Treatment of a breast cancer

Stage in situ T_{is or 0}N₀M_0—surgical treatment — a sector resection of breast.

Stage I T₁N₀M₀, T₂N₀M₀ (the tumor is less 3 cm) — the combined medical treatment: 1)Mastectomy with postoperative distant (external beam) gamma-therapy (EBGT) on a way lympho-current, TBD 40 Gy; 2) organ-safe operation, EBGT in a mode fractional tangential fields (4 – 5 filds in the sizes 10х15 cm) on breast TBD 50 Gy and locally on afteroperation scar TBD 60 Gy, polychemotherapy.

Stage II T_1-2N₁M₀ — the combined medical treatment: mastectomy, postoperative rate EBGT on a way lympocurrent TBD 40 Gy, polychemotherapy.

Stage II T₂N₀M₀ (the tumor is more 3 cm) — the combined treatment: mastectomy, postoperative EBGT on a way lympocurrent TBD 40 Gy, polychemotherapy.

Stage III T₃N_0-3M₀ — the combined treatment: preoperative EBGT the SBD 5 Gy, TBD 25 Gy on a mammary gland, the SBD 5 Gy, TBD 20 Gy on axillary area tangential fields (2 fields in the sizes 9х10 cm), mastectomy, EBGT in a mode fractional on a way lympocurrent TBD 40 Gy and on area postoperativ ridge TBD 40 Gy.

Stage IV T₄N_1-2M₀ — the combined treatment: preoperative EBGT the SBD 2 Gy, TBD on a mammary gland 60 Gy, on a way lymph outflow - TBD 40 Gy, mastectomia, polychemotherapy.

Radiotherapy of lung cancer

In the structure of oncologic diseases of lung cancer occupies the first – the second place.

The following clinical forms of lung cancer are distinguished:

Central cancer:

а) endobronchial; б) exobronchial; в) peribronchial.

Peripheral cancer:

а) spherical; б) cavitar.

Untypical forms:

а) cancer of apex of lung ( Penkosta cancer); б) mediastinal cancer; в) miliar carcinosis.

Classification of lung cancer by system of TNM:

T₀ — a primary tumor is not determined;

T_{is (in situ)} — invasive carcinoma;

T₁ — tumor no more than 3 sm;

T₂ — tumor more than 3 sm, germinates visceral pleura or is accompanied by atelectasis;

T₃ — the tumor of any size germinates pectoral wall, diaphragm, mediastinal pleura, pericardium without involving of cardia, concomitant atelektasis or obstructive pneumonia is possible;

T₄ — the tumor of any size spreads on surrounding organs, can be accompanied by malignant pleural exudate.

N₀ — the signs of metastasis in regionar lymphatic nodes are absent;

N₁ — defeat of lung lymphatic nodes on the side of defeat;

N₂— defeat of lymphatic nodes of mediastinum on the side of defeat or bifurcation lymphatic nodes;

N_{3 —} defeat of lymphatic nodes of mediastinum or lungs root on an opposite side;

M⁰ — distant metastases are absent;

M₁ — there are distant metastases.

Indications to radiotherapy: central and peripheral lung cancer.

The non-small cellular lung cancer:

Stage I T₁-₂N₀M₀ — surgical medical treatment (lobectomy, segmentectomy).

Stage ІІ T_1-2N₁M₀ — the combined medical treatment: surgical medical treatment (pneumonectomy, lobekctomy, segmentectomy), after operational EBGT SBD 2 – 2,5 Gy to TBD 40 – 45 Gy, the radiation exposure on the areas of regionar metastases (2 – 3 fields - parasternal, paravertebral and lateral), chemotherapy.

Stage ІІІ T₃N_0-2M₀ — complex medical treatment: surgical treatment (the extended and combined operations), postoperative EBGT - TBD 40 – 45 Gy, chemotherapy.

Stage III T₄N₀-₃M₀, T_1-4N₃M₀ — 1 (2) courses of chemotherapy, radiotherapy EBGT palliative TBD 40 Gy, radical TBD 65 – 70 Gy by the shallow fractionating depending on prevalence of process;

Stage IV T₁-₄N₀-₃M₁ — palliative or symptomatic chemical-radio therapy TBD 40 Gy.