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Radiation effects for skin cancer on the face. Treatment of skin cancer: evaluation of effectiveness and modern methods of therapy

Doctor of Medical Sciences, Professor Afanasyev Maxim Stanislavovich, oncologist, surgeon, expert in photodynamic therapy of basal cell carcinoma.

Basalioma, or basal cell skin cancer, is a complex disease. Medicine offers many treatment methods, but all of them are traumatic, fraught with the formation of serious cosmetic defects, the development of long-term complications, and none of them eliminates relapses in the future.

Even Hollywood stars, who have access to the most high-tech and expensive treatments, have to undergo treatment for basal cell skin cancer for years. The most famous example is Hugh Jackman. The actor has been fighting the disease since 2013 to save his nose. And so far he has succeeded. But against the backdrop of his sixth relapse, Jackman has a serious risk of losing it.

Unfortunately, they do not guarantee getting rid of basal cell carcinoma forever.

And if even Hugh Jackman, who has access to the most modern medical care, cannot get rid of the problem, then a logical question arises: is this disease treatable? Is it possible to cure basal cell carcinoma?

Is it necessary to remove basal cell carcinoma?, if she doesn't bother?

Many people treat basal cell carcinoma treatment too leniently. Because this form of cancer grows slowly and almost never metastasizes, doctors rarely insist on treatment and usually do not warn about the consequences of failure.

And if for elderly patients such tactics can be considered justified with a stretch, then for young people - and over the past 10 years basal cell carcinoma has become very “younger” - it does not stand up to criticism.

With this approach, the patient does not take his seemingly insignificant disease seriously and decides not to do anything about it. Very often, treatment is limited to the use of so-called “green stuff”.

But I believe that Hugh Jackman is right in his persistent desire to get rid of basal cell carcinoma. And not only because of an aesthetic defect.

Treatment is necessary. Basalioma is a tumor that, although slowly, is constantly growing. It never goes away on its own. Sooner or later, it overcomes the skin, grows into muscles and nerves, penetrates cartilage and irreversibly disrupts the functioning of organs. If basal cell carcinoma is located on the face, it literally destroys it. Basalioma in the area of the eye or nose, growing, can lead to their loss. Over time, basalioma of the head can destroy the skull and grow to the brain.

Need I say that these processes are also extremely painful?

On this stage basal cell carcinoma It is practically impossible to treat, because along with basal cell carcinoma it will be necessary to remove part of the organ or the entire organ.

You need to know the enemy by sight

Before continuing our conversation, I must tell you about one type of basal cell carcinoma that cannot be recognized at the diagnostic stage.

In approximately 6% of cases, treatment of basal cell carcinoma does not have any effect - removal of the basal cell carcinoma ends in relapse, and it reappears in the same place. And after the next removal, the whole process repeats... This form of basal cell carcinoma is called persistently recurrent basal cell carcinoma.

Unfortunately, modern medicine does not have a single effective means of combating stubbornly recurrent basal cell carcinoma. The mechanism why it returns has not yet been figured out.

However, even for such a head start on basal cell carcinoma, the founder of PDT in Russia, Professor Evgeniy Fillipovich Stranadko, recommends using exclusively photodynamic therapy as the method of choice. Indeed, in case of manifestation of persistently recurrent basal cell carcinoma, it is necessary to repeated treatment, the cosmetic effect of which will depend entirely on the method of its removal chosen at an early stage.

We must understand that any surgical treatment is always a “minus tissue” treatment, a mutilating treatment. Only PDT allows for effective treatment without removing healthy tissue and obtaining an aesthetic result even against the background of persistently recurrent basal cell carcinoma.

Surgery for basal cell carcinoma

Surgical removal of basal cell carcinoma usually performed with a laser, scalpel or radio wave scalpel with the obligatory capture of 5 mm of healthy tissue. Surgical techniques also include the cryodestruction method - removal of basal cell carcinoma with nitrogen, and the Mohs method.

I strongly advise you not to agree to remove basal cell carcinoma with a scalpel - this method usually leaves behind a rough scar.

In the early stages, surgical removal of basal cell carcinoma has a good effect. Therefore, it makes sense to remove very small and accessible formations up to 2-3 millimeters surgically. I myself prefer this method: the procedure is simple, quick and does not require special rehabilitation.

Disadvantages of the surgical method:

High percentage of basal cell carcinoma recurrence after excision. Advanced basal cell carcinomas, which have managed to grow beyond the skin, recur especially often.

You should not trust information that surgery to remove basal cell carcinoma has a low recurrence rate. This figure is relevant only for small entities. When basaliomas larger than 2-3 mm are removed, usually more than half of them recur.

Difficulty and impossibility of re-treatment due to severe tissue loss.

Recurrence of basal cell carcinoma requires repeated surgery. But after the second or third relapse, surgery is usually impossible: imagine what happens to the area in which, with each removal of the basal cell carcinoma, an additional 6 mm of healthy tissue is removed.

Relapse after surgery occurs in the scar area. This area is almost impossible to treat with PDT. Therefore, in case of relapse of basal cell carcinoma after surgical treatment, you will have practically no alternative method left - only repeat surgery or irradiation.
If the tumor is located on the wings of the nose, on the auricle or in the corners of the lips, if multiple basal cell carcinoma is to be treated, then the surgical method literally turns into a mutilating operation. In these areas, every millimeter of tissue is important, but often, along with the tumor, it may be necessary to remove up to half of the nose or ear, and the lack of tissue cannot be compensated for by plastic surgery methods.
A contraindication to surgery is the location of the basal cell carcinoma in close proximity to the eye - there is a high risk of its loss.

Laser removal of basal cell carcinoma: features of the method and its disadvantages

Laser treatment of basal cell carcinoma is a surgical operation.

Laser removal of basal cell carcinoma has one significant drawback. The fact is that the laser beam does not cut the tissue, but evaporates it, layer by layer. After the laser, only a charred crust remains from the tumor. Thus, “cauterization” with a laser does not make it possible to send the removed tumor for histological examination. Only histology makes it possible to assess the completeness of basal cell carcinoma removal and exclude a more serious form of cancer, which in rare cases is hidden or adjacent to basal cell carcinoma.

