Radiotherapy in oncology consequences. Radiation therapy in oncology. consequences of radiation therapy. Therapy with open sources of radiation

Content

The history of the development of radiotherapy dates back to the first decade of the 19th century. French scientists A. Danlos and E. Besnier discovered the ability of radioactive substances to destroy young, rapidly developing cells and decided to use this to fight malignant neoplasms. Thus, a method was formed that demonstrates high efficiency to this day. Radiation therapy in oncology is like a mechanic's screwdriver: without it, the treatment of cancer and other dangerous diseases associated with tumors is not possible. More about this in the continuation of the article.

Types of radiation therapy and their features

Thanks to radiotherapy over the past fifty years, medicine has succeeded in the fight against cancer. Scientists have developed many specialized devices that have a destructive effect on the cells of malignant tumors. The modern arsenal of technical means intended for the treatment of oncological diseases includes more than a dozen various devices and devices. Each of them has its own role. As for the concept of radiation therapy, it covers a number of techniques, including:

1. Alpha therapy. As the name implies, it is based on the effect on the human body of alpha radiation. For this, some types of rapidly released and short-lived isotopes are used. It is aimed at normalizing the functioning of the nervous and autonomic systems, restoring the functions of the endocrine glands, stabilizing natural processes in the cardiovascular system, etc.
2. Beta therapy. Biological effects on the body of beta particles. Sources of the active element can be various radioactive isotopes. Demonstrates high efficiency in the fight against capillary angiomas and some eye diseases.
3. X-ray therapy. It implies the use of X-ray irradiation with an energy index from 10 to 250 keV. The higher the voltage, the greater the penetration depth of the rays. X-ray therapy of low and medium power is prescribed for superficial lesions of the skin and mucous membranes. Deep radiation exposure is used to combat pathological foci located deep.
4. Gamma therapy. This technique is prescribed for people who have been diagnosed with malignant or benign oncological tumors. Electromagnetic gamma radiation is emitted due to the de-excitation of cell atoms, which pose a threat to human health.
5. neutron therapy. The technique is based on the ability of atoms to capture neutrons, convert them and emit //-quanta, which have a powerful biological effect on target cells. Neutron therapy is prescribed for patients with severe resistant forms of cancer.
6. proton therapy. A unique technique for the treatment of small oncological tumors. The proton method allows you to influence the foci located in close proximity to critically radiosensitive organs/structures.
7. Pi-meson therapy. The most modern technique in oncology. It is based on the use of the features of negative pi-mesons - nuclear particles produced using special equipment. These particles are distinguished by a favorable dose distribution. Their biological effectiveness leaves far behind all the radiotherapy technologies described above. Pi-meson treatment is currently only available in the USA and Switzerland.

Modern methods of conducting

Methods for conducting radiotherapy are divided into two categories: remote and contact. Remote methods include methods in which the radiation source is located at a certain distance from the patient's body. Contact procedures are called procedures carried out with a dense supply of a radiation source to the neoplasm. Learn more about each of these categories in the table below.

Indications for appointment in oncology

Radiation therapy is a very serious and dangerous method of treatment, therefore it is prescribed in cases of absolute appropriateness, and not otherwise. Treatment with radioactive drugs may be needed for people with problems such as:

• a brain tumor;
• prostate and/or prostate cancer;
• cancer of the breast and chest area;
• lung cancer;
• cancer of the uterus and pelvis;
• skin cancer;
• throat cancer;
• lip cancer;
• a tumor in the abdomen - in the rectum, in the stomach, etc.

How is the course of treatment

After the oncology is detected, the patient undergoes an examination to determine the optimal treatment tactics. First of all, doctors choose a radiation therapy regimen. The average cycle time is 30-50 days. When it comes to planning a surgical intervention to remove a tumor, a short two-week course is prescribed to reduce the size of the neoplasm. After surgery, treatment with radioactive drugs may be needed to deal with residual tumor fragments.

When a patient arrives for a radiation therapy session, they are asked to sit in a special chair or lie down on a table (as shown in the photo). An irradiating device is brought to the previously marked areas of the body. Medical staff set up the device according to the instructions of the doctor and leave the room. The total duration is 20-30 minutes. During this time, the patient should sit still and try to relax. If you experience strong discomfort, you should immediately inform the doctor through a microphone.

How is recovery going?

In the process of treatment with radiological methods, the body is directly exposed to radionuclide particles. Yes, chemotherapy gives a powerful rebuff to cancerous growths, but human health also suffers quite a lot. Free radicals affect not only cancer cells, but also the tissues of internal organs. As a result, radiation sickness develops. After a course of radiotherapy, a general recovery is required to stabilize the condition. The complex of recovery measures after radiation therapy necessarily includes:

1. Medical support. Doctors take note of the intensity of radiation the patient has been exposed to and prescribe special antihistamine/antibacterial drugs and vitamin complexes.
2. Healthy food. Irradiation in oncology disrupts many natural processes in the human body. To normalize them, replenishment of the stocks of useful components is required. Doctors recommend following a diet for at least 6 months after completing a course of therapy. Food should be light and natural. Instead of a frying pan, you should use a double boiler. Fatty foods should be avoided. Specialists in the field of oncology note that fractional nutrition after radiation therapy demonstrates particular effectiveness.
3. Strengthening exercises. Light physical activity is useful for everyone, not to mention people who are faced with oncology, radiology. To improve your condition and avoid complications, play sports. Keep your body in good shape, and rehabilitation will progress much faster.
4. Phytotherapy. Folk herbal decoctions will be a good addition to all the recovery measures listed above after treatment in oncology. The body must receive a wide range of nutrients in order to eliminate the symptoms as soon as possible.

Possible side effects and consequences

The impact of radiation on oncological tumors cannot pass without a trace for the human body. After a course of radiation therapy, patients may experience the following side effects and complications:

• deterioration of the general condition, accompanied by fever, weakness, dizziness, short-term nausea when swallowing;
• dysfunction of the gastrointestinal tract;
• dysfunction of the cardiovascular system;
• hematopoietic disorders;
• irritation on the mucous membranes;
• hair loss;
• pain and swelling at the site of radiation therapy.

In some patients, exposure to radiation can be tolerated with minimal complications and local side effects. After skin treatment, dryness of the epidermis, slight itching and peeling often appear. The intracavitary procedure may cause mild to moderate metabolic disturbances. After irradiation of tumors localized deep inside, muscles often hurt.

