Radiation therapy. What is radiation therapy and what are the consequences of it? Radiation exposure

Radiation therapy uses ionizing radiation, usually x-rays, to treat disease. They were discovered in 1895, and since then have been used in medicine for diagnostic and treatment purposes.

What is radiation therapy?

Currently, doctors have accumulated extensive experience in the use of radiotherapy. 4 out of 10 people diagnosed with cancer (40%) are prescribed radiation therapy as part of their treatment. There are several types of it:

1. Remote radiation therapy, when the radiation comes from the outside from the linear accelerator in the form of electrons, less often - protons.

Internal radiotherapy. It can enter the body in the form of liquid and is absorbed by cancer cells. Or radioactive material is placed inside the tumor or in an area near it.

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How radiation therapy works in oncology

Radiation therapy destroys cancer cells in the treated area by damaging the DNA inside them. Although radiation for cancer also affects healthy cells, they, unlike malignant ones, have a greater ability to heal themselves.

The challenge of radiation therapy

An individual treatment plan is developed for each patient. The goal is to provide a high dose of radiation to the tumor and a low dose to surrounding healthy tissue. Healthy cells are able to recover after therapy. So, the goal of treatment is to ensure the maximum likelihood of cure while reducing the risk of development.

Let's take a closer look at how radiotherapy is used in the treatment of malignant diseases.

Radical radiation therapy in oncology

The doctor may recommend radiation therapy to destroy the tumor and rid the person of the disease. This is one of the most important procedures that will help cure the disease. Doctors may call it radical radiation therapy. The length of the course of treatment is determined by the location of the tumor, its type and size. In addition to this type of therapy, others can be used - surgery, treatment with cytostatic agents, hormonal therapy or targeted therapy.

What is radiation therapy for symptom control?

Radiotherapy before surgery

In some cases, radiation therapy is prescribed before surgery in order to reduce the size of the tumor, which will ensure safe and easy removal. This will also help reduce the risk of cancer cells spreading during surgery. This type of treatment is often used for certain types of cancer, such as colorectal cancer. It is also called neoadjuvant treatment or preoperative radiotherapy. Chemotherapy may be given at the same time as radiation.

Radiotherapy after surgery

Radiation for cancer may be prescribed after surgery to eliminate remaining malignant cells from the body - adjuvant therapy or postoperative therapy. This treatment reduces the likelihood of the disease returning. It is often used for malignant diseases of the breast, rectum, head and neck.

Radiotherapy and anticancer drugs

Cytostatic drugs can be prescribed before, during or after a course of radiation for cancer. This combination of these treatments is called chemoradiotherapy. Targeted therapy may also be prescribed along with radiotherapy.

Full body irradiation

This type of treatment is given to patients who are planning a bone marrow or stem cell transplant, such as for leukemia or lymphoma.

Along with chemotherapy, whole-body radiation is given to destroy bone marrow cells. Then a stem cell or bone marrow transplant is performed from a donor or the patient himself.

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Where is radiation therapy performed?

External radiotherapy is usually performed on an outpatient basis in the radiation therapy department of a cancer center.

Specialized equipment takes up a lot of space and requires specially trained staff. There are different types of linear accelerators. The choice for a particular patient is made by a clinical oncologist.

The radiotherapy procedure itself usually does not last more than a few minutes a day. However, it takes some time for the patient to achieve the exact position. An x-ray or scan may be taken before or during therapy to ensure that the radiation will be directed to the desired area.

Where is internal radiation therapy performed?

There are two main types of internal radiotherapy – radioactive implants and radioactive liquids.

Radioactive implants

The oncologist places a radioactive source inside the patient's body - in the cavity of the tumor or in an area near it. The source may be radioactive material in a small sealed metal tube or wire, or small "seeds". If an implant is recommended, treatment will most likely take place in a day hospital setting and will take several hours. Or you may have to stay in the hospital in a single room for several days with the implant. The patient will have to be alone in the room so as not to expose other people to radiation. Once the source is removed, it ceases to be radioactive.

Some types of radioactive "seeds" can be left in the body for a long time because they provide radiation in a small area and lose it over time. Doctors sometimes use this type of treatment in the early stages of prostate cancer.

Radioactive liquids

Treatment of certain types of tumors is carried out using radioactive liquid. This may be a drink or an intravenous injection. The fluid circulates in the bloodstream and is taken up by tumor cells. For some types of cancer, the doctor injects radioactive liquid into the specific part of the body with the tumor rather than intravenously.

After some types of such treatment, hospitalization is required, in a single room for several days. During this time, the level of radioactivity decreases to a safe level. This treatment is used for diagnoses of cancer. thyroid gland or a tumor process that has metastasized to the bones.

With some types of internal radiotherapy, the dose of radiation is so small that you can go home immediately after treatment.

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Who administers radiation therapy?

In the USA, Israel and a number of other countries, specialists in this treatment are called radiation oncologists. In the past, the term used was radiotherapist. In the UK, doctors who specialize in treating cancer using radiotherapy, chemotherapy and other drug treatments are called clinical oncologists.

Team of doctors

The patient works with a multidisciplinary team - a surgeon, radiation oncologists, radiologists (who specialize in interpreting medical images), pathologists, nurses, physical therapists and other specialists.

During radiation therapy, the radiation oncologist plans, monitors, and prescribes treatment. The patient interacts with the rest of the team throughout the course of treatment.

Radiology specialists

Doctors who prescribe and plan radiotherapy interact with scientists who specialize in radiology - medical physicists. They help ensure that radiation therapy equipment is accurate and safe. They also advise on the following issues:

• Which irradiation method should be prescribed?
• How long should the procedure last to receive the correct dose of radiation?

Other staff involved in the administration and planning of radiotherapy under the supervision of medical physicists may be dosimetrists. The patient can interact with the physicist during internal radiation therapy.

Radiation oncologists

Radiation oncologists work with linear accelerators, which deliver radiation. They are well trained in administering radiation therapy, caring for patients, and working with other specialists and medical physicists.

The patient will interact with radiation oncologists during the radiation therapy process. They advise and provide assistance if necessary. Provide advice on how best to manage any side effects.

Patients interact with nursing staff about medications, dressings, and information on how to cope with unwanted effects of treatment as well.