This method also has one more drawback. Laser treatment of basal cell carcinoma thermally damages tissue, and such a wound heals with the formation of a scar.

Removal of basal cell carcinoma using Surgitron: features of the method and its disadvantages

Radio wave removal of basal cell carcinoma, or electrocoagulation, or treatment with electric knife,

- another surgical method. In this case, a tip with a thin wire is used to remove the formation. When an electric current of a certain frequency is passed through a wire, it acquires the properties of a scalpel.

Most often, treatment of basal cell carcinoma with radio waves is performed using medical equipment from the American company Surgitron, which gave the method its second name.

This method is good because after its use, tissue remains for biopsy - the pathologist will be able to assess the completeness of basal cell carcinoma removal and rule out a more aggressive form of cancer. The disadvantage of electrocoagulation is the same as that of all surgical techniques - a high rate of relapse for all tumors exceeding 2 mm.

You also need to be mentally prepared for the fact that excision of skin basal cell carcinoma using radio waves leaves behind a scar.

Cryodestruction of basalioma: features of the method and its disadvantages

Cryodestruction, or cryotherapy, is the cauterization of basal cell carcinoma with liquid nitrogen.

The method is cheap and quite widespread. However, you shouldn’t count on a miracle. Removing basal cell carcinoma by cryodestruction has a very serious drawback: the depth of exposure of liquid nitrogen to tissue cannot be controlled. That is, after treating basal cell carcinoma with nitrogen, there is a risk of both leaving lesions in the skin and, conversely, affecting too large areas of healthy tissue. In the latter case, after cauterization of basal cell carcinoma, there is a high probability of developing an extensive scar.

Treatment of basal cell carcinoma with cryodestruction has another drawback. Since the method does not make it possible to assess whether the tumor has been completely removed or not, basal cell carcinoma after cryodestruction may well resume its growth and eventually require repeated removal.

Mohs method: features of the method and its disadvantages

This is a high-tech and expensive treatment method that requires special equipment, special training of the surgeon and the presence of the clinic’s own pathology laboratory. It is designed to achieve high aesthetic results in the treatment of tumors on the face, neck, legs and arms, and genitals.

This is probably the method used to treat Hugh Jackman.

The Mohs operation can be compared (very loosely, of course) to using a slicer: tissue is removed in thin layers, layer by layer, and immediately sent to the laboratory. The procedure is repeated until tumor cells are no longer detectable in the section.

Since the entire operation is carried out under the supervision of a pathologist, there is no need to remove the basal cell carcinoma “involving” 6 mm of healthy tissue.

The operation is highly aesthetic, and if there is a lack of skin in the operated area, it is replaced with implants.

Irradiation of basal cell carcinoma: features of the method and consequences after irradiation of basal cell carcinoma

Radiation, or radiation, treatment methods are used only if there are contraindications to alternative methods. This is the method of choice for complexly located (for example, on the face), deep or too large tumors up to 5 cm that cannot be treated surgically. They are also prescribed to elderly patients with contraindications to surgical treatment.

Since the use of the method is always accompanied by complications, it is used mainly for elderly people over 65 years of age.

Irradiation of skin basalioma is carried out:

using close-focus X-ray therapy,
using gamma rays,
using beta rays (electrons).

The use of a particular method is not always determined by rationality. Close-focus X-ray therapy is presented in every oncology clinic, so most often patients are referred to it. Electronic installations are expensive and complex, so literally only a few clinics are equipped with them.

Let's look at how radiation therapy works on basalioma.

It is believed that treatment of basal cell carcinoma with radiation therapy negatively affects the DNA of tumor cells. Ionizing radiation makes it impossible for them to further divide; after radiation therapy, basal cell carcinoma stops growing and is destroyed over time.

There is often information that radiation treatment of basal cell carcinoma does not have any serious consequences. Unfortunately, this is not true. Irradiation of skin basalioma causes a lot of complications, which impossible to avoid. Therefore, treating basal cell carcinoma with radiation is often comparable to shooting sparrows with a cannon, since the side effects of such treatment often exceed the severity of the disease itself.

This is what a radiation ulcer looks like

If at the beginning of treatment the skin in the training area only turns red and itches, then by the third week of therapy a non-healing bright red ulcer develops. It becomes very easily infected, has an extremely unpleasant odor, and heals with great difficulty only 1.5 months after the end of treatment.

2. A radiation ulcer always heals with the formation of a scar. This creates not only a defect in facial expressions, but also makes it very difficult to treat basal cell carcinoma in case of relapse.

3. It is impossible to predict in advance how radioactive particles will act. On the one hand, therapeutic radiation is aimed at rapidly dividing cells, and this is the main property of malignant neoplasms: radiation damages basal cell carcinoma cells and makes them non-viable.

But on the other hand, radiation exposure itself has high mutagenic properties. Healthy tissue is also exposed to radiation, and the DNA of healthy cells is damaged.

Thus, an initially safe basal cell carcinoma is highly likely to “degenerate” into metastatic forms of cancer – for example, squamous cell skin cancer.

The risk of developing this complication persists for the rest of your life after basal cell carcinoma irradiation. It is for this reason that radiation treatment is not given to patients under 50 years of age. Due to the high risks of complications, radiation treatment is not used for recurrent basal cell carcinoma.

4. If basal cell carcinoma occurs on the head, irradiation leads to hair loss in the affected area, which grows brittle and dull after treatment.

5. The risk of complications increases in proportion to the depth of penetration of basal cell carcinoma and the intensity of radiation.

6. When treating tumors located near the eyes, cataracts may occur.

7. Treatment of basal cell carcinoma with radiation leads to changes in the functioning of the sebaceous and sweat glands in the area of radiation exposure.

8. Anatomically difficult areas are not treated with any of the methods of radiation therapy.

9. With radiation treatment of basal cell carcinomas on the face, the risk of relapse is higher than on other areas of the skin.

