X-ray therapy a skin cancer

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

Classification of a skin cancer in system TNM:

Т - a primary tumour, N - metastases in regional lymph nodes, M - the remote metastases.

Т₀ — the tumour is not defined;

Т_{is (in situ)} — carcinoma in situ;

Т₁ — the tumour in diameter up to 2 cm is located superficially;

Т₂ — a tumour from 2 up to 5 cm in diameter or it is insignificant infiltrate derma;

Т₃ — the tumour is more then 5 cm in diameter or is deep infiltrate derma;

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

N₀ — lymph nodes don’t palpate;

N₁ — mobile lymph nodes near the primary tumor;

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

N₃ — immobile lymph nodes on one side or both the sides.

М₀ — the remote metastases are not defined;

М₁ — there are remote metastases.

The skin cancer 1-2 stages the most effective superficial or short-distance X-ray therapy. The field of radiation exposure includes a tumour and surrounding healthy tissues on its perimeter in width of 5-10 mm. The SBD variation within the limits of 4 - 6 Gy, TBD at basaliomes up to 60 Gy, at squamous cell carcinoma up to 70 Gy.

3-4 stages skin cancer of gamma-therapy SBD till 20-30 Gy is better to spend far-distans, and then above a site of the rest of a tumour appoint interstitial method SBD till 60-70 Gy, but results it is better at elctrontherapy.

At inoperable metastases in lymph nodes are used electrontherapy with energy electrons 15-25 mEv the SBD 6 Gy and TBD 60 Gy.

The results of remote-radiotreatment of a skin cancer (to a five years' survival):

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

X-ray therapy cancer of lower lip

The cancer red borders a lower lip is mainly observed at men-smokers of old age. Disease develops gradually, to occurrence of a tumour quite often precedes for a long time not healing cracks, superficial grazes, leukoplacies and others precancers.

The cancer of a upper lip meets very seldom and have good-quality development.

Histological structure cancer of a lower lip mostly squamous-cellular.

Metastasis in submaxillary and submandible lymph nodules, at the later stages extends on lymph nodes of a neck.

Classification cancer of a lip tnm:

Т₀ — the tumour is not defined;

Т₁ — a tumour diameter up to 2 cm, superficial;

Т₂ — a tumour in diameter ups to 2 cm with insignificant infiltration of hypoderma;

Т₃ — a tumour diameter more than 2 cm with deep infiltration of subiculum;

Т₄ — the tumour extends on a bone;

N₀ — lymph nodes do not palpate;

N₁ — mobile lymph nodes on the party of tumor are palpated;

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

N₃ — palpate motionless lymph nodes;

М₀ — metastases are not present;

М₁ — there are remote metastases.

The first and second stages of cancer of lower lip, use short-distance X-ray therapy, interstitial gamma-therapy, electronotherapy, surgical treatment. X-ray therapy provides high percent of treatment of the primary center, and also sufficient functional and cosmetic result. Radio treatment of metastases in lymph nodes not expediently in connection with high resistance, them extract a surgical method after the radio therapy in region the primary’s center.

Sanitation of an oral cavity should precede radiotherapy of the primary center. At short-distance X-ray therapy conditions of an radiation exposure: a voltage 60 kV, amperage -10 mA, SSD 7,5 sm. The field of radiation should include the primary center and 1-2 cm of healthy surrounding tissues. The SBD 3-5 Gy, TBD 60-70 Gy (І - ІІ stages).

Interstitial radiotherapy with closed gamma-preparations (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, use the defence from lead-containing gum. After removal regional metastases of a cancer appoint remote X-ray or gamma-therapy submaxillary, chinal areas at a tangential direction of a radiation: SBD 2-2,5 Gy, TBD 40-50 Gy. If lymph nodes increased than use a radiosurgical method of radiation exposure TBD up to 50 Gy. In such cases, the remote radiation exposure is not spent.

In III-IV, the item of disease is recommended electrono-therapy TBD up to 70 Gy or far-disstans X-ray therapy with following short-distance X-ray therapy or interstitial gamma-therapy. TBD increase till 80-90 Gy. Simultaneously irradiate zones of an arrangement of metastases with doses at 50-60 Gy.

After radiotherapy the first stage of lower lip cancer the recovery is about 90 % of cases, in second stage – about 80-84 % of cases. If metastases are present percent of recovery decreases considerably, life expectancy of the patient is reduced.

Radiotherapy of thyrotoxicosis.

Method of elective accumulation of isotopes use for the treatment of thyreotoxicosis.

Indications: patients with contra-indicated surgical medical treatment, patient with concomitant diabetes, white plagues, with the expressed gemorragicheskim syndrome.

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

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

For medical treatment of diffuse toxic goitre use ¹³¹I.

Computation of the therapeutic activity ¹³¹І. By sick thyrotoxicosis of middle weight appoint 2,5 - 3 MBk ¹³¹І on a 1 g tissue of thyroid, by a patient with the serios form of thyrotoxicosis - to 3,5 MBk on a 1 g tissue of thyroid.

Method of medical treatment. To the patient with thyreotoxicosis of middle degree of weight all calculated activity of iodine is appointed singly. By a heavy patient appoint activity valid for one occasion 75-110 MBk every 5-7 days to achievement of sumarnoy computation activity ¹³¹І or appoint activity valid for one occasion 35-70 MBk with an interval one month to achievement of total activity 220 MBk.

Scheduling of treatment of malignant new growths located deeply in an organicm. The plan of treatment of malignant new growths make according to structure of a rate of radiotherapy sees above.

In the preradio period after detailed inspection of the patient, define a histological structure of a tumour. At presence of a malignant tumour define indications and exclude contra-indications for radiotherapy then define a kind and a method of radiotherapy. Depending on histological structure, the sizes of a tumour, a stage of its development, and depth of an arrangement define optimum the SORT and TBD (section see „doses of radiations which use for treatment of malignant diseases”). Calculation deep local doses carry out on a schematic cut of a body of the patient, the quantity and the sizes of skin fields is defined and choose an optimum mode of an radiation exposure (section see „ways of leading of a dose to the center and a rhythm of an radiation exposure”).

In the radio period spend radiation exposure of the patient, at need apply additional methods of treatment and observe of a condition of the patient.

In postradio the period estimate results of treatment and spend periodic the dispensary-control.