Contraindications to radiation exposure

Radiation therapy in oncology is an indispensable tool, however, not all people can expose themselves to such tests. Contraindications are the following factors/conditions/diseases:

• anemia;
• low level of leukocytes in the blood;
• decrease in the number of platelets;
• cachexia;
• allergic dermatitis;
• pulmonary / heart failure;
• myocardial infarction;
• kidney disease;
• diseases of the central nervous system;
• decompensated diabetes mellitus.

Radiotherapy is a method of treating oncological diseases based on the use of ionizing radiation. It was first applied in 1886 to an Austrian girl. The impact turned out to be successful. After the procedure, the patient lived for more than 70 years. Today, the considered method of treatment is widespread. So, radiation therapy - what is it, and what consequences can a person exposed to radiation have?

Classical radiation therapy in oncology is carried out using a linear accelerator and is a directed effect of radiation on tumor cells. Its action is based on the ability of ionizing radiation to influence water molecules, forming free radicals. The latter break the DNA structure of the altered cell, and makes it impossible to divide.

It is impossible to outline the boundaries of the action of radiation so precisely that healthy cells are not affected during the procedure. However, normally functioning structures divide slowly. They are less affected by radiation and recover much faster after radiation damage. The tumor is not capable of this.

Interesting to know: the effectiveness of radiotherapy increases in proportion to the rate of tumor growth. Slowly growing neoplasms react poorly to ionizing radiation.

Classification and exposure dose

Radiotherapy is classified according to the type of radiation and the way it is delivered to the tissues of the neoplasm.

Radiation can be:

1. Corpuscular - consists of microparticles and, in turn, is divided into alpha type, beta type, neutron, proton, formed by carbon ions.
2. Wave - formed by X-rays or gamma rays.

According to the method of delivering radiation to the tumor, therapy is divided into:

• remote;
• contact.

Remote techniques can be static or mobile. In the first case, the emitter is stationary, in the second case it rotates around the patient. Mobile methods of external influence are more sparing, as they affect healthy tissues less. The sparing effect is achieved due to the changing angles of incidence of the beam.

Contact radiation therapy can be intracavitary or intrawound. In this case, the emitter is introduced into the patient's body and brought directly to the pathological focus. This allows you to significantly reduce the load on healthy tissues.

During treatment, the patient receives a certain dose of radiation. Radiation exposure is measured in grays (Gy) and is selected before the start of therapy. This indicator depends on many factors: the age of the patient, his general condition, the type and depth of the tumor. The final figure differs in each case. For example, the load needed to treat breast cancer varies from 45 to 60 Gy.

The calculated dose is too large and cannot be given at once. To make the load acceptable, specialists carry out fractionation - dividing the required amount of radiation by the estimated number of procedures. Usually the course is held for 2-6 weeks, 5 days a week. If the patient does not tolerate treatment well, the daily dose is divided into two procedures - morning and evening.

Indications for appointment in oncology

A common indication for radiation therapy is the presence of malignant neoplasms. Radiation is considered an almost universal method of treating tumors. The impact can be independent or auxiliary.

Radiotherapy performs an auxiliary function if it is prescribed after the surgical removal of the pathology focus. The purpose of irradiation is the elimination of altered cells remaining in the postoperative zone. The method is used in conjunction with chemotherapy or without it.

As an independent therapy, the radiological method is used:

• to remove small, intensively growing tumors;
• inoperable tumors of the nervous system (radioknife);
• as a method of palliative treatment (reducing the size of the neoplasm and alleviating symptoms in hopeless patients).

In addition to the above, radiation therapy is prescribed for skin cancer. This approach avoids the appearance of scars at the site of the tumor, which is inevitable if the traditional surgical method is used.

How is the course of treatment

A preliminary decision on the need for radiotherapy is made by a doctor involved in the treatment of oncology. He refers the patient to a consultation with a radiologist. The latter chooses the method and determines the features of the treatment, explains to the patient the possible risks and complications.

After the consultation, the person undergoes computed tomography, which determines the exact localization of the tumor and creates its three-dimensional image. The patient should remember the exact position of his body on the table. It is in this position that therapy will be carried out.

The patient enters the radiological room in a loose hospital gown. It is located on the table, after which the specialists put the equipment in the required position and put marks on the patient's body. In subsequent procedures, they will be used to configure the equipment.

The procedure itself does not require any action from the patient. The person lies in a predetermined position for 15-30 minutes, after which he is allowed to stand up. If the condition does not allow this, transportation is carried out on a stretcher.

Note: to fix the patient's body in a given position, various external structures can be used: head masks, Shants collars, mattresses and pillows.

Effects of radiation therapy and side effects

As a rule, the dose of radiation is selected in such a way as to minimize the effect on healthy tissues. Therefore, the negative effects of therapy occur only with multiple long sessions. One of the most common complications in this case is radiation burns, which can have 1st or 2nd degree of severity. Treatment of uninfected burns is carried out using regenerating ointments (Actovegin, Solcoseryl), infected - with antibiotics and local antimicrobial agents (Levomekol).

Another common side effect of radiotherapy is nausea due to high doses of radiation. You can reduce it if you drink hot tea with lemon. Cerucal is a drug remedy for correcting the condition. Other effects are less common.

Patients complain about:

• fatigue;
• alopecia (hair loss);
• puffiness;
• skin irritation;
• inflammation of the mucous membranes.

The side effects on the list are difficult to treat if it is carried out against the background of an incomplete course of radiotherapy. They pass on their own some time after the treatment is completed.

Nutrition during radiation therapy

Exposure to radiation leads to the gradual destruction of tumor tissue. Decay products enter the bloodstream and cause intoxication. To remove it, as well as minimize the negative impact of the procedures, you need to eat right.

Nutrition during radiation therapy should be carried out in accordance with the principles of healthy eating. The patient should consume up to 2 liters of liquid (compotes, juices, fruit drinks) per day. Food is consumed fractionally, up to 6 times a day. The basis of the diet should be protein foods and foods rich in pectin.

• egg;
• seeds;
• sea ​​fish;
• cottage cheese;
• fruits and vegetables;
• berries;
• greens.

Interesting to know: radiotherapy will be better tolerated if the patient daily eats a large baked apple with honey.