This is what a device for close-focus X-ray therapy looks like.

Since the depth of exposure to this radiation ranges from a few millimeters to 7–8 cm, the dosage and number of sessions are calculated individually.

Close-focus X-ray therapy is effective only in the initial stages of basal cell carcinoma and is used only on accessible areas of the skin. For example, the corner of the nose is considered difficult to treat.

This method also has its drawback. X-ray radiation is well absorbed by dense tissues, such as bones. Therefore, when basal cell carcinoma is located close to the bone - in the area of the ears and on the head - electron radiation therapy is recommended.

Electronic therapy for basal cell carcinoma: features of the method and its disadvantages

Beta rays are called electrons. Accordingly, beta ray treatment is called electron therapy.

Compared to X-rays, electron radiation is considered more gentle, selective and highly targeted. Electrons are absorbed by tissues equally and regardless of their density. Unlike X-rays, whose energy is lost with increasing depth, uh The energy of the electron beam increases to a peak at a certain depth and then drops sharply.

All this means that with the correct dose calculation, radiation minimally injures healthy tissue around the tumor. Also, electron therapy allows you to irradiate large areas of skin for multiple basal cell carcinomas.

But electronic therapy treatment also has limitations. On the one hand, this is the high cost of equipment. On the other hand, the technique is indicated in advanced stages - the size of the basal cell carcinoma should be no less than 4 cm2, since the device is quite labor-intensive to set up and does not allow focusing the flow onto a smaller area.

Electron irradiation is also not used to treat basal cell carcinoma in the eye area: modern radiology does not effectively protect the organ of vision.

The main disadvantage of all existing treatment methods is the high risk of relapse. As a result, you have to cut or irradiate again and again. Moreover, each stage of treatment is accompanied by significant loss of healthy tissue and scarring.

The need for deep tissue excision is a critical moment in the treatment of basal cell carcinomas on the face - especially on the nose, ears and corners of the lips, when each recurrence of basal cell carcinoma is accompanied by irreversible loss of a significant part of the organ.

Relapsebasal cell carcinomasin the scar - perhaps the most terrible consequence of treating basal cell carcinoma using classical methods

You need to understand that almost all existing treatment methods lead to the formation of a scar, which is a dense connective tissue, poorly penetrated by blood vessels and poorly supplied with blood. In this case, relapse of basal cell carcinoma occurs in the area of its original localization - that is, always in the scar area.

Unfortunately, in this case, PDT loses its effectiveness - the microcirculation of the rumen does not allow the photosensitizer to accumulate in sufficient concentration. Accordingly, recurrence of basal cell carcinoma in the scar is poorly amenable to any alternative treatment methods other than surgery.

So, having performed an operation to remove basal cell carcinoma just once, you become a hostage to the surgical method.

How to treat basaliomato cure. Treatment of basal cell carcinoma using PDT

PDT is an effective method of relapse-free treatment of basal cell carcinoma in one procedure.

Extensive personal experience in treating basal cell carcinoma using PDT allows me to confidently say that:

PDT in 96% of cases forever eliminates basal cell carcinoma in one procedure,
Photodynamic treatment of basal cell carcinoma shows the highest efficiency among all existing techniques. The method targets cancer cells and fully eliminates them. The risk of recurrence of even large basal cell carcinoma after correct and fully performed PDT is several times lower than from other treatment methods and is only a few percent.
Only the photodynamic method of treating basal cell carcinoma provides the highest aesthetic result: either no scar remains or it is almost invisible.
The method is suitable for the most complex basal cell carcinomas in the nose and eyelids.
PDT shows very good results in the treatment of large basal cell carcinomas.
It has almost no side effects, since healthy cells are not harmed during PDT.

What is the essence of the technique

Photodynamic removal of skin basalioma begins with a dropper - a photosensitizer drug is injected into the patient’s blood, which increases the photosensitivity of tissues. The photosensitizer has the special property of being retained only in old, atypical, damaged and cancer cells.

2-3 hours after injection, the tissues are irradiated with a laser according to a special scheme. The photosensitizer is activated by light and enters into a complex photochemical reaction, which results in the release of toxic compounds and reactive oxygen species that destroy cancer cells.

The duration of the procedure depends on the size and number of tumors and takes from 20 minutes to 2.5 hours.

It is precisely this targeted effect on cancer cells that ensures complete tumor removal and an excellent aesthetic result after the procedure.

Is it that simple?

Of course, the PDT procedure is not at all as simple as it might seem at first glance. To obtain a guaranteed result, it requires very high-quality equipment, the highest craftsmanship, jewelry precision and strictly individual developed treatment plan.

For every patient I I am developing my own treatment protocol, which depends on age, medical history, size and location of the tumor, and concomitant diseases.

I make sure to diagnose and differentiate the tumor:

visual examination with dermatoscopy;
collection of material for cytological evaluation;
taking a fingerprint-smear in the case of an ulcerated form;
taking a biopsy for tumors larger than 5 cm2.

This procedure allows you to accurately diagnose basal cell skin cancer and exclude the more aggressive squamous cell cancer.

Before the procedure, I carefully calculate the dosage of the photosensitizer, as well as the intensity and time of laser exposure. I carefully control the power of laser radiation during the procedure.

Compliance with the PDT protocol and an individual approach allows me to achieve good treatment results of 96% the first time.

By the way, not all specialists trained in PDT are able to trigger the necessary photochemical reaction and achieve a cure.

The photograph shows hyperthermia - a tissue burn that should not occur after a correctly performed PDT procedure. From the reaction of the tissues, I understand that no photochemical reaction occurred in this case, even if before the procedure the patient was injected with a photosensitizer and a laser was used. The treatment result shown in the photograph does not give the right to call it PDT. Therefore, after completion of treatment, the patient will not receive the benefits of the technique that I spoke about above.

The photochemical reaction may be accompanied by whitening of the tissue in the affected area, as shown in the photograph.

On days 14-20, a crust forms, under which epithelization occurs.

Rehabilitation

After the procedure, cyanosis appears at the site of treatment, which becomes covered with a black crust on days 14-20.

