Radiation consequences for oncology. Plan for rapid rehabilitation and elimination of complications after radiotherapy. Side effects of radiation

Modern installations and techniques of radiotherapy have made it possible to significantly increase the effectiveness and safety of treatment, as well as expand the indications for its implementation, including by increasing the number oncological diseases.

Stereotactic radiosurgery has become a real success in recent years. She solved the problem of damage to tissue cells and organs through which the beam penetrated to the tumor. Stereotactic radiosurgery is a fundamentally new treatment method. Unlike traditional radiation therapy, the entire dose of radiation falls directly on tumor cells, without affecting healthy ones. Gamma knife is one of the most famous options for such radiation treatment in our country.

Radiation dose

Correct dose calculation is very important. It allows you to achieve maximum effect with minimal harm to healthy cells body. This takes into account the type of tumor, its size, and the patient’s health status. Gray (Gy) or its derivative centigray (1 cGy=100 Gy) are used as units of measurement. When using radiation therapy as an auxiliary treatment for breast cancer, head and body tumors, the dose is 45-60 Gy. It is called general and is divided into several procedures that form a course of treatment. On average, the patient has about 5 sessions per week, which are repeated several times over 5-8 weeks. Sometimes these small doses are further divided into two procedures, which are carried out on the same day.

Preparing for radiation therapy

Any treatment is preceded by a conversation with a doctor and additional examinations. Radiation therapy is no exception in this case. The attending physician will tell you about the upcoming procedure, possible results, risks and side effects.

Radiotherapy can be harmful to the fetus. Therefore, pregnancy during this period is undesirable. But if a woman is already expecting a child, the doctor, together with the patient, will select the most best option treatment.

You should definitely inform your doctor about the presence of cochlear implants and pacemakers.

During a course of radiotherapy, the patient may have difficulty coping with work and even ordinary household problems, so it is better to decide in advance about the issue of a house assistant and the amount of professional workload.

When planning a course of therapy, the doctor determines the optimal type of radiation, dose, and direction of the beam. In this case, images of the problem area are obtained and a simulation of treatment is carried out, during which it is necessary to find the most comfortable position of the body during irradiation so that the patient does not have the need to move during the procedure. To do this, the patient is asked to lie on the table and choose the most comfortable of several proposed positions. Restraints and pillows help keep you still throughout the radiation session. Once a comfortable position has been found, the doctor marks the location of the beam's penetration on the patient's body using a marker or applying a tiny tattoo. Next, they move on to the second part of planning - obtaining an image of the tumor, for which the computed tomography method is usually used.

How is radiation treatment performed?

Radiation therapy is a wide arsenal of methods that can be divided into two large groups: external and internal (brachytherapy). In the first case, radiation is generated special apparatus, which moves near the problem area and sends rays to the tumor at different angles. The patient lies motionless on the table in the position chosen at the planning stage. The exposure time may vary. On average, one session takes 10-30 minutes. In most cases, the patient is prescribed several of these procedures. After some time, the course is repeated. If the purpose of radiotherapy is pain relief, it can be performed once.

The procedure itself is completely painless, but causes anxiety for some people. Irradiation rooms are equipped with audio equipment. With its help, the patient can tell doctors about any problem or just talk to relax. The doctors themselves are in the next room at this time.

Brachytherapy involves irradiating the tumor with radioactive substances, which are injected directly into the tumor or adjacent tissues. It has two varieties: temporary and permanent. In the temporary version, radioactive drugs are placed inside a special catheter, which is injected into the tumor for a while and then removed. Permanent brachytherapy uses a tiny implant that is placed directly into the tumor, where it gradually releases radioactive substances. Over time, they run out, and the grain of the implant remains in the body for life, without causing any inconvenience.