Recovery period

The recovery period usually passes without the use of drugs. If the treatment was successful and the tumor was completely removed, the patient is recommended to lead a healthy lifestyle: giving up bad habits, psychologically comfortable environment, sufficient rest time, good nutrition, moderate physical activity. In such conditions, rehabilitation takes several months. During this time, a person visits a doctor several times and undergoes an examination.

If therapy was carried out with a palliative purpose, there is no talk of recovery as such. The patient is prescribed antibacterial agents, analgesics, provides him with good nutrition. It is better if a person is surrounded by relatives and relatives, and not in a hospital.

Radiation therapy is a modern and highly effective way to treat tumors. With early detection of a pathological focus, radiation can remove it completely, with inoperable neoplasms, it can alleviate the patient's condition. However, this method should be treated with caution. Its improper use negatively affects the patient's well-being.

Radiation therapy rightfully occupies one of the main places in the treatment of malignant tumors of various organs and tissues. This method can significantly increase the survival of patients, as well as alleviate their condition in the case of advanced stages of the disease.

The discovery of X-rays was a real breakthrough in medical science, because it became possible to “see” the body from the inside, to find out how already known diseases of various organs and systems “look like”. Inspired by the possibilities of using X-rays and experiencing a feeling akin to euphoria, scientists began to use it not only for diagnostic purposes, but also for treatment. So it became known about the detrimental effect of x-rays on tumors, which decreased in size, and patients felt significant relief.

However, the reverse side of the coin was the numerous complications and radiation reactions that inevitably haunted irradiated patients. Information about the negative effect of ionizing radiation on healthy tissues was accumulating, and criticism of the method was growing. For some time, the use of radiation therapy was significantly reduced, but the ability to fight malignant tumors, the number of which only increased every year, did not allow completely abandoning radiation. Fighting for the possibility of safe radiation therapy in oncology, physicists, radiologists, together with doctors, developed new devices and methods of irradiation that would reduce radiation exposure, and, therefore, the likelihood of side effects, making treatment both effective and safe.

Today, radiation therapy is considered one of the main methods of cancer treatment, and in some cases it allows you to refuse surgery, leading to a complete cure. The number of side effects has significantly decreased due to the possibility of targeted action of radiation on the tumor tissue, as well as the use of not only X-rays, but also beams of elementary particles strictly aimed at the tumor. In most cases, such treatment is well tolerated by patients, however, there are still some rules and lifestyle features, and we will consider them further.

Types of radiation therapy and their features

Radiotherapy involves the impact of various types of ionizing radiation on tumor tissue. Since cancer cells divide very quickly, they are very sensitive to various kinds of physical influences. Radiation causes damage to the main apparatus of cells - DNA, as a result of which not only their death occurs, but also, which is extremely important in the case of oncopathology, a violation of the division process. The result of irradiation is a decrease in the size of the tumor due to the death (necrosis) of its constituent elements, as well as stopping the growth of neoplasia. Healthy cells suffer to a much lesser extent, and focusing the beam strictly on the tumor helps to avoid undesirable consequences. In parallel with chemotherapy and surgical treatment, radiotherapy contributes to the rapid improvement of the condition of patients, and in favorable cases, the complete removal of the tumor from the body.

Irradiation in cancer is possible both independently, especially in the case of superficially located tumors (skin, for example), and combined with chemotherapy and surgery. Radiotherapy performed before surgery helps to reduce the size of the tumor, reduce the risk of detachment and entry of cancer cells into the blood and lymphatic vessels, and, therefore, the effectiveness of treatment as a whole will be much higher. In the case of advanced forms of cancer, if available, the use of radiation energy makes it possible not only to improve the life of patients and reduce the severity of pain, but also prevents further spread of cancer cells throughout the body, and existing metastatic nodes undergo regression.

Often, radiotherapy is given after surgery, when there is a chance of leaving tumor cells at the site of cancer growth. This approach allows you to destroy all the cells and avoid the recurrence of the disease in the future.

The type and method of radiotherapy in each case is chosen by the doctor based on the characteristics of the tumor, its location, stage and general condition of the patient. Since radiation can damage healthy tissues, doses are determined individually, divided into several sessions, in contrast to chemotherapy, which most often uses standard treatment regimens.

The types of radiation therapy are determined by the radiation used:

• α-particles;
• β-particles;
• γ radiation;
• neutron;
• proton;
• x-ray.

X-ray radiation was used the very first, later, thanks to the efforts of physicists, installations appeared that made it possible to generate beams of elementary particles in special accelerators.

Methods of radiation therapy depend on the method of exposure to the tumor tissue:

1. External radiation therapy, when the device is outside, and the beam passes through other tissues directly to the tumor;
2. Contact treatment, which implies the impact only on the tumor tissue by introducing radiation carriers (needles, wire, balls, etc.) into it. It can be interstitial, intracavitary, intravascular, in the form of applications. An example of interstitial irradiation is brachytherapy for;
3. Radionuclide therapy - the introduction of pharmacological preparations containing a radioactive element that can accumulate in strictly defined tissues (iodine in).

The very promising and effective method of treating tumors with proton beams. Accelerated in special accelerators, protons reach their destination and give off a maximum of radioactive radiation in the last millimeters of their run. In other words, only a small amount of radiation energy is scattered along the path to the tumor, and it does not spread to the tissues behind the tumor node at all. This feature allows minimizing the damaging effect of radiation on healthy organs and tissues with high efficiency within the neoplasm itself.

The ability to focus the proton beam strictly on the tumor tissue and the low likelihood of side effects is a great advantage in the treatment of children in whom secondary tumors after conventional irradiation can become a real problem. In addition, before the use of proton therapy, such a tumor as retinal melanoma inevitably ended with the removal of the entire eye, which significantly worsened the quality of life after the operation. With the advent of proton therapy, it became possible to treat a tumor while preserving the organ of vision, while the patient does not experience the severe consequences of adaptation, as after surgical treatment.

For many years, this technique was available only in the conditions of specialized centers conducting research in the field of physics, but recently in North America and Europe there has been significant progress in the use of this type of treatment, as evidenced by the functioning of proton therapy clinics. In Russia and other countries of the post-Soviet space, unfortunately, such methods are still of very limited use, and proton therapy centers are only being built. This is due to the high cost of equipment, the need to equip facilities that provide reliable radiation protection, where the wall thickness can reach 5 meters or more. Only 1% of patients in Russia have the opportunity to undergo such treatment, but the construction of centers with the appropriate equipment gives hope for the availability of proton therapy in the future for the majority of oncological patients.