If the patient carefully follows the doctor’s requirements in the postoperative period for 4–6 weeks, after the PDT procedure a small and almost invisible scar remains on the skin. If a small basal cell carcinoma is removed, the tumor often disappears without a trace after PDT.

Why is the PDT method poorly represented in Europe and the USA?

This primarily applies to facial skin tumors. Considering that there are basal cell cancers on the skin of the face, radiation therapy provides a high percentage of cures with a good cosmetic effect.

Radiation therapy for skin cancer has the following advantages over surgical treatment: it is a bloodless, painless method of treatment, and provides an excellent cosmetic effect.

Indications for radiation therapy for skin cancer

1) for primary skin cancers;

2) for metastatic skin cancers;

3) for prophylactic purposes after surgery;

4) in case of relapses.

Radiation therapy methods for skin cancer

Fractionated irradiation method. Its essence is this. that over 10-12 days treatment is carried out in relatively fractional doses, and the total dose is brought to 4000 rads.

The fractionated irradiation method has the advantage that tumor tissues are more damaged and healthy tissues are spared more than with older methods; on the other hand, the reactive ability of the tissues surrounding the tumor is preserved, which largely determines the therapeutic effect.

The positive features of the fractionated irradiation method include the influence of the time factor. Extending treatment to 12-15 days ensures that all cancer cells are exposed to x-rays, since during this period all cells go through the mitosis phase and, therefore, are exposed to radiation.

In the literature we have collected on the treatment of skin cancer, a common thread is the idea that all efforts should be aimed at achieving a cure after one course of radiotherapy.

The currently accepted principle for the treatment of malignant neoplasms is to give in one course the maximum dose compatible with the need to spare healthy tissue. Repeated irradiations due to the cumulative effect of X-rays are dangerous - they entail changes in vascularization, damage to surrounding healthy tissue, and cause necrotic changes.

Based on this, fractionated irradiation using a high total dose is recognized as the most effective method that guarantees the elimination of the cancer focus in one course of treatment.

Concentrated short-focus irradiation method according to Shaul. The short-focus irradiation method is based on the principle of creating conditions for the distribution of X-ray energy similar to those found when using radium, despite the fact that the wavelength of these two types of radiation is not the same. From the point of view of modern X-ray biology, the therapeutic and biological effect depends only on the amount of energy absorbed, be it the energy of y-rays or the energy of X-rays. The qualitative side of radiation is not given significant importance.

Based on the equivalence of y- and x-rays, Shaul believes that the greater effectiveness of radium therapy is due only to a more appropriate distribution of 7-rays. It is appropriate to note here that the issue of spatial dose distribution during radiation therapy is extremely relevant, especially in the treatment of malignant neoplasms. The relationship between the energy absorbed by the tumor and adjacent tissues becomes extremely important.

The difficulty with radiation therapy for skin cancer is that the sensitivity differences between tumor cells and surrounding tissue cells are often insufficient. That is why the currently accepted principle of using radiation therapy for malignant neoplasms is based on the desire not only to destroy the tumor as much as possible, but also to spare the surrounding tissue as much as possible.

When radium is applied directly to the affected area, the greatest impact of rays on the site of radium application and minimal impact on surrounding tissues is achieved, since the intensity of the radiation action decreases sharply to the depth and to the periphery.

In this regard, the method of concentrated close-focus irradiation is aimed at creating the same conditions.

According to Shaul, the method he proposed should be an imitation of radium therapy; and indeed, it began to be successfully used instead of radium therapy for some localizations of skin cancer, oral cavity, as well as for malignant melanomas and. Treatment is carried out using a special X-ray tube, in which the anode in the form of a hollow cylinder is brought out.

Radiation therapy for skin cancer with this method is carried out with a single dose of 400 - 800 rads, and a total dose of 6000 - 8000 rads.

Results of radiation therapy for skin cancer

Results depend on:

1) morphological picture;

2) localization and soil on which cancer develops;

3) treatment methods.

Basal cell carcinoma is most successfully cured with radiotherapy. The mixed form is more resistant than the purely basocellular form. Squamous cell carcinoma is the most dangerous form of skin cancer. The success of treatment for this form depends on the timeliness of diagnosis.

In some locations (corner of the eye, ear), the effectiveness of radiation therapy for skin cancer is reduced.

The prognosis sharply worsens with damage to bone and cartilage tissue. This is explained by the fact that bone and cartilage tissue, due to their anatomical and physiological properties, cannot respond to X-ray irradiation with an appropriate reaction.

The soil on which the neoplasm developed also matters. The reason for the worse treatment results for cancer caused by lupus and scars is that the surrounding tissue, being weakened by the underlying disease, is not able to respond with the desired reaction to x-ray irradiation.

The reason radiation therapy for skin cancer fails is that sometimes the proliferation of epithelial tissue in the deeper parts of the tumor stops for a very short time and then resumes again. This may be a result of inappropriate selection of beam quality, inappropriate filtration and dose. To select a carcinicidal dose in relation to deep-lying cells, it is necessary to use filtered beams, appropriate voltage and cross-irradiation. Large doses should be used without damaging normal tissue.

Failure is rare due to the presence of resistant cells, especially in basocellular epitheliomas. It is also necessary to remember that not all cells that make up a malignant neoplasm have the same degree of sensitivity; some cells in the same tumor may be very resistant.

Patients after radiation therapy for skin cancer should be monitored every six months for 5 years. Failure to comply with this rule often leads to serious consequences.

For stages 1 and 2, radiation therapy for skin cancer is carried out under short-focus radiotherapy conditions. A single dose is 300 - 400 rad, the total dose is 5000 - 7000 rad. Doses of 500 - 600 rads per session significantly reduce the treatment time, but leave large changes on the skin, which gives worse results from a cosmetic point of view. Cure in stage 1 is observed in 95-98%, and in stage 2 - in 85-87% of cases.