Possible risks of radiation therapy

Unfortunately, radiation has Negative influence not only on tumor cells, but also on healthy cells. Therefore, most patients may develop side effects after treatment. Manifestations and severity depend on the dose of radiation and the area of ​​the body, as well as the ability of healthy cells to recover. Each person's body reacts to treatment very differently. Therefore, it is extremely difficult to accurately predict side effects. Some appear immediately during treatment, others make themselves felt weeks and months later. Fortunately, the most common side effects are fairly mild, manageable, and go away over time.

Long-term side effects are rare, but they can be severe and irreversible. For this reason, the doctor must talk them through.

Side effects

Depending on the time of occurrence, all side effects are divided into two groups: those that appear during or immediately after treatment and long-term ones. The first include skin lesions, fatigue, nausea, diarrhea (diarrhea), loss of appetite, hair loss, difficulty swallowing (with chest irradiation), erectile disfunction in men (during irradiation of the pelvis), problems with joints and muscles.

Serious long-term side effects are rare, but one must understand that the possibility of their development exists. For example, in women, radiation to the pelvic area can lead to early menopause and the inability to conceive. In such cases, a woman has the opportunity to freeze several of her eggs before treatment. A man can do this with sperm samples. Other delayed effects include fecal incontinence, lymphedema, thickening of patches of skin, and secondary cancer.

Ways to make your life easier during radiation therapy

Treatment of cancer is a serious burden on the body, which affects general health and mood. This difficult period It will be easier if you prepare for it and discuss all aspects of treatment with your doctor. It is advisable that relatives and close people are also ready to help.

It is normal for the sick person to feel exhausted, tired, scared, lonely and abandoned. Relatives can provide great help to patients. Expressed emotions make a person’s life easier, and the patient can express all his feelings. And it would be good for loved ones to remember to tell the patient that he is loved and will be cared for no matter what mood he is in.

If necessary, the patient can contact a psychologist who will choose a way to deal with feelings. This could be meditation, a massage, or even just going to a concert. Some patients find it helpful to communicate with people who have similar problems at specially organized meetings.

Many patients suffer from skin problems. They can be alleviated by following simple tips:

• stop shaving for a while or use an electric razor instead of a regular one;
• opt for fragrance-free soap. This also applies to deodorants, creams and other cosmetics in contact with skin;
• protect skin from cold wind and use sunscreen with an SPF level of 15 or higher on sunny days;
• choose loose clothing made from natural materials that do not have protruding seams, knots or other elements that can rub the skin.

Diet

It is very important to eat healthy and regularly during radiation therapy, consuming enough calories and protein and avoiding weight loss. After all, the treatment plan and dose calculation are made based on the body weight and volume of the person. If these parameters change, it is necessary to review the entire course of treatment. A person’s diet must include meat, fish, eggs, whole milk, cheese, and legumes.

The attending physician must be aware of problems with appetite. Nausea, apathy, and stomach upsets do not make food desirable. But these unpleasant symptoms can be controlled by frequent split meals or with the help of medications. If you have no appetite at all, you can try replacing solid foods with high-calorie drinks: milkshakes, pureed soups with the addition of protein powders. Alcoholic drinks may not be used in all cases. Therefore, it is better to consult a doctor on this issue.

Recovery after radiation therapy courses

Experienced stress and health problems negatively affect general and emotional well-being. A rehabilitation program after radiation therapy helps a person cope with psychological problems and unpleasant symptoms, which are individual for everyone. Recovery may include work with a psychologist, physical therapy, massages, physical therapy, and medication.

Fatigue after radiation therapy is an absolutely natural condition. Doctors believe that it is the result of the body’s work on recovery. It's natural to want to take a nap throughout the day, and it can be very beneficial. The cause of fatigue in some cases may be anemia (insufficient number of red blood cells in the blood). Depending on the severity of the condition, such patients may be prescribed a blood transfusion.

When irradiation is given to the pelvic or abdominal area, patients experience nausea and stomach upset for some time after treatment. Fortunately, doctors now have big amount remedies that help control these unpleasant symptoms.

Regular exercise can help relieve joint and muscle problems. There are also special program for the prevention of lymphedema.