Radiosurgery successfully used to treat brain tumors

Another modern and very effective method of radiation therapy is the use of radiosurgery, when the radiation beam is focused in a strictly defined place, causing cell death and destruction of neoplasms. Radiosurgery is successfully used to treat not only malignant, but also benign brain tumors (meningioma, pituitary adenoma, etc.), especially those that are difficult to access for conventional surgical intervention. Stereotactic radiosurgery (popularly known as the "gamma knife", "cyber knife") allows you to remove tumors without craniotomy and other surgical procedures, but its effect does not occur immediately, it takes several months or even six months - a year, as in case of benign tumors. The patient at this time is under the dynamic supervision of specialists.

Stages of radiation therapy

Taking into account the complexity of the methods and equipment used, as well as the possibility of radiation reactions and other complications, radiotherapy should be strictly indicated to the patient, and the scheme of its implementation should be precisely verified. The whole complex of procedures consists of three stages:

• Preradiation.
• Ray.
• Postradiation.

The behavior of the patient at each stage has its own characteristics, which may determine how effective the treatment will be, and following simple rules will help to avoid unwanted side effects.

Prebeam period is perhaps the most important, because the correct planning of procedures, the calculation of the dose and method of influencing the tumor determine the final result. It is also important to take care of the condition of healthy tissues, which in one way or another can be exposed to radiation.

Radiotherapy planning carried out simultaneously by several specialists - a radiotherapist, an oncologist, a medical physicist, a dosimetrist, who calculate the required doses of radiation, choose the optimal way of introducing it into tissues during brachytherapy (in this case, a brachytherapist is connected), determine the maximum radiation exposure and the reserve capacity of surrounding tissues that can be exposed to radiation.

Planning in the prebeam period may require not only the efforts of specialists and several days of their hard work. To accurately determine all the parameters of radiation therapy, additional studies and the help of modern computer technology are indispensable, since only the device can calculate the entire path of the radioactive beam to tumor cells with an accuracy of a millimeter, using three-dimensional images of the affected organs or tissues obtained using a tomograph .

The important point is marking on the patient's body, which is carried out according to the results of CT, MRI, radiography. The doctor marks the borders of the tumor and the irradiated area on the body with a special marker, and if it is necessary to switch to another irradiating device, “zeroing” is performed automatically according to the existing marks. The patient should be aware that the marks must be kept until the end of the treatment, so washing them off while showering should be avoided, and if this happens, the nurse or doctor should be informed, who will correct the situation.

What are the basic rules of behavior in the pre-beam period? First, one should try to keep the marking at the irradiation site. Secondly, you do not need to sunbathe or use various creams, irritants, perfumes, iodine in the area of ​​​​the intended exposure. Finally, if there are lesions on the skin, dermatitis, diaper rash or a rash, then it is worth informing the doctor about this, who will help get rid of the existing problems. If it is necessary to irradiate the head and throat area, it is worth taking care of the condition of the teeth, curing caries and putting the oral cavity in order as a whole.

Beam period includes the actual irradiation according to the scheme developed earlier. The course of radiation therapy usually lasts no more than 4-7 weeks, and for preoperative reduction of the size of the neoplasm, 2-3 weeks are enough. Sessions are carried out daily five days a week, with a two-day break to restore the skin and tissues involved in radiation exposure. If the daily radiation dose is large, then it can be divided into several sessions.

The treatment is carried out in a specially equipped cabinet with radiation protection, and the staff leaves it for the duration of the procedure, while the patient has a connection with the doctor through a loudspeaker. The patient is placed on a table or chair, the radiation source is set to the desired area, and the surrounding tissues are covered with protective blocks. At the time of the procedure, the table or emitter may move in space or create noise, which should not be frightening and which the nurse usually warns about.

The procedure is painless, lasts 5-10 minutes, during which the patient must maintain the accepted position of the body, do not move, breathe calmly and evenly.

Throughout the course of treatment, you must adhere to the following rules:

1. Nutrition during radiation therapy should be complete, high-calorie, containing all the necessary vitamins and minerals. You should not deny yourself carbohydrates, the proportion of which can be 3-4 times the amount of proteins and fats consumed. Since radiation exposure causes the disintegration of tumor tissue and the formation of a large amount of toxins, it is necessary to ensure a good drinking regime (up to three liters of fluid per day), using juices, compotes, tea, and mineral water.
2. During treatment, smoking and drinking alcohol should be completely excluded, although it is better to get rid of bad habits completely and forever.
3. Particular attention should be paid to areas of the skin that are in the irradiation zone. Clothing should be made of natural fabrics (cotton, linen), loose, not adjacent to the places of exposure to radiation. If possible, these areas are best kept open at all, but protected from the sun when going outside.
4. It is better to postpone the use of cosmetics and perfumes for later, it is better not to use even soap, so as not to overdry already dry skin. When taking a shower, you need to remember the marks in the radiation zone.
5. If redness, dryness, itching, excessive sweating occur, you should not take independent measures, apply cold or hot objects to the skin, it is better to talk about this with your doctor.
6. General recommendations for all cancer patients, such as walking in the fresh air, good sleep, adequate physical activity, apply to the period of radiation therapy.

Irradiation in various forms of malignant neoplasms has its own characteristics, which are usually warned patients in advance. When most often resort to postoperative remote radiotherapy, designed to destroy tumor cells that could remain after the removal of neoplasia. In the presence of metastases, the goal is to reduce their size, as well as reduce the severity of the pain syndrome. During treatment, fatigue and a feeling of tiredness may appear, which should disappear after the end of the course of radiation.

In the case of cancer, irradiation before surgery is most effective, and in some cases, chemoradiotherapy is sufficient to cure even without surgical removal of the tumor. In addition to remote exposure, there are techniques with the introduction of a radiation source directly into the rectum. Radiation therapy is not performed for the overlying parts of the large intestine.

Prostate tumors are successfully treated with brachytherapy, when capsules or needles containing a radioactive isotope are injected directly into the tumor tissue. This approach allows you to avoid unwanted reactions from nearby organs (diarrhea, impaired urination, etc.).

Neoplasms of the female genital organs involve remote irradiation of the pelvic area, and with radiation therapy is often of paramount importance. So, if in the case of microinvasive cancer, irradiation is carried out in the postoperative period, then at II-III stages of the disease, it is the main and often the only method of treatment. In the fourth stage of cervical cancer, radiotherapy is palliative in nature, helping only to alleviate the condition of patients.