At stage 3, radiation therapy should be carried out under conditions of deep radiotherapy, on a cesium installation, and in some cases, on a telegamma installation. A single dose should not exceed 250 rads. The question of the total dose is decided in each individual case, depending on the size of the lesion. If radiation therapy alone raises doubts about the possibility of achieving good results, then after the radiation reaction has subsided, surgical or electrosurgical treatment methods can be recommended. At stage 4, treatment (if it can be carried out) must begin with radiation (deep radiotherapy or telegammatherapy).

After radiation therapy, in some cases it is possible to excise the tumor with or without plastic surgery, depending on the condition and location of the pathological process. For x-ray cancer that has developed due to scars, and for recurrent skin cancer after radiation treatment, surgical treatment is indicated. The volume should not be confusing, since tumor growth does not spare the patient and leads to severe disability.

The article was prepared and edited by: surgeon

Radiation in oncology, or radiation therapy, is used to cause the harmful effects of ionizing radiation on cancer cells. As a result, malignant tumors are destroyed at the molecular level. This method of therapy has proven effectiveness and is widely used in medicine. However, the use of radiation in oncology has a number of negative consequences that can manifest themselves both at the beginning of therapy and long after it.

Radiation, or radiotherapy, is used to eliminate tumor formations of malignant and benign origin, as well as to treat non-tumor diseases when other therapy is ineffective. Most cancer patients with different types of cancer are treated with radiation. It can be carried out as an independent method of treatment or combined with other methods: surgery, chemotherapy, hormone therapy, etc.

The goal of radiation therapy is the penetration of ionizing radiation into the pathological formation and having a destructive effect on it. The effect of therapy is due to the high radiosensitivity of cancer cells. When exposed to radiation, trophic processes and reproductive function are disrupted at the molecular level. This determines the main effect of radiotherapy, since the main danger of cancer cells lies in their active division, growth and spread. After some time, pathological tissues are destroyed without the possibility of restoration. Formations that are particularly sensitive to radiation include lymphomas, seminomas, leukemia, and myelomas.

Reference! During radiotherapy, the negative effects of radiation also extend to healthy cells, but their susceptibility to it is much lower than that of cancer cells. At the same time, the ability to recover in normal tissue is quite high compared to pathological lesions. Therefore, the benefits of the treatment prevail over its possible consequences.

Radiation therapy does not cause organic and functional disorders in organs and is the leading method in the treatment of cancer. It quickly eliminates the symptoms of the disease and increases survival rates. In palliative treatment, it improves the quality of life of seriously ill patients, softening the clinical picture of the disease.

Attention! The age and size of the tumor directly affect the effectiveness of the radiation given. The younger the formation, the easier it is to treat. Therefore, in this case, timely consultation with a doctor is of great importance.

Classification of radiation therapy

With the development of medical technologies, radiotherapy methods are being improved that can significantly reduce the negative consequences of treatment and increase its effectiveness. Based on the source of ionization radiation, the following types of exposure are distinguished:

alpha, beta, gamma therapy. These types of radiation differ in the degree of penetration;
X-ray therapy– it is based on X-ray radiation;
neutron therapy– carried out with the help of neutrons;
proton therapy– based on the use of proton radiation;
pi-meson therapy– a new radiotherapy technique that uses nuclear particles produced by specialized equipment.

Based on the type of radiation exposure to a person, radiotherapy for oncology can be:

external(external) - focused ionized beams are delivered through the skin using a linear accelerator of charged particles. Usually the doctor determines a specific area for exposure, in some cases general body irradiation is prescribed;

internal(brachytherapy) - a radioactive substance is placed inside the formation or nearby tissue, neutralizing pathological cells. This method is effective for oncology of the female reproductive organs, mammary and prostate glands. Its advantages lie in the precise impact on education from the inside, while the negative consequences of treatment are practically absent.

The choice of method is made by the oncologist, based on the location of the tumor. He also develops an individual treatment regimen to obtain maximum results from radiation. In this case, the following types of treatment are available:

in certain situations, radiation therapy completely replaces surgical procedures;

adjuvant treatment - in this case, radiation is used after surgery. This regimen for breast cancer is not only effective, but also organ-saving;
induction therapy (neoadjuvant) - the use of radiation before surgery. Facilitates and increases the efficiency of surgical intervention;
Combination therapy – radiation is combined with chemotherapy. After this, surgery is performed. Combining the three methods allows you to achieve maximum efficiency and reduce the volume of surgical procedures.

Important! Sometimes combining chemotherapy and radiation is enough to cure and surgery is not required (cancer of the lung, uterus or cervix).

To avoid the negative consequences of radiotherapy as much as possible, it is carried out in a targeted manner, avoiding damage to healthy tissue. For this purpose, in the process of preparing for radiotherapy, various methods of visualizing the formation and surrounding space are used.

This causes a direct effect of radiation on the pathological focus, protecting healthy cells. The following methods are used for this:

intensity modulated radiotherapy(RTMI) - modern technology promotes the use of radiation doses higher than with conventional irradiation;
image-guided radiotherapy(RTVK) – effective when used on mobile organs, as well as on formations close to organs and tissues. When combined with IMRT, it delivers the radiation dose as accurately as possible not only to the pathological focus, but also to its individual areas;
stereotactic radiosurgery– precise delivery of radiation doses through three-dimensional visualization. This gives clear coordinates of the formation, after which the rays target it. Known as the Gamma Knife method.

Radiation dose

The negative consequences of radiation directly depend on the dose of ionizing radiation entering the human body. Therefore, at the stage of preparation for therapy, accurate dose calculation is important. When determining an individual treatment plan, a variety of factors are assessed:

size and type of education;
precise placement;
the patient’s condition based on the results of additional studies;
presence of chronic diseases;
previous irradiations.

Taking into account the indicators, medical specialists determine the total dose of radiation for the full course and for each session, their duration and number, breaks between them, etc. A properly calculated dose helps achieve maximum treatment effectiveness with minimal unwanted side effects.

Consequences of radiation in oncology

Tolerance to radiation therapy varies greatly among patients. Some patients experience side effects exclusively during the treatment period, while others develop side effects some time after it. It happens that negative phenomena are completely absent.