Questions to ask your doctor about radiotherapy:

1. Why is radiation prescribed in my case?
2. What type of radiation therapy will be used?
3. Will this be the only treatment or will other therapies also be used?
4. Is this therapy aimed at curing or reducing the symptoms of the disease?
5. What is the treatment plan?
6. How many treatment sessions will be required?
7. How long will the therapy last?
8. Where will the treatment need to take place?
9. Will I need therapy in the future?
10. What are the possible side effects?
11. Where can I get more information on radiotherapy?

Is it possible to live somewhere during treatment if it is too far to get to the hospital?

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Cancer poses a threat to human health and life and is very difficult to treat. Radiation in oncology is one of the leading methods of combating cancer.

According to medical statistics, today more than 65% of people with cancer need this type of treatment.

Let's figure out what radiation therapy is, how such procedures are done, how long the therapeutic course lasts and how dangerous it is.

The essence of the therapeutic method

Radiation therapy is a technique of exposing a source of ionizing radiation to the focus of pathological growth of cancer cells in order to suppress their vital activity. All human tissues are sensitive to radiation, but in varying degrees.

A characteristic feature of cancer cell structures is that they extremely quickly carry out the process of replication, that is, duplication. There is such a law: the faster cells divide, the stronger influence radiation on them. This rule formed the basis of the method.

Radiation itself does not kill cells, but has a depressing effect on their genome, DNA helixes, which leads to changes in their structures and stops division. The water contained in the cell undergoes radiolysis, molecular bonds are broken, disturbances occur at all stages of metabolic processes, and the structure is destroyed.

Radiation or radiotherapy may be used as the only treatment option oncological diseases, or may be part of a treatment complex. In this way, doctors try to reduce the tumor before surgery. Radiation exposure is also used after surgical intervention to destroy any abnormal cells remaining in the lesion.

In palliative medicine, radiation therapy is used in the terminal stages of cancer, when the tumor gives multiple metastases and becomes inoperable. Irradiation can relieve a person of intense pain and improve his overall health.

Before radiotherapy, a comprehensive examination is carried out, and various diagnostic techniques are used. Based on the nature, location of the tumor, and the stage of development of the oncological process, specialists determine the type of intervention necessary in a particular case.

To calculate dosages and select the type of radiation therapy, doctors assess the general condition of the patient, the presence of any pathologies, the characteristics and location of the tumor.

Radiotherapy methods

Several methods have been developed for the action of ionizing radiation on the body in cancer. Radiotherapy is classified according to various criteria. There are different ones. This can be alpha, beta, gamma radiation, x-rays, proton and neutron beams of energy. The name of the treatment methods depends on what type of radiation is used.

Based on the location of the radiation source, methods are divided into remote exposure, brachytherapy and radionuclide method. Each of them has its own advantages and disadvantages.

Remote method

Remote is a method in which the source of ionizing radiation is located at a certain distance from the patient and does not have direct contact with tissues. The effectiveness of treatment and the number of its side effects depend on how many healthy tissues separate the source of radiation exposure and the tumor.

The remote method is used most often in oncology and gives good results. It is universal and can be used for almost any type of cancer. In addition, remote exposure to cancer cells is the most accessible type of radiotherapy existing today.

One of the most promising remote methods is proton irradiation. This technique allows you to very accurately “aim” and destroy tumors, even when they are deep.

A characteristic feature of this type of irradiation is the ability of the proton beam to release the greatest amount of radiation during the last part of the path of charged particles, that is, the maximum dose falls on the lesion.

This property of the proton beam makes it possible to almost completely protect the healthy tissues it passes through on its path. The high cost of equipment does not yet allow the widespread use of this type of radiotherapy.

Contact irradiation

The essence of brachytherapy or the contact method is the introduction of a radioactive element into the tissue of the affected organ or directly into the focus of the pathological process. Most often, iridium-192 or cesium-137 is used for this. Radioactive elements are enclosed in capsules; methods of introducing them in the form of wires, needles, and balls are also used.

Most often, contact radiotherapy is used for cancer of the uterus, prostate, esophagus, eyes, and rectum. The source of radiation radiation can be placed in the cavity of an organ, if its structure allows it, inside the tissues of the affected organ, and even inside blood vessel.

Radionuclide method

This technique is based on the ability of radioactive elements to accumulate in body tissues. Radioactive isotopes of various elements prefer to accumulate in different organs. Scientists know that iodine is mainly accumulated in the tissues of the thyroid gland, and phosphorus - in the bones and spinal cord.

Radiotherapy drugs enter the body through the blood or orally. After completing the full course, calculated using special formulas, the patient accumulates in certain tissues a sufficient amount of radioactive substance capable of destroying cancer cells.

Contraindications for use

Radiation is not carried out if a low level of hemoglobin or negative transformations in the blood composition are detected. It is also unacceptable to use this technique in patients who are in serious condition, as well as in those who have an elevated temperature, febrile symptoms, or severe pathological processes.

Contraindications to the procedure are the active stage of tuberculosis, chronic renal, cardiac, hepatic, pulmonary failure, severe diseases of the central nervous system.

Procedures cannot be performed within three or four months after a heart attack or other serious conditions. It is strictly not recommended to subject pregnant women to such procedures.

Carrying out treatment through irradiation

Let's figure out how radiation therapy works. The average duration of treatment is from one to two months, if the technique is chosen as the leading one in a particular case.

When radiotherapy is carried out before or after surgery to remove a tumor, on average the radiation lasts about two weeks.

The patient is placed in a special chair or couch. The source of ionizing radiation can be either in a static state or constantly moving.

The doctor sets up the equipment, calculating how long the session will last at the selected dose of radiation. As a rule, this time is about half an hour.

During treatment, the patient is alone in the office, communication with the doctor is carried out through a special system. If a person feels severe discomfort, the session can be terminated.

Possible side effects and consequences of radiation

Radiation exposure is dangerous not only for malignant neoplasms, but also for the entire human body, so radiation therapy, of course, has side effects.

In the area or several areas where a beam of destructive radioactive energy was directed, skin burns and multiple small subcutaneous hemorrhages may be observed. Vessels in areas exposed to radiation become fragile. With contact methods of action on the tumor, deep skin damage and the formation of long-healing ulcers can be observed.