Radiotherapy is the main way to combat cancer. After irradiation, the human body needs to recover. To enhance protection and prevent relapse of the disease, you should choose the right rehabilitation process for the person’s condition.

Recovery after radiation therapy

Radiation affects not only cancer cells, but also healthy tissue, causing them harm. After the procedures performed, the human body can react with the occurrence of various internal and external phenomena. During this period, monitoring of the patient's condition is necessary.

Radiation sickness

The degree of development is affected by radiation exposure. Free radicals that are formed during irradiation affect not only cancer cells, but also healthy tissues.

Radiation sickness develops in everyone as a result of radiation attack, which is usually carried out after surgery. Radiotherapy may be given after chemotherapy. The overlap of these two processes leads to a strong inhibitory effect on all functional and vital properties of the body.

The effect of radiotherapy on the human body

Early and painful manifestations of radiation sickness include: nausea, swelling, pain, vomiting, fever, intoxication, cystitis, etc. Damage to cells of the gastric and intestinal tracts, immune system, bone marrow, genital organs and nervous tissue may occur. Radiation sickness can have many stages. Each subsequent stage has its own complications, which worsens the patient’s condition.

Treatment of radiation sickness

Radiation sickness is characterized by general intoxication of the body. You will need to restore it using methods complex impact. They resort to phytoremediation and phytodetoxification.

The preventive treatment regimen for radiation sickness includes special herbal preparations. This greatly alleviates the patient's suffering and improves performance.

Concomitant herbal medicine reduces the intensity of the development of symptoms of this disease. Temperature (fever), radiation burns, weakness, swelling, pain, general intoxication can be eliminated using herbal medicine. Such rehabilitation significantly increases the chances of recovery and overall success.

Radiation exposure causes burns

Regular thermal burns, and burns after radiation therapy differ significantly from each other. The latter do not appear immediately. First, the burn is characterized by redness of the skin at the site of penetration of ionizing radiation into the tissue. Affect the degree of burn damage.

Skin burn after radiation therapy

Acute cutaneous burn lesions as side effects of radiation therapy can be divided into three types:

• Dry epidermis - redness, peeling of the skin, swelling at the site of the lesion;
• Erythema – complications such as redness, swelling of the skin and itching are observed;
• Wet epidermis - the burn site is covered with many papules containing exudate and, possibly, pus.

Later long time Radiation dermatitis may develop in the area treated with radiation. It is characterized by swelling or fibrosis of the skin, and radiation ulcers may appear. When the breasts or chest organs are irradiated, the lungs are affected. The development of radiation pneumosclerosis or pneumofibrosis may occur.

To prevent burns after irradiation, you need to use lotions containing a 10% dimexide solution. Sea buckthorn or rosehip oils may also help. Special ointments are often used to treat affected areas: iruksol, levosin, dibunol, dermozolin, sinalar, prednisolone. With this therapy, the consequences of burns will be minimal.

Which drug will help during the recovery period?

Use of all kinds medicines forms the basis of maintenance treatment. An effective remedy is released, thanks to which the body quickly responds to regenerative therapy. It's about about whey, which is enriched with lactates and is called “Hydrolaktivin”.

Hydrolaactivin - recovery after irradiation

The distinctive features of this drug include the presence of:

• Complex impact on complications of radiation;
• Easy to digest by the body;
• Simplicity and safety of consumption;
• Compatible with many drugs.

If you accompany the radiotherapy process with the use of this drug and do not stop taking it in the period after surgery, the restoration of the skin exposed to irradiation will be much faster. “Hydrolactivine” has an anti-inflammatory effect, enhances digestion, normalizes intestinal function, which restores the activity of the gastric and intestinal tracts.

Radiation often causes complications associated with the development of stomatitis. If you regularly rinse your mouth and throat with a solution of “Hydrolaktivina”, the mucous membranes oral cavity will recover faster. Dryness and discomfort will disappear and decrease painful sensations.

This drug normalizes metabolism, increases immunity and stress resistance, which is important for returning the body to normal after radiotherapy. This means that we recommend Hydrolaactivin as an accompanying therapy, as a drug that can mitigate many side effects.

