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 tumour is not determined;
Tis (in situ) — invasive carcinoma;
T1 — tumour no more than 3 sm;
T2 — tumour more than 3 sm, germinates visceral pleura or is accompanied by atelectasis;
T3 — the tumour of any size germinates pectoral wall, diaphragm, mediastinal pleura, pericardium without involving of cardia, concomitant atelektasis or obstructive pneumonia is possible;
T4 — the tumour 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;
N3
—
defeat
of lymphatic nodes of mediastinum or lungs root on an opposite side;
M0 — remote metastases are absent;
M1 — there are remote 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 T1-2N1M0 — the combined medical treatment: surgical medical treatment (pneumonectomy, lobekctomy, segmentectomy), after operational DGT 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 T3N0-2M0 — complex medical treatment: surgical treatment (the extended and combined operations), postoperative DGT - TBD 40 – 45 Gy, chemotherapy.
Stage III T4N0-3M0, T1-4N3M0 — 1 (2) courses of chemotherapy, radiotherapy DGT 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 of SD 40 Gy.
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
- DGT self-dependent radiotherapy is TBD on a tumour 60-65 Gy (SBD 1,8-2 Gy 5 times per a week);
- combine radiotherapy (DGT 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 DGT 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 DGT (20-40 Gy), palliative chemotherapy.
Radio therapy of stomach cancer
Classification by system of TNM:
Tis - invasive carcinoma (carcioma in situ).
T1 — tumour, is limited by a mucous membrane and submucous layer.
T2 – tumour with deep infiltration, but occupies the less than half of one department of stomach.
T3 — interpenetrating tumour which occupies the more than half of department of stomach, but not more than one department of stomach.
T4 — interpenetrating tumour which occupies more than one department of stomach or spreads on neighbouring structures.
TX — unenough data for estimation of primary tumour.
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 tumour.
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 - remote metastases are absent.
M1 - there are remote 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 cancer of rectum:
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 24-72 hours after.
Stage ІІ - preoperative radiotherapy to TBD 50 Gy ( SBD 2 Gy, 5 times per a week) operative medical treatment 4-6 weeks after.
Stage ІІІ - preoperative radio therapy to SD 50 Gy (25 h 2 Gy 5 times per a week) + operative medical treatment 4-6 weeks after + polychemicaltherapy.
Stage ІV - at presence of solitar metastases in a liver or lungs it is possible oncotomy and (or) polychemicaltherapy.
Radiotherapy of cancer of cervix uteri.
Among the malignant tumours of womanish privy parts takes first seat.
Classification of cancer of cervix uteri TNM:
T0 — a tumour is not determined;
Tis (in situ) — carcinoma of in situ;
T1 — carcinoma is limited by the cervix uteri;
T2 — karcinoma is widespread outside the cervix uteri, does not ainjured the walls of pelvis and/or pass on a vagina to the its lower third, don’t infiltrated or infiltrated parametrium;
T3 — carcinoma is widespread on lower third of vagina and/or spreads to the walls of pelvis, may to arise hydronephrosis (as a result injure ureter by tumour);
T4 — a tumour is widespread on the mucous membrane of urinary bladder or rectum and/or spreads outside a small pelvis;
N0 — there are not metastases in regionar lymph nodes;
N1 — there are metastases in regionar lymph nodes;
M0 — there are not remote metastases;
M1 — there are remote metastases.
Radiotherapy cancer of cervix uteri. In 1938 Tod and Meredіt suggested are performed using point A and point B for irradiating cancer of cervix utery (see fig. 8.2.). Point A is situated on 2 cm of lateral middle axis of uterine channel (primary tumor). Point B is situated thereon level and is remote from the axis of uterus on 5 cm (area of lateral parametrium and lymphatic nodes of lateral wall of pelvis – area of regional metastases).