Side effects are also due to the fact that remnants of destroyed cellular structures enter the bloodstream. This is the cause of the so-called radiation sickness. It has the following symptoms: general severe weakness, profuse vomiting, loss of hair, extreme fragility of nails, bones, teeth.

When a person is exposed to radiation, the mechanism of hematopoiesis is disrupted, the composition of the blood itself changes, which negatively affects general condition. These functions will be restored, and the negative consequences will disappear if the person has completed a full course of rehabilitation.

Rehabilitation period

Recovery after radiation therapy takes a long time. By destroying a cancerous tumor in this way, a person pays with his health. However, cancer is such a terrible disease that the risk of radiation exposure is much lower than no treatment. After a therapeutic course, people sometimes recover for months or years.

Rehabilitation after radiation therapy includes taking medications, proper nutrition, moderate physical exercise, the use of immunostimulating agents. To recover, a person must completely give up alcohol, tobacco, and drugs.

The diet must include a full set of vitamins, microelements, amino acids, and the intake of nutrients must be balanced. Very often, patients experience a lack of appetite. You should force yourself to eat by force of will, because with adequate nutrition, the body recovers much faster.

It is necessary to give up junk food, eat more vegetables, eat dietary meats and fish, and limit salt intake. Rehabilitation involves taking immunostimulants, vitamins, and medicinal herbal decoctions. This allows you to strengthen your immune system and get rid of radioactive substances faster.

Doctors advise spending as much time as possible outside, in parks and forests, and ventilating living spaces. Because the immune system is in a depressed state, opening the windows, it is necessary to leave the room in order to prevent colds.

Recovery after irradiation includes moderate physical activity, performing simple exercises. Walking, cardio exercises, swimming, and horseback riding are encouraged. In this case, care must be taken to prevent colds and hypothermia.

Pros and cons of radiotherapy

The undoubted advantages are a large percentage of recovery, the ability to reduce the size of the neoplasm before surgical excision, the ability to completely destroy small tumors.

In addition, experts consider the property of radioactive particles to make blood vessels brittle and provoke thrombosis to be an advantage of radiotherapy. A malignant neoplasm ceases to receive nutrition from the damaged vessels surrounding it, therefore it is not able to grow further.

The disadvantages of the technique include multiple negative side effects, transformation of blood under the influence of radiation. For these reasons, patients require treatment after undergoing radiotherapy.

The disadvantages of the technique include the variable sensitivity of tissues to the action of irradiation. Bone structures, cartilaginous tissues, and kidneys are almost resistant. They can be exposed to ionizing radiation, but the fact how long it takes and what doses need to be applied makes irradiation of tumors in these organs extremely dangerous for humans.

Not amenable to radiation treatment and brain tissue, as they have protection in the form of strong cranial bones and the blood-brain barrier.

What are the benefits of using radiotherapy?

Doctors and scientists do not yet know how to completely and permanently overcome dangerous disease. However, the effectiveness of radiation therapy is quite high. Such a complication as re-growth of the tumor is extremely rare, and in most cases it occurs no earlier than 18-20 years after the treatment.

Timely application almost always provides a favorable outcome.

The action of ionizing radiation allows you to completely overcome cancer in initial stages, significantly reduce the likelihood of metastases, destroy abnormal cellular structures that remain even after successful operations.

Palliative medicine will use this method to significantly alleviate the condition of patients, relieving them of severe pain.

Cancers are treated different ways, one of them is the destruction of their cellular structure by exposure to isotopic radiation. Consider the pros and cons of radiation therapy in the treatment of cancer, its effectiveness after surgical removal of tumors.

What it is

A few decades ago, it was noticed that some types of young cancer cells - formed in cancer of the mammary glands, cervix, prostate, brain, etc. - lose the ability to divide and develop when radiation treatment. Consider when this method of therapy is used in oncology and how effective it is.

Radiation therapy in oncology is called treatment when specially created ionizing radiation the doctor acts on the tumor. The main tasks in this case:

1. Violation of the structure of abnormal cells;
2. Suppression of their growth;
3. Slowdown or complete inhibition of the formation of metastases;

When irradiated, cells do not disintegrate, but structure of DNA is broken which makes it impossible for them to function normally. Due to the directivity of the beam, it is possible to deliver the maximum dose exactly to the cancer focus, while minimally affecting the surrounding tissues.

Radiation therapy or radiotherapy in the treatment of cancer is used in combination with chemotherapy and surgery to remove formations. The method has found application outside of oncology, with its help suppress bone growths.

When is it prescribed?

Radiation therapy is the main method prescribed by 65% ​​of people with cancer different types. It shows a good result for malignant cells that are highly sensitive to radiation when there is a high risk rapid growth, as well as with a special location of the neoplasm.

Radiation exposure treats cancer that affects:

• The cervix, body of the uterus and mammary glands in women;
• Larynx, throat, nasopharynx, tonsils;
• Skin (melanoma);
• Prostate in men

Classification

Under the name of radiation therapy, a number of different methods are hidden. Here is the first classification that subdivides this type of treatment according to the effect of radiation:

1. Treatment alpha radiation when Rawdon isotopes are used. The method is widely used, it has a good effect on the central nervous system, thyroid gland, heart muscle.
2. Beta Therapy is based on different isotopes emitting beta particles. Based on the need, interstitial, intracavitary or application therapy is selected.
3. X-ray therapy indicated for skin cancer, tumors on the mucous membranes. The necessary energy is selected based on the localization of the pathology.

Consider the main types of radiation treatment.

Contact radiotherapy

With this method, the source is placed on the tumor itself; it is selected so as to deliver the main dose to the tumor. The contact method is effective for tumors up to 20 mm; it is divided into a number of subtypes:

Remote

Based on the name, the radiation source is located at a distance from the therapy site. Due to the need for high power, gamma radiation is used, thanks to the targeted action of which it is possible to preserve nearby healthy structures without damage.

When the cancer is small, it is treated with ducts and neurons. External beam radiation therapy can be static or mobile. In the second case, irradiation is carried out along the developed trajectory, which gives a greater effect.

Radionuclide

With this radiation therapy, the patient is given special drugs with a radiation effect that affects the foci of cancerous structures. Thanks to targeted delivery of the substance, large doses can be given to tumors without fear of side effects on healthy areas.