Typically, the severity of side effects depends on the duration of radiation and its dose. The location of the cancer, its stage, the patient’s condition, and individual tolerance to the procedure also have an impact.

The general effects of radiotherapy are presented in the following table.

Organs and systems	Consequences
Leather	Soreness, swelling of varying degrees of severity, increased sensitivity, dryness, the appearance of bursting blisters, weeping of the affected area, and when an infection occurs, ulcers form. In complicated cases, non-healing ulcers, atrophy, and thinning of the skin form
Respiratory system	Shortness of breath, nonproductive cough, pneumonia, difficulty breathing
Mucous membranes	Damage to the epithelium of the digestive tract, genitourinary system (during irradiation of the peritoneum and pelvis). There is a disruption in the functioning of these organs
ENT organs	Stomatitis, laryngitis, dryness, pain and difficulty swallowing, swelling
General condition	Chronic fatigue, irritability, sleep disturbance, restlessness, anxiety, hair loss
Digestive system	Nausea, vomiting, diarrhea, loss of appetite, development of colitis, esophagitis, colitis, rectitis, in severe cases, development of fistulas
Circulatory system	Bone marrow dysfunction, reduction of red blood cells, leukocytes in the blood, anemia
Female reproductive system	Manifestations of menopause. Menstrual irregularities, amenorrhea, vaginal narrowing and dryness, sweating, infertility
Male reproductive system	Erectile dysfunction, acute pain during ejaculation (with irritation of the urethra), decreased sperm count
Urological system	Cystitis
Skeletal system	Bone necrosis, inflammation of the periosteum, perichondritis, problems with joints and muscles

The most common negative effect of radiation is hypersensitivity reactions on the skin, similar to a burn. They usually appear two weeks after the start of therapy and heal a month after the cessation of radiation exposure. There are three degrees of damage to the epidermis:

first - slight redness;
the second – redness, peeling, possible swelling;
third – significant redness with weeping peeling, severe swelling.

Attention! When a radiation wound becomes infected, symptoms intensify, swelling and redness increase, an unpleasant odor appears from the affected area, and a high temperature is possible.

Respiratory effects occur with chest irradiation and usually occur within three months of therapy. Disturbances in the circulatory system occur when radiation is exposed to a large area of the body.

A common side effect of radiation therapy is fatigue. General weakness persists for a long time and does not go away after sleep and rest. In some cases it is a consequence of anemia.

Long-term consequences of radiotherapy include:

fibrosis (replacement of affected connective tissue);
dry skin and mucous membranes (eyes, mouth);
oncology (development of secondary formations);
skin pigmentation;
hair loss;
death (with concomitant cardiovascular pathology);
decreased cognitive function.

The occurrence of serious consequences is quite rare and is associated with prolonged exposure to ionizing radiation on the body or concomitant diseases. Usually the manifestations are moderate and disappear over time. The benefits of treatment significantly outweigh the risk of undesirable consequences.

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During and after treatment, the body needs help to rehabilitate. The oncologist prescribes a set of drugs and measures to stabilize the patient’s condition and restore the body’s strength.

For minor skin reactions, hygiene and moisturizing the damaged area with cream is recommended. For severe lesions, hormonal ointment is used. Radiation wounds serve as “entry gates” for infection, so antiseptic treatment with a bandage should be carried out regularly. Clothing should be comfortable and loose, and avoid rubbing the affected areas.

Don't forget about a healthy lifestyle. It is necessary to observe the daily routine, work and rest, perform feasible physical exercises, take walks in the fresh air, gradually increasing the distance.

Nutrition is of great importance; your doctor can recommend a list of foods you want to eat.

Important! During radiation therapy and during the recovery period, you cannot follow a diet!

The menu should be high in calories and high in protein. At the same time, fried, fatty, smoked foods, and alcohol are excluded. It is advisable to include foods rich in vitamins, antioxidants, and plant fiber in your diet. In case of nausea and vomiting, antiemetic drugs are prescribed, in some cases they are taken some time before the start of treatment. It is recommended to drink plenty of fluid, about three liters per day. This helps eliminate intoxication and restore the body.

To get rid of the effects of radiation, physiotherapy (electric and phonophoresis, magnetic therapy) is used; inhalations and special gymnastics are used for respiratory disorders. To improve the general condition and get rid of chronic fatigue, massage sessions are prescribed.

Skin cancer is an oncological pathology that develops on the surface of the skin from atypical cells. The disease is very dangerous, since cancer can penetrate into the deep subcutaneous layers, affecting the vessels and lymphatic ducts through which cancer cells spread throughout the body, provoking the formation of secondary tumors. Treatment of skin cancer should begin immediately, before the malignant process extends beyond one layer of the epithelium and active metastasis begins. Modern methods of treating skin cancer make it possible to achieve long-term remission without the development of severe complications.

When faced with cancerous growths on the skin, patients panic - it would seem like a small lesion, but it poses so many dangers to life and health. The question always arises: is it possible to cure skin cancer, and how to prevent the disease from completely destroying your health.

Oncology specialists say that malignant tumors respond well to treatment, provided... Depending on the stage of skin cancer, treatment is selected and the prognosis of the disease is established.

If the patient seeks help at an early stage, skin cancer can be cured using less aggressive treatment methods that do not have a negative impact on the patient’s general condition. Treatment of skin cancer at stages 1-2 guarantees recovery for 70-90% of patients.

The difficulty in treating skin cancer is that most people do not go to the doctor when small defects appear on the skin, not considering them dangerous. Doctors note that more than a third of patients come for examination with overgrown tumors, often penetrating into internal organs and bone structures.

It is difficult to cure skin cancer if the patient has diseases that are considered contraindications to surgery, radiation therapy and chemotherapy - the main methods of treatment. Therefore, the patient’s condition is first normalized, but this takes a long time, during which the tumor can grow or develop metastases, which significantly complicates treatment.

What methods are used?

Skin cancer can be treated in various ways, which are selected based on the stage of the disease. Experts prefer to use an integrated approach, consisting of alternating or combining several types of treatment.

