Radiotherapy 1. Radiotherapy indications and contraindications
Very broad indication of radiation therapy, can be divided into "radical" radiation and "palliative" radiation two categories. Irradiation method is divided into two kinds of external irradiation and intracavitary irradiation. Early food special cancer radiotherapy can achieve the same therapeutic effect as surgery. Cervical and upper thoracic esophageal cancer is difficult due to surgery, complications, radiotherapy should be preferred; breast surgery and radiation effects section close to the two methods can be used; surgical treatment of thoracic esophageal carcinoma is better than radiotherapy, should be preferred surgery, except in severe heart, liver, kidney, pulmonary insufficiency, cachexia and distant metastasis outside the wide range of absolute contraindications are not considered feasible and palliative care.
Esophageal cancer radiation therapy 2. esophageal dose
A medium-sensitive esophageal cancer, radical radiotherapy is usually absorbed dose 60-70Gy/6-7 weeks, 5 times per week exposure, absorbed dose per 2GY. Preoperative radiation to shrink tumors, reduce adhesions and improve the rate of local excision to reduce local recurrence. Preoperative use of moderate dose of radiation absorbed dose of 40Gy / (4 weeks / 20), surgical treatment interval of 2-4 weeks. Because the tumor length, tumor invades adjacent organs, lymph nodes near a successful addition to the main foci have residual cancer, postoperative radiotherapy may be considered, tumor absorbed dose reported good effect in more than 60Gy, according to postoperative "precautionary" than the clinical radiotherapy recurrence or lymph node metastasis and radiotherapy effect, and in recent years, high-dose afterloading technique widely used in radiotherapy in esophageal cancer after external beam plus ultra-low dose should not be installed away from the anchor cavity after the supplementary radiation source, the esophageal improved survival after radiotherapy, brachytherapy the total dose should not exceed 20Gy. Hyperfractionated radiotherapy of esophageal cancer is a topic of current research. It has been reported by the primary tumor and adjacent lymph node irradiation 2 times a day, a given 2Gy irradiation and then given to the primary tumor Ono 1.1-1.2Gy irradiation, total dose of the tumor were 62-66Gy/15 Week / 40, survival rate and the rate of local tumor control than the conventional group.
Radiotherapy 3. Radiotherapy and treatment of complications
In radiotherapy, despite treatment efforts designed to reduce the radiation reaction to a tolerable limit, but still occur in different degrees of radiation reaction, the most common is esophagitis, bronchitis, esophageal perforation, radiation dermatitis, radiation pneumonitis and radiation myelitis. Radiation mucositis more in the radiotherapy of 10 times or so there, especially in the esophagus in the upper lesions, due to mucosal edema, occur when swallowing pain, radiotherapy volume of 40Gy occurs around choke being increased, chest pain, mostly occurring radioactive esophagitis, taking mucosal surface anesthetic and a small quantity dexamethasone (dexamethasone) mixed solution can alleviate the symptoms. A few severe cases can be sub-treatment. Such as severe chest pain, cough with fever, there may be thin trachea or mediastinum, radiotherapy should immediately stop taking the appropriate treatment. Prevention is closely observed in the radiation process condition changes. Deep in the ulcer patients to adjust the radiation dose. Radiation exposure occurred in elderly patients with inflammatory lung disease in poor or chronic bronchitis, manifested as cough, shortness of breath, fever, lung and small wet eyes could be heard sounds of these patients when the general illumination area less than 100m2 absorbed dose not more than 50_60Gy, more than 100m2 does not exceed 40Gy, in the event of radiation pneumonitis, should be actively given large doses of antibiotics, vitamins, hormone treatment. Another radiation myelitis reported initially may have numbness, pain, discomfort, gradually increased, paraplegia, the treatment methods to give a lot of vitamins, nutrition preventive measures to avoid the spinal cord mainly by the dose of T too, generally no more than 40_50Gy / 6 Week safer.