One of these commonly used is radioiodine therapy. It is prescribed not only for oncology, but also for endocrine diseases, for example, thyrotoxicosis, which is often found in women. Iodine with isotopes naturally penetrates the thyroid gland and kills some of its cells. They fight bone metastases in a similar way, but they immediately introduce a group of chemical compounds.

Conformal

Complex radiation therapy with three-dimensional planning. Thanks to “smart irradiation,” exactly the required number of charged particles is delivered to the cancer tumor, which gives a predictable result and a high chance of successful treatment after surgery.

Proton

The source is based on protons, accelerated to enormous speeds, which leads to an accurate dosage to the desired depth. As a result, neighboring tissues are practically not affected and there is no scattering of radiation over the surface of the patient’s body.

Intracavity

There are a number of subtypes of this type of radiation therapy. With its help, good prevention is provided during operations and the risk of metastases. The radiating element is inserted into the cavity on the body and left for the estimated time.

Thus, the dosage is maximized in malignant neoplasms. Intracavitary treatment has proven itself in the treatment of cancer of the intestine, uterus and esophagus.

Stereotactic

With the help of such radiation exposure, the duration of therapy is reduced, which is critical for rapidly progressing cancer with metastases. The technique has found application in cancer tumors in the brain and internal organ systems. There is the possibility of precise adjustment in place, with control over changes in location during breathing and other movements.

The death of malignant structures occurs slowly; effectiveness is assessed after 2-3 weeks.

Contraindications

We list cases when radiation therapy treatment is contraindicated and can have negative consequences:

• Severe intoxication with rich external signs and symptoms;
• Heat;
• Multiple cancer lesions causing bleeding;
• Susceptibility to radiation sickness;
• Background diseases that do not allow the disease to be treated in this way;
• anemia;

How is radiation therapy performed?

At the first stage, it is important to establish exactly where the cancerous tumor is located and its parameters. Based on these data, the doctor selects the dose and method of irradiation. During the procedure, the patient must not make even the slightest movements, so radiation therapy is carried out in lying position, sometimes with fixation of the patient. When moving, the dose is transmitted to the surrounding healthy tissues, which are exposed to destructive effects.

You should prepare mentally for the procedure, since modern devices for treating cancer with radiation therapy are large machines that make buzzing sounds, which can frighten even an adult man.

Already at the initial stage, improvements are possible, manifested by pain suppression, but the maximum effect is achieved only with a full course.

How long does the course last?

Radiation therapy treats cancer on an outpatient basis, sessions of 20-50 minutes. Considerable time is spent on correctly positioning the person and positioning the device; the irradiation itself lasts only 1-3 minutes and, by analogy with an x-ray, the doctor leaves the treatment room for this period.

The duration of the course for malignant oncology usually varies from a month to two, sometimes only two weeks are enough, when you only need to reduce the size of the formation to normalize your well-being. Sessions are scheduled every weekday, with a significant dose, it is divided into several visits.

Effects and tolerability

During radiation therapy there is no pain or discomfort; after it, rest for 2-3 hours is recommended so that the body comes to its senses. In addition, this helps reduce the side effects and consequences of such treatment.

As the course progresses, radiation therapy causes the following symptoms:

1. Increased fatigue;
2. Insomnia and mood swings;
3. Local inflammation on the mucous membranes and skin surface;
4. When treating the chest area, shortness of breath, difficulty breathing, and cough are likely to occur.

Among consequences irritations stand out skin, change, colors, structures, etc. All this is reminiscent of a sunburn, only extended over time. Blisters are possible if the affected areas are not disinfected, which means there is a risk of infection.

If radiation therapy is carried out for organs respiratory system , then the consequences appear over the next 2-3 months. The patient develops a cough that does not provide relief, the temperature rises, and there is a general loss of strength and psychological state.

At significant dosages, the following symptoms are observed:

• Hair falls out on the head;
• Vision decreases, hearing deteriorates;
• The heart beats faster;
• The composition of the blood changes;

How to recover after

In order for a patient who has undergone radiation therapy to fully restore strength and health, it takes time and quick result It's not worth counting on. Let's consider the main problems that people face after a course of such treatment for oconology.

Burns

In most cases, the formation of burns is observed from the first days. To minimize them, you should consult with your doctor which cream to apply to the skin after each visit. Usually the drug D-Patentol or similar products are applied that activate the regeneration of the epidermis.

It is not recommended to apply anything to the skin surface before irradiation, as this may reduce the therapeutic effect.

Low white blood cell count

Forming an increase in the number of leukocytes is omitted only after approval by a specialist. In normal mode, you can achieve a similar effect by diversifying your diet and including raw vegetables, buckwheat, and fresh vegetables. Improves blood composition by drinking red juices - pomegranate, beetroot. If dietary changes are ineffective, the use of special medications will be required.

Heat

If during radiation therapy it is fixed elevated temperature, which means that against the backdrop of a weak protective function of the body, an infection has penetrated into it. For quick treatment, it is necessary to determine what the person is sick with and carry out the necessary treatment, combined with radiation. If you have a fever, you must be on bed rest.

Pneumonitis

In case of illness, they are treated with steroids, which allows you to get rid of symptoms within the first two days. In addition, breathing exercises, therapeutic massage, inhalations, etc. will be useful.

Pneumonitis during radiation therapy is treated with an individual approach, taking into account the size and type of tumor, the existence of metastases.

FAQ

People often confuse chemotherapy and radiation therapy, so here are the answers to some frequently asked questions regarding this treatment method.

1. What are the differences between radiation therapy and chemotherapy? These are fundamentally different approaches to cancer treatment. During chemotherapy, the patient takes special medications that destroy malignant structures; radiation therapy uses isotope radiation for this. Today, both techniques are combined with each other and used before or after surgery.
2. Will my hair fall out? Unlike taking drugs, after radiation exposure the patient becomes bald only at the site of its application. Sometimes hair falls out on the head, but only in case of high dosages and a long course. It is better to prepare for the procedure in advance by choosing a hairstyle with short hair. During sessions, it is better to use a special comb that does not damage the hair.
3. Pregnancy and radiation therapy. This technique negatively affects a woman’s reproductive function, so it is recommended not to try to have a child for 2-3 years after treatment. If you successfully defeat oncology, during this period the body will fill all the gaps caused by radiation, which will allow you to get pregnant normally and bear a healthy baby.