Post-radiation period begins after the end of the course of treatment. As a rule, most patients feel well, and side effects are either completely absent, or expressed insignificantly. Nevertheless, there are still some consequences and you need to know about them in order not to get confused and seek the necessary help in time.

Recovery after radiation therapy begins immediately after the end of radiation sessions and consists in observing a sparing regimen, ensuring proper sleep, and rest during the day. Equally important is the nature of nutrition, as well as the emotional mood of the patient. At the stage of rehabilitation, you may need not only the help of a doctor, but also relatives and close people, whose participation and support is very important during this period.

Due to the presence of a tumor, as well as the need to undergo all kinds of studies and medical procedures that are not always pleasant for the patient, emotional disorders may occur. It can be apathy, a feeling of melancholy or anxiety, and sometimes depression. It is very important not to withdraw into oneself, to try to communicate more with friends and family, if possible, to maintain the usual rhythm of life, but reducing overall activity to such an extent that there is no feeling of fatigue. You should not give up household chores, hobbies, hobbies, and if you have a desire to lie down to rest, then plans can be postponed for a while. Walking and socializing help many patients return to their previous lifestyle and improve their mood.

The feeling of fatigue often accompanies radiation therapy, since the burden on the body associated with the procedures, as well as the destruction of the tumor, require significant energy costs and may be accompanied by metabolic changes. During this period, it is recommended to rest more, arrange a short daytime sleep, and if the patient continues to work, then it makes sense to talk with management about the possibility of switching to lighter work. Many patients even prefer to go on vacation during treatment.

After the end of treatment, you should regularly visit a doctor to monitor the condition and results of the therapy. Observation is usually carried out by an oncologist at a polyclinic or oncology dispensary, who determines the frequency of examinations. In the event of a sudden deterioration in the condition, the development of pain, disorders of the gastrointestinal tract, fever and other symptoms, you should consult a doctor without waiting for the next scheduled visit.

An important place in rehabilitation after radiotherapy is occupied by skin care, which in most cases is involved in irradiation, and almost always suffers during remote radiation therapy. At least a year after the end of the course of irradiation, the skin should be protected from the sun and various damage. Skin areas that were in the area of ​​​​radiation should be lubricated with a nourishing cream, even if there are no signs of inflammation or burns. It is better for those who like a bath or a bath to temporarily abandon these procedures, replacing them with a shower, and skin-irritating products and hard washcloths should be removed away.

Sometimes patients may experience communication difficulties due to the lack of awareness of others about oncology and its treatment. Thus, some believe that people who have undergone radiation therapy themselves are capable of emitting radiation, so it is better to stay away from them. This opinion is erroneous: patients at all stages, including rehabilitation, do not pose a danger to others, and the tumor itself is not contagious. If possible, do not give up on intimate relationships, because this is part of a fulfilling life. If there are changes in the mucous membranes of the genital tract or discomfort, the doctor will tell you how to deal with it.

To overcome stress, it is worth diversifying your leisure time. It can be visiting the theater, exhibitions, doing your favorite hobbies, walking and meeting with friends. It is important to be distracted from the painful thoughts that may accompany all stages of the treatment of a malignant tumor.

A little about the complications and side effects of radiotherapy

Like any other type of treatment, radiotherapy can cause various side effects, both local and general. Common side effects of radiation therapy include fatigue, weakness, changes in emotional state, and bone marrow damage caused by radiation. If it is necessary to irradiate large areas of the body, one way or another, constantly renewing blood cells suffer, their maturation in the bone marrow is disturbed, which is manifested by a decrease in the number of leukocytes, erythrocytes, and platelets. The patient regularly undergoes blood tests to monitor its components, and if necessary, appropriate treatment is prescribed or the radiation course is suspended for a week.

Other common effects of radiation therapy include hair loss, nail deterioration, decreased appetite, nausea, and even vomiting. These changes are most often associated with irradiation of the head area, organs of the gastrointestinal tract, as well as with the decay of tumor tissue under the influence of radiation. After the end of the course of treatment, the patient's condition gradually returns to normal.

Particular attention should be paid to the nutrition of patients undergoing radiotherapy.. Changes in appetite, nausea do not contribute to eating, and, meanwhile, the need for nutrients is quite high. If the feeling of hunger does not arise, that is, it is necessary, as they say, "through I do not want." Since the list of recommended products is quite large, there is no need to limit yourself to sweets, meat and fish dishes, fruits, juices. The diet should be high in calories and saturated with all the necessary substances.

When cooking, you need to follow some rules:

The most frequently observed local complications of radiation therapy in the form of skin reactions. After several sessions of irradiation, reddening of the skin is possible, which eventually disappears, leaving pigmentation behind. Some patients complain of a feeling of dryness, itching, burning, peeling of the skin in the radiation area. With proper care and respect, the skin recovers within 4-6 weeks after the course of treatment.

Complications may include burns, sometimes severe, with the formation of ulcers or infection of the radiation wound. The likelihood of such a development of events increases with an increase in the dose of radiation, the presence of individual sensitivity to radiation, and comorbidities, such as diabetes mellitus.

To avoid such troubles, after the procedure, treat the irradiation site with a moisturizer, oils, and protect the skin from sunlight. In case of severe skin damage, the doctor may recommend medications containing corticosteroids, so any change in health should be reported to the doctor.

When irradiating the organs of the head or neck, the damaging effect of radiation on the mucous membrane of the mouth and throat is possible, therefore, again, some guidelines must be followed:

• Stop smoking, alcohol, irritating food;
• Using a soft toothbrush and gently brushing your teeth;
• Rinsing the mouth with a decoction of chamomile or other solutions recommended by the attending physician.

With radiotherapy of the chest organs, cough, difficulty breathing, soreness and swelling in the breast area are possible. In the treatment of tumors of the rectum, there may be a tendency to constipation, blood in the feces, abdominal pain, so it is important to follow a diet that prevents retention of contents in the intestines.

Any deterioration in health, the appearance of these changes, it is necessary to inform the attending physician, who will help with the appointment of additional treatment.

Radiation therapy is an integral part of the treatment of most malignant tumors, the effect of which can be recovery. Subject to all the recommendations and rules, it is usually well tolerated, and patients can feel improvement after several sessions of irradiation.