Appeal to traditional medicine

Post-radiation rehabilitation may include not only the use of medications. A sufficient effect is possible through the use of folk medicinal drugs based on many products.

A decoction of pine needles helps with radiotherapy Apples to combat radionuclides Walnuts restore health after radiation

The use of specially prepared medicinal herbal preparations will help eliminate the effects of radiation exposure:

• Needles. Needles from any coniferous tree (fir, pine or spruce) are suitable. You just need to fill them with water, boil for 5 minutes and leave in a warm place overnight. The patient should take this infusion instead of water all day. Then a break is taken for a day, after which the intake of pine liquid is repeated. The treatment process should take at least a month.

The needles have an enveloping effect and are able to remove radionuclides from the body, relieving it of intoxication. Taking pine liquid should accompany proper nutrition.

• Apples. According to oriental medicine these fruits are valuable products. The healing effect is associated with pectins, organic acids that make up apples. Pectin helps remove mercury, lead, strontium, cesium and other harmful substances from the body. Apple diet will bring great benefit in the fight against radionuclides.
• Sea buckthorn oil. It is enough to take a teaspoon of this product for a month. This treatment can also help the body get rid of radionuclides. Sea buckthorn oil can be replaced with decoctions and infusions of young sea buckthorn leaves and branches. Post complications operating period will become less pronounced.
• Walnuts. Fruits or infusions, decoctions of nut partitions help remove radionuclides, mercury compounds, lead, and strontium from the body. Therefore, their use can also help after irradiation.

Appeal to folk medicine justified in almost all cases. No exception is rehabilitation period associated with radiation practice. When combined with other restorative methods, this method can work wonders.

A proper diet will speed up recovery

Preventing unwanted effects from radiation exposure will depend on maintaining a healthy lifestyle. Proper nutrition plays an important role. First of all, it should be taken seriously by patients who have undergone radiation to the abdomen or pelvis.

Most likely, the attending physician will prescribe a certain diet during treatment, which should be strictly adhered to. The diet will be filled with low-fat foods, limited in lactose or fiber. During rehabilitation therapy, such a diet should last at least two weeks. New more nutritious foods further introduced into it sequentially and gradually.

Further nutrition allows for a small consumption of rice, mashed potatoes, low-fat varieties cheese. It is temporarily better not to consume any dairy products, hot and spicy foods, gas-forming products(cabbage, peas, soybeans, beans), fried foods, caffeine-containing dishes and drinks - such a diet will be justified. To support the body during the rehabilitation period, it is recommended to consume black currants and pumpkin.

The meals themselves should be fractional, the portions should be small, but the number of meals per day should be up to six times. It is worth paying attention to the drinking regime, especially taking medicinal decoctions. Nettle, eleutherococcus, radiola rosea, lungwort, bergenia, celery - all these plants will help the recovery process.

Therapeutic nutrition during the rehabilitation period has the main goal of preventing complications associated with the stomach and intestines. Diarrhea and mucositis are quite common consequences of radiation exposure. Therefore, it is very important what food enters the patient’s body.

How to behave during the rehabilitation period

The rehabilitation period should be accompanied by close monitoring by the attending physician. He must be aware of all the changes that appear in the patient during the period of rehabilitation therapy. Special medications will be prescribed and taken according to a specific schedule.

A light one wouldn't hurt physical activity during this period – this will trigger recovery protective forces body. Of course, intense running will not do. But walking on fresh air will have the desired effect. During the first month it will be felt general weakness and the desire to lie down, however, the body does not need to be allowed to stagnate.

Plenty of fluid intake (at least three liters per day) is recommended to reduce the negative effects. You can drink both regular and mineral water. The consumption of natural juices, fruit drinks and compotes is also not excluded. You just have to avoid consuming sugary carbonated drinks.

It is necessary to eliminate bad habits - the body should not be saturated with toxins. True, to improve appetite, patients are allowed to consume beer (200 ml) or red wine (100 ml). But such a retreat is possible only after approval by the attending physician.