Cost of radiation therapy

Prices for a course of radiation treatment for cancer vary significantly, based on the duration of the course, type of exposure, etc. Wherein this procedure is included in the compulsory medical insurance policy and can be carried out free of charge upon reaching your turn, which usually lasts for many months. In addition, state clinics do not have the most modern equipment.

If necessary, radiation therapy is available without a queue in private clinics using more advanced machines, but it costs money. Emergency radiation therapy is also provided there in case of severe pain in incurable patients.

The price of a course of radiation therapy in large cities of Russia - Moscow, St. Petersburg and others - ranges in cost from 10 to 40 thousand rubles, which depends on the phase of cancer development, installed equipment, and duration of treatment.

Radiation therapy (radiotherapy) of malignant tumors is a method of treating cancer using the radioactive properties of certain chemical elements. Most often, isotopes of radium, iridium, cesium, cobalt, fluorine, iodine and gold are used. Good results with this treatment are achieved due to the fact that the beam specifically acts on the DNA of the tumor cell, due to which it loses its ability to reproduce and dies.

The main indications for radiation therapy are various cancer tumors: carcinomas, malignant tumors and benign tumors.

In order to use this treatment method, it is also necessary to take into account a number of factors, such as:

• blood picture
• structure of tumor tissue
• spread throughout the body
• contraindications
• general condition of the patient
• accompanying illnesses

An important aspect in the successful treatment of oncology is a correctly selected course of radiation therapy. In which the radiation dose, the patient’s condition, and the correct diagnosis of the stage of the disease will be taken into account.

The phenomenon of radioactivity was discovered in 1896 by A. Becquerel, after which the process was actively studied by P. Curie. Almost immediately, studies were directed into the medical field. After all, the process had a biological effect. Already in 1897, doctors from France first used radioactivity to treat patients. At the same time, the first results were noticed and the development of the direction began to grow. Today, radiation therapy has taken a strong place in the treatment of cancer. Developed effective methods radiation therapy.

Radiotherapy, radiation therapy - treatment with ionizing radiation

According to the purpose of treatment, they are divided into:

• radical radiation therapy - complete elimination of the tumor followed by recovery;
• palliative radiation therapy - slowing the growth and reproduction of tumor cells in order to prolong human life;
• symptomatic radiation therapy - eliminating pain and discomfort to reduce the patient's physical suffering.

The most common types of radiotherapy by particle type are:

• Alpha therapy - in this case, radon is actively used in the form of baths, microenemas, irrigations and inhalations;
• Beta therapy - the source of this radiation is most radioactive elements (fluorine, cesium, strontium). The tumor is affected by artificially accelerated particles, which stop its development and growth;
• Gamma therapy - or Curie therapy, the main effect is the dose of radiation absorption by the cancerous tumor, the peculiarity is that healthy tissue is minimally damaged;
• Pi-mesonic therapy - the action of negatively charged nuclear particles, is characterized by high bioavailability, i.e. the smallest effective dose;
• X-ray therapy - the impact on the object of x-rays. Due to the fact that these rays do not penetrate deep into the tissue, they are more often used in the treatment of tumors that are located on the surface layers of the organ;

X-ray therapy is one of the methods of radiation therapy

• Proton therapy - the effect of accelerated particles on tumors that are located close to healthy tissues or in hard-to-reach places, such as the treatment of pituitary tumors, due to the high selectivity of the particles;
• Neutron therapy is carried out by intracavitary, interstitial and remote methods. It works most actively in conditions of low oxygen content.

First of all, to use this treatment method, the ability of radiation to cause biological changes in tissues, organs and the body as a whole is determined. Those. How effectively the chosen method reduces the growth and death of tumor cells. In this case, indications for radiation therapy are taken into account.

Sensitivity to radiation, how pronounced the changes in cancer cells are, how they respond to treatment and changes in the radiation dose. It is very important to monitor the process of tumor decay and how it is expressed - in the form of inflammation, dystrophy or necrosis. Based on these data, methods of radiation therapy are selected.

An important factor is the body's response. How quickly he is able to restore the function of a damaged organ. Indeed, with an incorrectly selected dose of radiation, irreversible changes can be obtained; in this case, areas damaged by radiation therapy will be replaced connective tissue, which is not able to perform the functions of damaged tissue.

Types of treatment according to the method of exposure according to the general classification

• internal influence. It is carried out by introducing a radioactive component into the body, depending on the organ in which the tumor cells are located. After that, the substances begin to emit charged particles from the inside.

• external influence. Can be general or local. Lately they are more often choosing local treatment, because it acts directly on the tumor and has less effect on surrounding tissue. Also, this type of influence is used at various distances from the organ. Deep-lying tumors are irradiated at a considerable distance, called external beam radiation therapy (30-120 cm), while, for example, they are treated at a close distance (3-7 cm from the radiation source)

In more detail, these methods are divided into:

• application or contact therapy - refers to external influences, while the radiation source is in maximum contact with the skin;
• intracavitary radiation therapy - refers to internal effects, irradiation is carried out in tubular and hollow openings of the body (uterus, vagina, rectum, bladder);
• external beam radiation therapy - the use of a radiation source at a considerable distance from the surface of the body, refers to the external type;
• internal therapy - the ability of radioactive particles to accumulate in a specific organ is used;
• interstitial treatment - when the tumor is directly exposed to the emitting component, which is introduced inside it.

To successfully eliminate any tumors, the following is used in parallel with radiotherapy:

• chemotherapy (medication treatment);

Chemotherapy after radiotherapy increases survival

• surgical treatment (excision of the damaged area or organ);
• diet (by limiting certain foods).

Preparing for treatment

It is very important that before starting treatment, a set of measures is taken to prepare for therapy.

It consists of several stages:

• volumetric topographic studies of the organ;
• selection and calculation of the optimal radiation dose;
• assessment of technological treatment resources;
• control of radiological data before the start of treatment and during the process.

During a topographic study, using methods such as X-ray, ultrasound, tomography, lymphography, the exact location of the organ, its size, tumor volume, degree of damage and the ratio of healthy and diseased tissue are determined. Based on this analysis, an anatomical map of the site is drawn up, and central position tumors. As a rule, during such an examination the patient is in a position as close as possible to the position in which treatment will be carried out.