Thus, even taking into account possible side effects, radiation therapy should not be abandoned, because it gives a chance for a favorable outcome of the disease, which without it dooms a person to death. For successful treatment, you should lead a correct lifestyle, follow the recommendations listed above and promptly report any changes in your health to your doctor.

Video: reportage on radiotherapy

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.

There is probably no worse disease today than cancer. This disease does not look at either age or status. He mercilessly mows down everyone. Modern methods of treating tumors are quite effective if the disease is detected in the early stages. However, cancer treatment also has a downside. For example, radiation therapy, the side effects of which sometimes have high health risks.

Benign and malignant tumors

A tumor is a pathological formation in tissues and organs that grows rapidly, causing mortal harm to organs and tissues. All neoplasms can be conditionally divided into benign and malignant.

The cells of benign tumors are not much different from healthy cells. They grow slowly and do not spread further than their focus. Treating them is much easier and easier. For the body, they are not fatal.

The cells of malignant neoplasms are structurally different from normal healthy cells. Cancer grows rapidly, affecting other organs and tissues (metastasizes).

Benign tumors do not cause much discomfort to the patient. Malignant ones are accompanied by pain and general exhaustion of the body. The patient loses weight, appetite, interest in life.

Cancer develops in stages. The first and second stages have the most favorable prognosis. The third and fourth stages are the germination of the tumor in other organs and tissues, that is, the formation of metastases. Treatment at this stage is aimed at pain relief and prolonging the life of the patient.

No one is immune from a disease like cancer. People at particular risk are:

with a genetic predisposition.

With a weakened immune system.

Leading the wrong way of life.

Working in hazardous working conditions.

Received any mechanical injury.

For prevention purposes, you need to be examined by a therapist once a year and take tests. For those who are at risk, it is advisable to donate blood for tumor markers. This analysis helps to recognize cancer in the early stages.

How is cancer treated?

There are several ways to treat malignant tumors:

Surgery. main method. It is used in cases where oncological formation is still not large enough, and also when there are no metastases (early stages of the disease). Radiation or chemotherapy may be done first.

Radiation therapy of tumors. Irradiation of cancer cells with a special device. This method is used as an independent method, as well as in combination with other methods.

Chemotherapy. Cancer treatment with chemicals. Used in conjunction with radiation therapy or surgery to reduce the size of a lump. It is also used to prevent metastasis.

Hormone therapy. Used to treat ovarian, breast and thyroid cancer.



Surgical treatment of tumors is the most effective today. The operation has the least number of side effects and gives the patient more chances for a healthy life. However, the application of the method is not always possible. In such cases, other methods of treatment are used. The most common of which is radiation therapy. Side effects after it, although they cause a lot of health problems, but the patient's chances of recovery are high.

Radiation therapy

It is also called radiotherapy. The method is based on the use of ionizing radiation, which absorbs the tumor and self-destructs. Unfortunately, not all cancers are sensitive to radiation. Therefore, it is necessary to choose a method of therapy after a thorough examination and assessment of all risks for the patient.

Radiation therapy, although effective, has a number of side effects. The main one is the destruction of healthy tissues and cells. Radiation affects not only the tumor, but also neighboring organs. The method of radiation therapy is prescribed in cases where the benefit to the patient is high.



For radiation, radium, cobalt, iridium, cesium are used. Radiation doses are compiled individually and depend on the characteristics of the tumor.

How is radiation therapy performed?

Radiotherapy can be done in several ways:

1. Exposure at a distance.

   contact irradiation.

   Intracavitary irradiation (a radioactive source is injected into an organ with a neoplasm).

   Interstitial irradiation (a radioactive source is injected into the tumor itself).

Radiation therapy is used:

after surgery (to remove the remnants of cancer formation);

before surgery (to reduce the tumor in size);

during the development of metastases;

with relapses of the disease.

Thus, the method has three purposes:

Radical - complete removal of the tumor.

Palliative - reduction of neoplasm in size.

Symptomatic - elimination of pain symptoms.



Radiation therapy helps to cure many malignant tumors. It can help alleviate the suffering of the patient. And also to prolong his life when healing is impossible. For example, radiation therapy of the brain provides the patient with legal capacity, relieves pain and other unpleasant symptoms.

To whom is radiation contraindicated?

As a method of fighting cancer, radiation therapy is not suitable for everyone. It is prescribed only in cases where the benefit to the patient is higher than the risk of complications. For a separate group of people, radiotherapy is generally contraindicated. These include patients who:

Severe anemia, cachexia (a sharp decline in strength and exhaustion).

There are diseases of the heart, blood vessels.

Radiation therapy of the lungs is contraindicated in cancerous pleurisy.

There is renal failure, diabetes mellitus.

There are bleeding associated with the tumor.

There are multiple metastases with deep germination in organs and tissues.

The blood contains a low number of leukocytes and platelets.

Radiation intolerance (radiation sickness).

For such patients, the course of radiation therapy is replaced by other methods - chemotherapy, surgery (if possible).



It should be noted that those who are indicated for radiation may later suffer from its side effects. Since ionizing rays damage not only the structure but also healthy cells.

Side effects of radiation therapy

Radiation therapy is the strongest irradiation of the body with radioactive substances. Besides the fact that this method is very effective in fighting cancer, it has a whole bunch of side effects.

Radiation therapy patient reviews are very different. Some side effects appear after several procedures, while others have almost none. One way or another, any unpleasant phenomena will disappear after the end of the course of radiotherapy.

The most common consequences of the method:

Weakness, headache, dizziness, chills, increased

Disturbed work of the digestive system - nausea, diarrhea, constipation, vomiting.

Changes in the composition of the blood, a decrease in platelets and leukocytes.

Increased number of heartbeats.

Edema, dry skin, rashes at the sites of radiation application.

Hair loss, hearing loss, vision loss.

Small blood loss, provoked by the fragility of blood vessels.

This is what concerns the main negative points. After radiation therapy (full completion of the course), the work of all organs and systems is restored.

Nutrition and renewal of the body after irradiation

During the treatment of tumors, no matter how, it is necessary to eat properly and balanced. In this way, many unpleasant symptoms of the disease (nausea and vomiting) can be avoided, especially if a course of radiation therapy or chemotherapy is prescribed.

Food should be taken often and in small portions.

Food should be varied, rich and fortified.

For a while, you should give up food that contains preservatives, as well as pickles, smoked and fatty foods.

