Radio therapy of the esohpagus cancer
Classification of the esophagus cancer:
The Stage 0 TisN0M0
The Stage 1 T1N0M0
The Stage ІІ T2 -3 N0-1 M0
The Stage III T3-4 N1-2 M0
Stage ІV any T, any N, M1
A. The Neck and superior thoracic parts of esophagus:
The I-III Stage
- EBGT self-dependent radiotherapy is TBD on a tumor 60-65 Gy (SBD 1,8-2 Gy 5 times per a week);
- combine radiotherapy (EBGT 46-50 Gy + ICGT to TBD 70-75 Gy)
B. The mediothoracic, inferiorthoracic and abdominal parts of esophagus:
The I-III Stage
- The combined radiotherapy: preoperational EBGT in one of variants:
•TBD 40-45 Gy in the classic mode of fractionating (SBD 1,8-2 Gy 5 times per a week). The operation is executed in 2-3 weeks after completion of radio therapy.
• TBD 20 Gy ( on 4 Gy daily during 5 days). Operation 1-2 days after.
Stage IV - the symptomatic operations (gastrostomy), palliative EBGT (20-40 Gy), palliative chemotherapy.
Radio therapy of stomach cancer
Classification by system of TNM:
Tis - invasive carcinoma (carcioma in situ).
T1 — tumor, is limited by a mucous membrane and submucous layer.
T2 – tumor with deep infiltration, but occupies the less than half of one department of stomach.
T3 — interpenetrating tumor which occupies the more than half of department of stomach, but not more than one department of stomach.
T4 — interpenetrating tumor which occupies more than one department of stomach or spreads on neighbouring structures.
TX — unenough data for estimation of primary tumor.
N0 - there are not signs of metastases.
N1 - is present defeat of the lymphatic nodes located in the distance less than 3 by sm from a primary tumor.
N2 - lymphatic nodes which are located along left gastric, abdominal and general hepatic arteries are staggered.
N3 - is present defeat of paraaortal hepatic-duodenal and other mesenterial lymphatic nodes.
NX - insufficiently data for estimation of lymphatic nodes injured.
MO - distant metastases are absent.
M1 - there are distant metastases.
Two variantes of fractionating of dose are used - classic and combined into larger units.
• at the classic fractionating the radiation exposure is conducted 5 times per a week, SBD 2 Gy of TBD 40-45 Gy.
• at the combined fractionating into larger units of dose - SBD 4 Gy daily 5 times per a week, TBD 40 Gy.
Radiotherapy of rectum cancer
Stages of disease:
Stage 0 – TisN0M0
Stage I – T1-2 N0M0
Stage II – T3-4 N0M0
Stage III – any T, N1-2 M0
Stage IV – any T, any N, M1
Medical treatment of rectum cancer:
Stage 0 - transanal or endoscopy oncotomy.
Stage I - preoperative radio therapy by the factions SBD on 5 Gy during 5 days, TBD 25Gy + operative medical treatment in 24-72 hours.
Stage ІІ - preoperational radio therapy to TBD 50 Gy (25 session 2 Gy 5 times per a week) operative medical treatment in 4-6 weeks.
Stage ІІІ - preoperational radio therapy to TBD 50 Gy (25 session 2 Gy 5 times per a week) + operative medical treatment in 4-6 weeks + polychemicaltherapy.
Stage ІV - at presence of solitar metastases in a liver or lungs it is possible oncotomy and (or) polychemicaltherapy.