The optimal dose of radiation is calculated taking into account the location of the organ, the penetrating ability of the beam, and the absorption properties of the cancer tissue. Based on these data, the equipment, isotope and method of action on the organ are selected. The information obtained is applied to an anatomical map. In addition to the radiation dose, the degree of radiation distribution is also determined at this stage. This task is performed by a specialist engineer-physicist. Calculations are carried out on the basis of special atlases, taking into account all data on the volume and location of the tumor, and on the deflection of the radiation beam of various elements. Only after scrupulous measurements and recording of all data, the doctor makes a decision on treatment in one way or another.

Preparing for radiotherapy for cancer

At the stage of assessing technological resources, appropriate marks are made on the patient’s skin, describing the direction of action of the radiation beam and the movement of the sensor head in relation to the target organ. If necessary, special protective elements are also made individually for each patient. They select all the tools necessary for the work and put them in proper condition.

Lastly, the thickness of the beam relative to the target is calculated. Also, using a gammagram or x-ray, the latest data on the required radiation dose are obtained. During the first therapy session, the dose received and the effectiveness of its effect are studied. During the treatment process, the width of the radiation beam is periodically monitored and changed. In this way, they try to prevent possible negative consequences of radiation therapy.

Contraindications and side effects of radiotherapy

Radiation therapy is contraindicated for:

• General serious condition of the patient with symptoms of intoxication;
• State of fever heat, arterial hypertension;
• Wasting (cachexia);
• A large number of metastases, tumor disintegration, germination into large vessels or organs, widespread spread of the process throughout the body;
• Radiation sickness;
• The presence of severe diseases - myocardial infarction, type 2 diabetes, coronary insufficiency, active pulmonary tuberculosis, renal failure;
• Reduced number of main blood cells - leukopenia, thrombocytopenia, anemia.

Side effects are usually divided into general (those that are common with any radiotherapy) and specific, which are divided relative to the targets of therapy:

Side effects of radiotherapy

• Therapy of bones, pelvis, limbs and spine - osteoporosis, myalgia (muscle pain), sudden changes in blood composition;
• Face, neck - pain while eating, hoarseness in the voice, headaches, loss of appetite, feeling of dry mouth;
• Head - alopecia (severe hair loss with the appearance of bald spots), hearing loss, tinnitus, dizziness and a feeling of a heavy head;
• Organs chest- cough, shortness of breath, myalgia, pain in the mammary glands, difficulty swallowing;
• Abdominal cavity - sudden weight loss, pain, diarrhea, vomiting, loss of appetite, nausea;
• Pelvic organs - menstrual irregularities, intense vaginal discharge, pain and burning when urinating, involuntary urination.

To general side effects include:

• weakness
• nervousness
• arrhythmias
• pain in the heart area
• changes in blood picture

They try to minimize all the consequences of radiation therapy during the treatment process, if possible, for this the patient is given a number of recommendations:

• after the procedure, the patient rests for at least 3 hours;
• a strictly followed diet in order to avoid weight loss;
• the irradiated area must be protected from exposure to ultraviolet radiation;
• clothing, bedding and underwear only made from soft and natural fabrics, so that the skin is protected from irritating factors;
• gargle and gargle with herbal decoctions to eliminate and prevent dry mouth;
• avoid the use of creams, ointments, cosmetics and perfumes;
• do not smoke or drink alcohol;
• before treatment, put your teeth in order (get rid of caries, gingivitis, stomatitis, pulpitis, etc.);
• according to the doctor’s indications, do breathing exercises;
• if possible, spend more time outdoors;
• apply protection to healthy areas that should not be exposed to radiation.

Although modern methods Radiation therapies are designed in such a way that they minimize the negative effects of radiation on the body, but it is still worth adhering to the basic requirements for maintaining your own health.

As for chemotherapy, this method of treatment is also used by many doctors as the main one, while, for example, external beam radiation therapy or application therapy are used in parallel, additionally. The main difference between these methods is in the means of influence. Thus, during chemotherapy, powerful medical supplies, and in radiotherapy they use physical phenomenon- radiation. Using chemotherapy alone is quite difficult to cure the disease completely; the main problem is the acquisition of drug resistance by cancer cells. That is why most specialists use radiation therapy as a basis.

The use of ionizing radiation for the treatment of malignant neoplasms is based on its damaging effect on cells and tissues, leading to their death when appropriate doses are received.

Radiation cell death is primarily associated with damage to the DNA nucleus, deoxynucleoproteins and DNA membrane complex, and gross disturbances in the properties of proteins, cytoplasm, and enzymes. Thus, in irradiated cancer cells, disturbances occur in all parts of metabolic processes. Morphologically, changes in malignant neoplasms can be represented by three successive stages:

1. damage to the tumor;
2. its destruction (necrosis);
3. replacement of dead tissue.

The death of tumor cells and their resorption do not occur immediately. Therefore, the effectiveness of treatment is more accurately assessed only after a certain period of time after its completion.

Radiosensitivity is an intrinsic property of malignant cells. All human organs and tissues are sensitive to ionizing radiation, but their sensitivity is not the same, it varies depending on the state of the body and the action external factors. The most sensitive to irradiation are hematopoietic tissue, the glandular apparatus of the intestines, the epithelium of the gonads, the skin and the bursa of the lens of the eye. Next in degree of radiosensitivity are endothelium, fibrous tissue, parenchyma internal organs, cartilage tissue, muscles, nervous tissue. Some of the neoplasms are listed in order of decreasing radiosensitivity:

• seminoma;
• lymphocytic lymphoma;
• other lymphomas, leukemia, myeloma;
• some embryonal sarcomas, small cell lung cancer, choriocarcinoma;
• Ewing's sarcoma;
• squamous cell carcinoma: highly differentiated, moderately differentiated;
• adenocarcinoma of the breast and rectum;
• transitional cell carcinoma;
• hepatoma;
• melanoma;
• glioma, other sarcomas.

The sensitivity of any malignant neoplasm to radiation depends on the specific characteristics of its constituent cells, as well as on the radiosensitivity of the tissue from which the neoplasm originated. The histological structure is an indicative sign for predicting radiosensitivity. Radiosensitivity is influenced by the growth pattern, size and duration of its existence. Radiosensitivity of cells at different stages cell cycle not the same. Cells in the mitotic phase have the highest sensitivity. The greatest resistance is in the synthesis phase. The most radiosensitive neoplasms that originate from tissue characterized by a high rate of cell division, with a low degree of cell differentiation, exophytically growing and well oxygenated. Highly differentiated, large, long-existing tumors with a large number of radiation-resistant anoxic cells are more resistant to ionizing effects.