Surgical treatment

Antitumor treatment includes other drugs:

Temozolomide.
Carmustine.

Complications of chemotherapy:

hair loss;
nausea, vomiting;
headaches, dizziness;
severe weakness;
bleeding gums;
dysfunction of hematopoiesis.

After chemotherapy, the patient needs to drink plenty of fluids and eat well so that the body can recover faster. To relieve intoxication and restore the liver, you must take Gastrosil, Cerucal, Karsil, Essentiale. To strengthen the immune system and speed up the recovery of the body, immunostimulants are prescribed - Polyoxidonium, Interferon, Immunal.

Cryodestruction (liquid nitrogen)

Cryodestruction is the simplest method of treating skin cancer, which involves exposing the malignant tumor to liquid nitrogen. It has been noted that atypical cells, compared to healthy ones, are most sensitive to the effects of low temperatures - all processes in them are disrupted, which leads to the complete destruction of the affected tissues.

Cryodestruction does not require special preparation, hospitalization or anesthesia. The patient only needs to come to the treatment room on the appointed day with a referral from the doctor. The cryodestruction procedure takes several minutes, during which liquid nitrogen is applied to the affected area using an applicator.

To avoid relapse, they move away from the tumor border by 0.5 cm, capturing healthy tissue. Experts recommend doing double freezing for 3-5 minutes in one session, since aggressive types of cancer do not die in one session.

Cryodestruction can be used to treat cancer on the skin of the face and any other parts of the body, since after healing there are no scars left, a short recovery period and rarely unwanted consequences.

The most dangerous complication after a relapse is suppuration under the scab, which occurs when the crust is damaged. To prevent the spread of infection, the doctor removes the scab, treats the affected areas with an antiseptic and applies a bandage with a hypertonic solution.

Photodynamic therapy

Photodynamic therapy for skin cancer () is one of the most modern methods of treating malignant neoplasms. This is a combination of cytostatic and radiation effects directly on the affected area. PDT is included in the treatment of skin cancer at an early stage, which allows you to get rid of the tumor without surgery. At subsequent stages of the disease, photodynamic therapy is performed to reduce the size of the tumor before surgery.

Preparation for photodynamic therapy:

Blood urine tests.
Determination of the exact size and boundaries of the tumor.
Identification of the condition of internal organs.

The PDT procedure begins with the introduction into the body or application of photosensitizing agents with antitumor activity to the tumor. When atypical cells absorb the drug, the malignant focus is exposed to laser beams. Under the influence of light radiation, a reaction is triggered that destroys cancer cells and blood vessels that feed the tumor.

Photodynamic therapy for skin cancer rarely causes complications, since healthy tissue is not exposed to radiation. In rare cases, severe pain or swelling may occur in the affected area, which can be relieved with glucocorticosteroids.

Electrocoagulation

Electrocoagulation is a minimally invasive operation for skin cancer, used only in the early stages of the disease. Electrocoagulation is performed on an outpatient basis using local anesthesia, and a few hours after tumor removal the patient is sent home.

For the procedure, a special device is used with a small loop into which an electric current is supplied. The loop is used to remove skin cancer and 0.5 mm of healthy tissue. Simultaneously with the removal of the tumor, the wound surface and small capillaries are cauterized.

Electrocoagulation ensures rapid healing with minimal risk of infection. In rare cases, severe pain or temporary loss of sensitivity in the skin area may occur after the procedure.

In order for recovery to proceed without complications, it is necessary to treat the wound surface with a manganese solution, avoiding the ingress of water and mechanical stress. After two weeks, complete tissue healing occurs.

Supportive treatments

Skin cancer can be treated not only with basic methods, but also with auxiliary methods. They are usually used in two cases - if the cancer was detected at an early stage or there are contraindications to the main methods of treatment.

Laser removal

Laser cauterization of tumors is carried out in the early stages of development, while there are no metastases. Compared to others, this method of treating skin cancer has a number of advantages - painlessness, absence of scars, short recovery period, antiseptic and immunostimulating effects.

Before performing laser removal, you must complete the following preparation:

get tested;
undergo a biopsy;
determine the boundaries of the tumor.

Laser removal of skin cancer begins with treating the skin with antiseptics and local anesthesia. Laser beams are targeted at the affected area, causing the cancer cells to heat up. At the same time, the proliferation of healthy cells and collagen is stimulated, which leads to an accelerated healing process.

A few days after the procedure, a crust forms on the surface of the wound, which disappears after two to three weeks. To prevent infection, the damaged area must be treated with antiseptics and avoid contact with water and sunlight.

If these rules are not followed, laser removal can cause complications - severe itching, swelling, redness and suppuration of the wound. To cope with inflammation, it is necessary to use steroidal and non-steroidal anti-inflammatory drugs.

Treatment with ointments

If skin cancer is detected at 0-1, treatment can be carried out with ointments that have an antitumor effect. Typically, external agents are used before preparing for surgery or in combination with other methods.

Skin cancer on the scalp is often treated if the tumor has grown into the skull and surgery is not possible. Ointments help stop the progression of the tumor and reduce pain.

To choose which external agent is suitable for the patient, it is necessary to determine the morphological structure of the tumor, its extent and depth.

What ointments can treat skin cancer:

Omain.
5-Fluorouracil cream.
Colhain.
Demecolcine.
Altevir.
Prospidin ointment.

Ointments and creams are used when squamous cell and basal cell skin cancer is diagnosed; treatment of melanoma with external agents is unacceptable due to its high aggressiveness.

Treatment with ointments is carried out in courses, the duration of which is determined individually; on average, the duration of treatment lasts from 4 to 12 weeks. The ointment is applied under an occlusive dressing, on which a ring of zinc ointment is applied to protect healthy areas of the skin. It is recommended to change the bandage 2-3 times a day, and between applications, wipe the affected area with hydrogen peroxide and give the skin a little rest.

After applying the bandage, you may experience mild pain or burning. It is possible to develop local side effects in the form of allergic reactions - itching, swelling, redness, rashes around the tumor.