It is necessary to limit the use of dairy products due to the possible lactose intolerance.

Carbonated and alcoholic drinks are prohibited.

Preference should be given to fresh vegetables and fruits.

In addition to proper nutrition, the patient should adhere to the following rules:

Get more rest, especially after the radiation procedures themselves.

Do not take a hot bath, do not use hard sponges, toothbrushes, decorative cosmetics.

Spend more time outdoors.

Lead a healthy lifestyle.



Radiation therapy patient reviews are very different. However, without it, successful cancer treatment is impossible. By adhering to simple rules, many unpleasant consequences can be avoided.

What diseases are treated with LT?

Radiotherapy is widely used in medicine for the treatment of cancer and some other diseases. depends on the severity of the disease and can be broken down into a week or more. One session lasts from 1 to 5 minutes. Used in the fight against tumors that do not contain fluid or cysts (skin cancer, cervical cancer, prostate and breast cancer, brain cancer, lung cancer, as well as leukemia and lymphomas).

Most often, radiation therapy is prescribed after surgery or before it in order to reduce the size of the tumor, as well as kill the remnants of cancer cells. In addition to malignant tumors, diseases of the nervous system, bones, and some others are also treated with radio emission. Radiation doses in such cases differ from oncological doses.

Repeat radiotherapy

Irradiation of cancer cells is accompanied by simultaneous irradiation of healthy cells. Side effects after RT are not pleasant phenomena. Of course, after the course is canceled, the body recovers after a while. However, having received a single dose of radiation, healthy tissues are not able to endure repeated exposure. In the case of using radiotherapy a second time, it is possible in emergency cases and at lower doses. The procedure is prescribed when the benefit to the patient outweighs the risks and complications to his health.



If re-irradiation is contraindicated, the oncologist may prescribe hormone therapy or chemotherapy.

Radiation therapy in the last stages of cancer

Radiotherapy is used not only to treat cancer, but also to prolong the life of the patient in the last stages of cancer, as well as to alleviate the symptoms of the disease.

When the tumor spreads to other tissues and organs (metastasizes), there is no chance of recovery. The only thing left is to reconcile and wait for that “judgment day”. In this case, radiotherapy:

Reduces, and sometimes completely removes pain attacks.

Reduces pressure on the nervous system, on the bones, maintains capacity.

Reduces blood loss, if any.

Irradiation for metastases is assigned only to the places of their distribution. It should be remembered that radiation therapy has a variety of side effects. Therefore, if the patient has a sharp depletion of the body and he cannot withstand the dose of radiation, this method is not practiced.

Conclusion

The worst of all diseases is cancer. The whole insidiousness of the disease is that it can not manifest itself in any way for many years and in just a couple of months bring a person to death. Therefore, for the purpose of prevention, it is important to periodically be examined by a specialist. Detection of an ailment in the early stages always ends in complete healing. One of the effective methods of fighting cancer is radiation therapy. Side effects, although unpleasant, however, completely disappear after the cancellation of the course.

Is radiation therapy. It was revealed that young, malignant cells cease to multiply under the influence of radioactive radiation.

concept

In radiation therapy, the effect of ionized learning occurs. His goals:

• damage to malignant cells
• cancer growth restriction,
• prevention of metastasis.

It is used in combination with surgical treatment and chemotherapy.

During radiation exposure, cells do not decay, but their DNA changes. The advantage of the method is that healthy structures do not undergo any changes.

Strengthening the effect is also achieved due to the fact that the doctor can correct the direction of the rays. This makes it possible to use the maximum doses in the lesion.

Sometimes this method is also used to treat non-oncological pathologies. For example, to combat bone growths.

Video about pre-beam preparation:

Indications

The method is used in 60-70% of patients with cancer. It is considered the main one for the treatment of tumors that are characterized by a high degree of radiosensitivity, rapid progression, and also with some features of the localization of the formation.

Radiation therapy is indicated for cancer:

• nasopharynx and rings of pharyngeal tonsils,
• cervix,
• larynx,
• skin, breast,
• lung
• language,
• uterine body,
• some other organs.

Types of radiation therapy

There are several treatments. Alpha radiation involves the use of isotopes, such as radon, thoron products. This type has a wide type of application, positively affects the central nervous system, endocrine system, heart.

Beta therapy is based on a healing effect based on the action of beta particles. Various radioactive isotopes are used. The decay of the latter is accompanied by the emission of particles. There is such therapy interstitial, intracavitary, application.

X-ray therapy is effective for the treatment of superficial lesions of the skin, mucous membranes. The energy of X-ray study is selected depending on the location of the pathological focus.

Radiation therapy is also divided for other reasons.

Contact

The view differs from the rest in that the sources of rays are located directly on the tumor. It is typical for him to distribute the dose so that its main part remains in the tumor.

The method is good if the size of the formation is not more than 2 cm. This type is divided into several types.

Remote

It implies that the source of radiation is at some distance from the human body. the beam enters the body through a certain area.

Gamma therapy is more commonly used. This method is good because it allows you to bring a high dose of radiation to the formation, while keeping healthy cells intact.

For small cancers, protons and neurons are used. Remote therapy can be static or moving. In the first case, the radiation source is stationary.

In modern oncological dispensaries, the method is rarely used. The mobile technique allows you to direct the source along different trajectories. This provides the most efficiency.

Radionuclide

The specificity lies in the introduction of radiopharmaceuticals into the patient's body. They affect hearths. Targeted delivery of substances generates very high doses in the foci with little side effects and minimal damage to healthy tissues.

Radioiodine therapy is popular. The method is used not only for cancer patients, but also for the treatment of people with thyrotoxicosis. If there are bone metastases, then several compounds are used at once.

Conformal

Radiative forcing when 3D exposure planning is used to obtain the shape of the field. The method makes it possible to deliver adequate doses of radiation to tumors. This greatly increases the chance of a cure.

To exclude the exit of the tumor from the irradiated area, special devices are used, for example, equipment for active control of breathing.

Proton

Radiation therapy based on the use of protons, which are accelerated to large values. This allows for a unique dose distribution over depth, with the maximum dose concentrated at the end of the run.

At the same time, the load on other surface cells is minimal. The radiation does not scatter through the patient's body.

Typically, the method is used for small formations, tumors located close to critically radiosensitive structures.

intracavitary

This species has several types. Allows for the prevention of recurrence and metastasis. The source is introduced into the body cavity and remains during the entire irradiation session.