To determine the amount of absorbed energy, the concept of radiation dose was introduced. Dose refers to the amount of energy absorbed per unit mass of irradiated substance. Currently, according to the International System of Units (SI), absorbed dose is measured in grays (Gy). A single dose is the amount of energy absorbed during one irradiation. The tolerable (tolerable) dose level, or tolerant dose, is the dose at which the incidence of late complications does not exceed 5%. The tolerable (total) dose depends on the irradiation mode and the volume of irradiated tissue. For connective tissue, this value is taken to be 60 Gy with an irradiation area of ​​100 cm 2 with 2 Gy irradiation daily. The biological effect of radiation is determined not only by the magnitude of the total dose, but also by the time during which it is absorbed.

How is radiation therapy performed for cancer?

Radiation therapy for cancer is divided into two main groups: remote irradiation methods and contact irradiation methods.

1. External beam radiation therapy for cancer:
   • static - open fields, through a lead grid, through a lead wedge-shaped filter, through lead shielding blocks;
   • mobile - rotary, pendulum, tangential, rotational-convergent, rotary with controlled speed.
2. Contact radiation therapy for cancer:
   • intracavitary;
   • interstitial;
   • radiosurgical;
   • application;
   • close focus x-ray therapy;
   • method of selective accumulation of isotopes in tissues.
3. Combined radiation therapy for cancer is a combination of one of the methods of remote and contact radiation.
4. Combined methods of treatment of malignant neoplasms:
   • radiation therapy for cancer and surgical treatment;
   • radiation therapy for cancer and chemotherapy, hormone therapy.

Radiation therapy for cancer and its effectiveness can be increased by increasing the radiation exposure of the tumor and weakening the responses of normal tissues. Differences in radiosensitivity of neoplasms and normal tissues are called the radiotherapeutic interval (the higher the therapeutic interval, the greater the dose of radiation that can be delivered to the tumor). To increase the latter, there are several ways to selectively control tissue radiosensitivity.

• Variations in dose, rhythm, and exposure time.
• The use of the radiomodifying action of oxygen - by selectively increasing the radiosensitivity of the neoplasm of its oxygenation and by reducing the radiosensitivity of normal tissues by creating short-term hypoxia in them.
• Tumor radiosensitization with some chemotherapy drugs.

Many anticancer drugs act on dividing cells that are in a certain phase of the cell cycle. At the same time, in addition to a direct toxic effect on DNA, they slow down the repair processes and delay the passage of a particular phase by the cell. In the phase of mitosis, which is most sensitive to radiation, the cell is inhibited by vinca alkaloids and taxanes. Hydroxyurea inhibits the cycle in the G1 phase, which is more sensitive to this type of treatment compared to the synthesis phase, 5-fluorouracil - in the S-phase. As a result, a larger number of cells simultaneously enter the mitosis phase, and due to this, the damaging effect of radioactive radiation is enhanced. Drugs such as platinum, when combined with ionizing effects, inhibit the processes of repairing damage to malignant cells.

• Selective local hyperthermia of the tumor causes disruption of post-radiation recovery processes. The combination of radioactive irradiation with hyperthermia can improve treatment results compared with the independent effect of each of these methods on the tumor. This combination is used in the treatment of patients with melanoma, rectal cancer, breast cancer, head and neck tumors, sarcomas of bones and soft tissues.
• Creation of short-term artificial hyperglycemia. A decrease in pH in tumor cells leads to an increase in their radiosensitivity due to disruption of post-radiation recovery processes in acidic environment. Therefore, hyperglycemia causes a significant increase in the antitumor effect of ionizing radiation.

The use of non-ionizing radiation (laser radiation, ultrasound, magnetic and electric fields) plays a major role in increasing the effectiveness of such a treatment method as radiation therapy for cancer.

In oncological practice, radiation therapy for cancer is used not only as an independent method of radical, palliative treatment, but also much more often as a component of combined and complex treatment (various combinations with chemotherapy, immunotherapy, surgical and hormonal treatment).

Alone and in combination with chemotherapy, radiation therapy for cancer is most often used for cancer in the following locations:

• Cervix;
• leather;
• larynx;
• upper esophagus;
• malignant neoplasms of the oral cavity and pharynx;
• non-Hodgkin's lymphomas and lymphogranulomatosis;
• inoperable lung cancer;
• Ewing's sarcoma and reticulosarcoma.

Depending on the sequence of application of ionizing radiation and surgical interventions, pre-, post- and intraoperative treatment methods are distinguished.

Preoperative radiotherapy for cancer

Depending on the purposes for which it is prescribed, there are three main forms:

• irradiation of operable forms of malignant neoplasms;
• irradiation of inoperable or doubtfully operable tumors;
• radiation with delayed selective surgery.

When irradiating areas of clinical and subclinical tumor spread before surgery, lethal damage is first achieved to the most highly malignant proliferating cells, most of which are located in well-oxygenated peripheral areas of the tumor, in areas of its growth both in the primary focus and in metastases. Non-reproducing complexes of cancer cells also receive lethal and sublethal damage, which reduces their ability to engraft if they enter a wound, blood or lymphatic vessels. The death of tumor cells as a result of ionizing effects leads to a decrease in the size of the tumor, delimiting it from the surrounding normal tissues due to the proliferation of connective tissue elements.

These changes in tumors are realized only when the optimal focal dose of radiation is used in the preoperative period:

• the dose should be sufficient to cause the death of most of the tumor cells;
• should not cause noticeable changes in normal tissues, leading to disruption of the healing processes of postoperative wounds and an increase in postoperative mortality.

Currently, two methods of preoperative external irradiation are most often used:

• daily irradiation of the primary tumor and regional zones at a dose of 2 Gy up to a total focal dose of 40 - 45 Gy for 4 - 4.5 weeks of treatment;
• irradiation of similar volumes at a dose of 4 - 5 Gy for 4 - 5 days up to a total focal dose of 20 - 25 Gy.