Electrodissection and curettage

Electrodissection and curettage is a minimally invasive but rarely used procedure for skin cancer. The method is used when it is not possible to carry out treatment in another way, since during the intervention it is not possible to microscopically assess the depth of the tumor and make sure that all cancer cells are destroyed.

Electrodissection and curettage can only be used after a histological examination confirming a high degree of cancer differentiation. For poorly differentiated tumors, curettage is not performed, since the likelihood of relapse is quite high.

During the operation, the doctor uses a loop-shaped blade to cut out the tumor, capturing a small amount of healthy tissue. After removal, the wound surface is cauterized with electric current, paying special attention to the edges and bottom of the wound. Sometimes, after cauterization, the curettage procedure is repeated and the wound is cauterized again. The procedure is repeated up to 3 times. After the intervention, a bandage with antibacterial ointment is applied to the wound.

Bleeding rarely occurs after electrodissection, but due to the aggressive effect on healthy tissue, the patient may experience pain and swelling in the wound area. If the operation was performed by an inexperienced doctor, a scar may remain in the affected area, and if not all malignant cells are removed, the tumor will form again.

Injections of cytostatics into the tumor

Treatment of squamous cell skin cancer and basal cell carcinoma can be carried out with intralesional injections of antitumor drugs. This method is only suitable for tumors in the initial stages of development. Therefore, before a course of therapy, a thorough examination is carried out - ultrasound of the affected area, MRI or CT and biopsy with histological examination.

A three-week course of intralesional injections is recommended, after which tumor regression is observed in 97% of patients. Cytostatic injections are injected directly into the tumor or subcutaneous layers located near the lesion.

During treatment, local reactions may occur - swelling, hyperemia, pain. In the most severe cases, severe necrosis develops, rapidly covering healthy areas of the skin. Therefore, after treatment, it is recommended to apply Solcoseryl or Methyluracil ointment to the affected area.

Disadvantages of a particular therapy method

Each of the methods of treating skin cancer has some disadvantages, so the doctor faces a difficult task - to determine which method of therapy is suitable for a particular patient, how it will affect the general condition of the patient and what complications it may cause.

All surgical methods are considered the most effective for removing a malignant tumor, but skin cancer that is not performed correctly can return and cause a recurrence. Other disadvantages of surgical treatment include postoperative complications - bleeding, suppuration, and cosmetic skin defects.

Treatment of skin cancer with radiation or chemotherapy has a negative impact on the entire body. Common disadvantages of these methods can be identified: a negative effect on hematopoietic functions, severe weakness, and failure of internal organs.

The disadvantages of chemotherapy and radiation include the body's addiction. After each course, an increase in the radiation dose or the use of more powerful antitumor drugs is required. Each subsequent course of treatment is increasingly poorly tolerated, so the patient needs a thorough examination.

Laser cauterization, cryodestruction, electrocoagulation and photodynamic therapy have the least disadvantages. They practically do not cause complications, but they can only be used in the initial stages of cancer.

To treat skin cancer with the most appropriate method, you need to take into account the opinion of not one doctor, but several, so a council of several specialists is assembled - an oncologist, a surgeon, a radiation therapist, an anesthesiologist and others. During the consultation, it is determined which treatment method will be most effective.

Treatment of skin cancer at stages 3 and 4 with metastases to the lymph nodes

Treatment for stage 3 skin cancer, when it appears in regional lymph nodes, begins with surgical removal of the primary tumor, surrounding tissue and lymph nodes. Such operations are extensive; you cannot try to preserve a large amount of healthy tissue, as this is dangerous for the development of relapse.

After surgery, treatment for skin cancer is aimed at preventing recurrence. Depending on the severity of the disease, radiation or chemotherapy is prescribed; in some cases, chemoradiotherapy is performed. One course is not enough; repeated treatment is carried out at intervals of 1-3 months and continues until remission occurs.

When metastases are found in distant areas of the body or bone structures, stage 4 skin cancer is diagnosed, causing severe symptoms, and treatment is only symptomatic.

Palliative treatment of skin cancer

Symptomatic or skin cancer treatment is aimed at making the patient feel better by preventing tumor growth. Typically, symptomatic treatment is carried out at the terminal stage, when many metastases are present in the patient’s body.

What is included in palliative treatment for skin cancer?

- first, non-steroidal anti-inflammatory drugs, when they stop helping, narcotic analgesics are prescribed.
Radiation and chemotherapy help stop the growth of tumors and provide temporary pain relief.
A balanced diet that excludes carcinogenic foods.
Surgeries to eliminate complications - intestinal obstruction, vascular stenosis, renal dysfunction.

Symptomatic treatment includes caring for the patient. At the last stage of cancer, it is necessary to support the patient, respect his opinion, and listen to his wishes. Psychological support helps to normalize the patient’s psycho-emotional state, which is important, since his physical functions are significantly limited.

The effectiveness of treatment depending on the type of tumor

Treatment for skin cancer may differ depending on the morphological structure of the tumor. Therefore, before choosing a therapy tactic, a histological examination of the tumor is carried out to determine its type and degree of cell differentiation.

Treatment of skin basal cell carcinoma can begin with any method, since it is a non-aggressive type of cancer that responds well to all types of therapy. It is noted that treatment at the initial stage of basal cell carcinoma allows for complete recovery in more than 90% of patients. In the later stages, an integrated approach is necessary, since, as basal cell carcinoma grows, it grows into cartilage and bone tissue.

Treatment of squamous cell skin cancer can also be carried out by any method, subject to early diagnosis. For small tumors, it is recommended to perform minimally invasive operations - cryodestruction, laser cauterization or electrocoagulation. With extensive growths, it is impossible to do without surgical removal followed by anti-relapse therapy.

Treatment for skin melanoma always involves surgery, during which the tumor and surrounding healthy tissue are excised with a scalpel. Most experts believe that three-stage treatment is most effective: a course of radiation therapy, a few days later excision of the melanoma, postoperative radiation or chemotherapy.