It is used to create the maximum dose in tumor tissues.

Usually this method is combined with remote. Radiation therapy of this type is used to treat cancers of the female genital area, rectum, and esophagus.

stereotactic

This method allows to reduce the time of cancer treatment.

It is used for the treatment of internal organs, the circulatory system. The rays act very precisely on the tumor.

Photo of stereotactic radiotherapy

It is carried out with full control over the location of the tumor, allows you to adjust to the patient's breathing and any other movement.

The result of such exposure is not immediately visible, but after a few weeks, since the tumor cells die off gradually.

Contraindications

There are several situations when radiation therapy is contraindicated:

• general serious condition with signs of intoxication of the body,
• fever,
• extensive damage to cancer cells, accompanied by bleeding,
• radiation sickness,
• severe forms of concomitant diseases,
• severe anemia.

The limitation is also a sharp decrease in the blood leukocytes or platelets.

How is radiation therapy performed?

First, additional procedures are performed to accurately determine the location of the tumor and its size. From this, the dose is selected. With the help of a special apparatus, the irradiation field is determined. There may be several such areas.

In the process of radiation treatment, the patient is in the supine position. It is important not to move during radiation, as this can cause the rays to damage healthy tissue. If a person cannot move for a long time, then the doctor fixes the patient or area of ​​the body.

Some parts of the machines can move and make noise, you should not be afraid of it. Already at the beginning of treatment, it is possible to reduce pain, but the greatest effect is achieved after the completion of the course.

Course duration

Treatment is most often done on an outpatient basis. The session, depending on the method used, lasts 15-45 minutes.

Most of the time is taken by the correct positioning of the patient and the direction of the device for irradiation. The process itself takes several minutes. The staff will leave the premises during this time.

The course is from 4 to 7 weeks. in some situations, it is reduced to 14 days. This is advisable if it is necessary to reduce the size of the tumor or improve the patient's condition. Sessions are held 5 times a week. Sometimes the dose is divided into 2-3 sessions.

How is the procedure tolerated?

Radiation therapy itself does not cause pain. After the procedure, it is recommended to rest for several hours. This will help restore strength, as well as reduce the risk of side effects.

If the throat or mouth was exposed to radiation, then it is recommended to rinse the mouth with decoctions of herbs or sea buckthorn oil to relieve discomfort.

Symptoms after exposure

After a course of radiation therapy, you may experience:

• fatigue,
• mood and sleep disorders
• reactions from the skin and mucous membranes.

If the impact was carried out on the chest area, there is shortness of breath, shortness of breath, cough.

Effects

The skin is most often affected. She becomes tender, sensitive. Can change color.

The reaction of the skin to radiation is about the same as with a sunburn, but it develops gradually.

There may be blisters. In the absence of proper care, such areas can become infected.

If the organs of the respiratory system were exposed, then radiation injuries develop over the next three months. An unproductive cough appears, body temperature rises, and general well-being worsens.

Experts note that often side effects are:

• hair loss,
• hearing and vision loss,
• an increase in the number of heartbeats,
• change in blood composition.

Recovery after radiation

The recovery process can take place at different times, doctors recommend setting yourself up for a long journey.

Burn treatment

Redness usually appears immediately, but in some people, burns do not begin to be detected immediately. After each session, it should be lubricated with a protective cream.

At the same time, this should not be done before the procedure, as this may reduce the effectiveness of the manipulation. For processing, "D-Panthenol" and other drugs are used to relieve inflammation and restore the dermis.

How to raise white blood cells after radiotherapy?

You can increase the number of leukocytes only after permission received from the doctor. Be sure to diversify your menu with raw vegetables, buckwheat, fresh fruits, hercules.

Pomegranate juice and beetroot have a positive effect on the composition of the blood. If these methods do not help, the doctor will prescribe special medications.

What to do with temperature?

Temperature in most cases is a sign of infection. After radiation therapy, it takes a long time to restore immunity.

It is better to immediately consult a doctor who will help identify the cause and prescribe treatment. If not possible, observe bed rest, use antipyretics that are not contraindicated for your illness.

Pneumonitis

They are treated with high doses of steroids. Then the symptoms disappear after 24-48 hours. The dose is reduced gradually.

Additionally, breathing exercises, massage, inhalation and electrophoresis are used.

The treatment program is compiled individually, taking into account the type of tumor and its prevalence, the presence of other complications.

Haemorrhoids

For treatment, it is necessary to strictly observe a diet and bed rest, use medicines and traditional medicine. Radiation radiation leads to a violation of the maturation of the epithelium, inflammatory processes on the mucous membranes.

For treatment, local therapy is used to cleanse the intestines and eliminate inflammatory processes.

Proctitis

To eliminate the problem, laxatives, cleansing enemas are used. High efficiency was shown by a warm shower directed to the area of ​​the rectum, baths with potassium permanganate.

The doctor may prescribe hormones, rectal suppositories, and anesthetics.

Diet food

Good nutrition is one of the main methods of treatment of radiation damage. you need to take soft foods. If the oral cavity has suffered from irradiation, then it is effective to use oil, a solution of novocaine.

During the radiation therapy itself, patients usually complain of a lack of appetite. At this time, add nuts, honey, eggs, whipped cream to the menu. They contain many nutrients. To get protein in the diet, puree soups, low-fat fish and meat broths are added.

It is contraindicated to use foods containing a large amount of cholesterol, fatty meat, mushrooms, tangerines, sausage.

Answers on questions

• How is chemotherapy different from radiotherapy?

Chemotherapy is the treatment of cancer with the use of drugs. Radiation therapy is based on the principle of destruction of cells under the influence of rays.

The world standards provide for a combination of these two methods, since the chance of a cure in this case increases.

• Does hair fall out after radiation therapy?

After exposure to radiation, the hair falls out only at the site of the passage of the rays. Usually doctors warn about the possibility of baldness. It is best in this case to make a short haircut.

For hair care from the start of treatment, use a wide-toothed comb or buy a newborn comb. Before going to bed, use a special sleep net so that the hair is not pressed and pulled out.

• Can you get pregnant after radiation therapy?

Many treatments leave a negative mark, affect reproductive functions. After radiation therapy, it is recommended to protect yourself for several years.

This will allow the body to recover, to give birth to a healthy child. The oncologist usually says the term, depending on the stage of the cancer, the results of the treatment.