When using the first technique, the operation is usually performed 2 - 3 weeks after the end of irradiation, and when using the second - 1 - 3 days later. The latter technique can only be recommended for the treatment of patients with operable malignant tumors.

Postoperative radiotherapy for cancer

It is appointed for the following purposes:

• “sterilization” of the surgical field from malignant cells and their complexes scattered during surgery;
• complete removal of remaining malignant tissue after incomplete removal of the tumor and metastases.

Postoperative radiation therapy for cancer is usually done for cancer of the breast, esophagus, thyroid, uterus, fallopian tubes, vulva, ovary, kidney, Bladder, skin and lips, with more common forms of cancer of the head and neck, neoplasms of the salivary glands, cancer of the rectum and colon, tumors of the endocrine organs. Although many of the tumors listed are not radiosensitive, this type of treatment can destroy any remaining tumor after surgery. Currently, the use of organ-sparing operations is expanding, especially for cancer of the breast, salivary glands and rectum, which requires radical postoperative ionizing treatment.

It is advisable to start treatment no earlier than 2 - 3 weeks after surgery, i.e. after the wound has healed and inflammatory changes in normal tissues have subsided.

To achieve a therapeutic effect, it is necessary to administer high doses - at least 50 - 60 Gy, and it is advisable to increase the focal dose to the area of ​​​​unremoved tumor or metastases to 65 - 70 Gy.

In the postoperative period, it is necessary to irradiate areas of regional tumor metastasis in which surgery was not performed (for example, supraclavicular and parasternal The lymph nodes for breast cancer, iliac and para-aortic nodes for uterine cancer, para-aortic nodes for testicular seminoma). Radiation doses can be in the range of 45 - 50 Gy. To preserve normal tissues, irradiation after surgery should be carried out using the classical dose fractionation method - 2 Gy per day or in medium fractions (3.0 - 3.5 Gy) with the addition daily dose into 2 - 3 fractions with an interval between them of 4 - 5 hours.

Intraoperative radiotherapy for cancer

IN last years interest in the use of remote megavoltage and interstitial irradiation of a tumor or its bed has increased again. The advantages of this irradiation option include the ability to visualize the tumor and the irradiation field, remove normal tissue from the irradiation zone, and implement the features of the physical distribution of fast electrons in tissues.

This radiation therapy for cancer is used for the following purposes:

• irradiation of the tumor before its removal;
• irradiation of the tumor bed after radical operation or irradiation of residual tumor tissue after non-radical surgery;
• irradiation of an unresectable tumor.

A single dose of radiation to the area of ​​the tumor bed or surgical wound is 15 - 20 Gy (a dose of 13 + 1 Gy is equivalent to a dose of 40 Gy, delivered 5 times a week for 2 Gy), which does not affect the course postoperative period and causes the death of most subclinical metastases and radiosensitive tumor cells that can disseminate during surgery.

With radical treatment, the main goal is to completely destroy the tumor and cure the disease. Radical radiation therapy for cancer consists of a therapeutic ionizing effect on the area of ​​clinical spread of the tumor and prophylactic irradiation of areas of possible subclinical damage. Radiation therapy for cancer, carried out primarily for radical purposes, is used in the following cases:

• mammary cancer;
• cancer of the oral cavity and lips, pharynx, larynx;
• cancer of the female genital organs;
• skin cancer;
• lymphomas;
• primary brain tumors;
• prostate cancer;
• unresectable sarcomas.

Complete tumor removal is most often possible in the early stages of the disease, with a small tumor with high radiosensitivity, without metastases or with single metastases to the nearest regional lymph nodes.

Palliative radiotherapy for cancer is used to maximize biological activity, growth inhibition, tumor size reduction.

Radiation therapy for cancer, carried out primarily for palliative purposes, is used in the following cases:

• metastases to the bones and brain;
• chronic bleeding;
• esophageal carcinoma;
• lung cancer;
• to reduce elevated intracranial pressure.

This reduces severe clinical symptoms.

1. Pain (bone pain due to metastases of breast, bronchial or prostate cancer responds well to short courses).
2. Obstruction (with esophageal stenosis, pulmonary atelectasis or compression of the superior vena cava, lung cancer, ureteral compression with cervical or bladder cancer, palliative radiation therapy often has a positive effect).
3. Bleeding (of great concern and usually seen in advanced cancers of the cervix, uterine body, bladder, pharynx, bronchi and oral cavity).
4. Ulceration (radiation therapy can reduce ulceration on the chest wall for breast cancer, on the perineum for rectal cancer, eliminate bad smell and thus improve the quality of life).
5. Pathological fracture (irradiation of large lesions in the supporting bones, both metastatic and primary in Ewing's sarcoma and myeloma, can prevent a fracture; if a fracture is present, treatment should be preceded by fixation of the affected bone).
6. Relief of neurological disorders (breast cancer metastases to the retrobulbar tissue or retina regress under the influence of this type of treatment, which usually also preserves vision).
7. Relief of systemic symptoms (tumor-related myasthenia gravis thymus responds well to irradiation of the gland).

When is radiotherapy for cancer contraindicated?

Radiation therapy for cancer is not carried out in severe general condition of the patient, anemia (hemoglobin below 40%), leukopenia (less than 3-109/l), thrombocytopenia (less than 109/l), cachexia, intercurrent diseases accompanied by a febrile state. Radiation therapy is contraindicated for cancer with active pulmonary tuberculosis, acute myocardial infarction, acute and chronic liver and kidney failure, pregnancy, severe reactions. Due to the risk of bleeding or perforation, this type of treatment is not performed for disintegrating tumors; not prescribed for multiple metastases, serous effusions in the cavity and severe inflammatory reactions.

Radiation therapy for cancer can be accompanied by the occurrence of both forced, inevitable or acceptable, and unacceptable unexpected changes in healthy organs and tissues. These changes are based on damage to cells, organs, tissues and body systems, the degree of which mainly depends on the dose.

Injuries are divided into reactions and complications based on the severity of their course and the time of their relief.

Reactions are changes that occur in organs and tissues at the end of the course, passing independently or under the influence of appropriate treatment. They may be local or general.

Complications - persistent, difficult to eliminate or permanently remaining disorders caused by tissue necrosis and their replacement with connective tissue, do not go away on their own and require long-term treatment.