on the both sides;

N₃ — palpate motionless lymph nodes;

М₀ — distant metastases are not present;

М₁ — there are distant metastases.

The 1st and 2nd stages of lower lip cancer: are used short-distance X-ray therapy, interstitial gamma-therapy, electronotherapy, surgical treatment. X-ray therapy provides high percent of recovery and also sufficient functional and cosmetic result. Radiotherapy of metastases in lymph nodes are not reasonable due to their high resistance.

Sanation of an oral cavity should be done before radiotherapy of the primary center. At short-distance X-ray therapy (voltage 60 kV, amperage -10 mA, SSD 7,5 cm). The field of radiation should include the primary focus and 1-2 cm of healthy surrounding tissues. The SBD is 3-5 Gy to TBD 60-70 Gy (І - ІІ stages).

Interstitial radiotherapy with closed gamma-sources (needles, nylon strings with an isotope ⁶⁰Со, etc.) is carried out during 6-8 days by a continuous radiation exposure of a dose 0,3 - 0,4 Gy/h up to TBD 55-60 Gy. For the prevent radiation exposure of surrounding healthy tissues, especially alveolar arch of jaw, are usually used the lead-impregnated rubber. After the regional metastases of a cancer are removed, distant X-ray-therapy have been used on area of submental and submandibular lymph nodes: SBD 2-2,5 Gy to TBD 40-50 Gy. If lymph nodes are increased in size or amount the radiosurgical method of radiation exposure must be used: TBD up to 50 Gy. In such cases, the distant radiation exposure is not applied.

In III-IV stage lower lip cancer is recommended electron-therapy (TBD up to 70 Gy) or external beam gamma-therapy (TBD up to 80-90 Gy). Metastases in regional lymph nodes are simultaneously irradiated by EBGT in a doses up to 50-60 Gy.

The recovery of the first stage of lower lip cancer after radiotherapy is about 90 %, in second stage – about 80-84 %. If metastases are present, the percentage of recovery is significantly reduced.

Radiotherapy of thyrotoxicosis.

Method of elective accumulation of isotopes is used for the treatment of thyreotoxicosis.

Indications: patients with contra-indicated to surgical medical treatment, patient with concomitant diabetes, ulmonary tuberculosis, with the expressed gemorragic syndrome.

Contra-indications: pregnancy and period of lactation, childhood, goitre.

Mass of thyroid in a norm 25 – 30 g. At the diffuse goitre of the second degree mass of thyroid is 50-60 g, third - 80 - 90 g, fourth – 120 – 140g.

The diffuse toxic goitre are treated with ¹³¹I.

Computation of the therapeutic activity ¹³¹І. For patient with moderate thyrotoxicosis need to adminisreting 2,5 - 3 MBk of ¹³¹І per 1 g thyroid mass, by a patient with the serious thyrotoxicosis - 3,5 MBk of ¹³¹I per 1 g thyroid mass.

Radiotherapy of breast cancer

Breast cancer have the second or the third rank among malignant tumors in women.

The breast cancer arises in the one place (monocentric grows). Sometimes there are several separate tumors (polycentric grows). It is injured upper-external breast area (46.8 %), upper -internal area - (11.5 %), lower -external area (7.9 %), area of thele (7.2 %) and lower-internal area (3.8 %).

The basic forms of a breast cancer- central and infiltrative. Clinical forms 1) mastitis-like cancer; 2) erysipelatous cancer; 3) testaceous cancer; 4) Pagets cancer; 5) a cancer of milk ducts; 6) a cancer of an additional segment of a mammary gland.

Distinguish following histologic forms of breast cancer: scirrhous carcinoma, solid carcinoma, mucous carcinoma, colloidal carcinoma and the mixed forms.

Classification of a breast cancer in TNM system.

Т₀ — the tumor is not defined;

T_is —epithelial cancer;

Т₁ — diameter of a tumor up to 2 cm, a skin it is not injured, there is no fixing a tumor to a chest wall, there is no retraction of thele;

Т₂ — diameter of a tumor from 2 up to 5 cm, its mobility it is limited, the tumor is partially soldered to a skin with a chest wall a tumor not connected.

Т₃ — diameter of a tumor is more 5 cm, full fixing with a skin (a symptom « orange crust »), incomplete or full fixing of a tumor to a chest muscle, but there is no fixing to a chest wall.

Т₄ — diameter of a tumor of any size with fixing to a chest wall, a symptom «orange crust».

N₀ —axillary lymph nodes don’t injured.

N₁ — mobile unilateral axillary lymph nodes are palpated.

N₂ — matted axillary lymph nodes palpation on one party.

N₃ — matted unilateral subclavicular or supraclavicular lymph nodes, main succulente.

М₀ — there are no distant metastases.

М₁ — there are distant metastases.

Stage I — Т₁N_0, M ₀; Т₂N₀М₀.

Stage II — Т₁N₁М₀; Т₂N₁М₀.

Stage III — Т₁N₂М₀;  Т₄N₃М₀.

Stage IV — any combination Т and N, including М₁.

Ways metastasis a breast cancer are various. The most widespread is lymphatic way. Breast cancer is more often treated with the combined method of medical treatment.

Radiotherapy of a breast cancer: distant (external beam) X-ray therapy; distant gamma-therapy; megavoltage therapy (radiation exposure brake radiation high energy, fast electrons); interstitial β-therapy (colloidal solution ¹⁹⁸Аu) and gamma-therapy (radioactive needles and granules ⁶⁰Со in nylon thread).