You'll have to start eating a balanced diet. You should adhere to the recommended ratio of carbohydrates, fats and proteins (4:1:1). A nutritious diet should exclude the consumption of sausage, smoked products and other harmful delicacies. The diet should consist only of natural food that does not contain flavoring additives.

Conclusion

Radiation exposure to the body, even for the purpose of destruction cancer cells– stress for the human body.

Completely safe methods of treating cancer have not yet been found. It is important to properly prepare the patient for the procedure itself and minimize the consequences.

Proper nutrition, the use of medications and procedures, the use of herbal medicine and folk remedies, maintaining a healthy lifestyle - in combination will help a person escape from cancer and successfully recover after treatment.

The topic of side effects and complications is one of the most important in medicine. “Do no harm” is the main commandment of a doctor’s work at all times. Modern concept might look like this: the risk of disability and death from treatment complications should not exceed similar risks from the disease.

There is no doubt that such a complex and dangerous look treatments such as radiation therapy, despite its high efficiency in oncology, is fraught with a high risk of side effects.

Classic factors of radiosensitivity of cells and tissues.

1. proliferative activity of a cell or tissue
2. degree of differentiation
3. cell cycle phase
4. partial pressure of oxygen in tissues
5. functional tension or pathological processes in tissues

Bergonier and Tribondo's law— radiosensitivity of tissues and cells is directly proportional to proliferative activity and inversely proportional to the degree of differentiation.

Phases of the cell cycle.

Maximum radiosensitivity is observed during the mitosis phase, followed by the postsynthetic and presynthetic periods. Maximum radioresistance is observed in the interphase and synthetic period. Thus, the radiosensitivity of a tissue is determined by the pool of cells proliferating in it.

Factors of radiosensitivity also include the partial pressure of oxygen in the tissue, the state of functional tension or the presence of pathological processes.

Taking into account radiosensitivity factors, let's list the most radiosensitive cells and tissues, although some of them do not obey the above laws:

– bone marrow stem cells

- epithelium

- germinal epithelium

— lymphocytes

- lens of the eye

Long-term consequences irradiation.

We must not forget that when irradiated even in small doses in biological systems morphological and genetic changes are possible. Long-term effects of radiation are divided into two types:

— deterministic effects

- stochastic effects

Deterministic effects– are characterized by the presence of a radiation dose threshold, below which they are not observed. Manifest in the form obvious pathology (radiation sickness, burn, cataract, leukopenia, infertility, etc.).

Stochastic (probabilistic, random) effects– there is no dose threshold for the occurrence of these effects. Have long lasting latent period(years). They are non-specific.

To date, two types of stochastic effects have been proven:

1. malignant transformation as a consequence of mutations in the genome of a somatic cell

2. inherited birth defects in offspring with mutations in the germ cell genome

Today the world scientific community has accepted no-threshold hypothesis biological effects of ionizing radiation. Based on this hypothesis, at any level of absorbed dose, there is theoretically always a possibility of biological consequences. As the dose increases, the likelihood of effects increases linearly with the dose absorbed.

In addition to the classical factors of radiosensitivity of cells and tissues, to understand the mechanisms of the biological action of ionizing radiation, it is necessary to outline the theory "The nature of the organization of cell populations in various tissues."

Based on the nature of the organization of the cell population, two types of tissues are distinguished:

1. Hierarchical fabrics. H-systems (hierarchial cell population). These are fast update systems.
2. Sequentially functional fabrics. F-systems (flexible cell lineage). Slow update systems.
3. Tissues incapable of cellular renewal

H-systems consist of a hierarchy of cells from stem to functional. That. these tissues contain a large pool of dividing cells. These include: bone marrow, epithelial tissue, germinal epithelium.

F-systems consist of a homogeneous population of functionally competent cells that are predominantly in interphase. These systems include: vascular endothelium, fibroblasts, parenchyma cells of the liver, lungs, and kidneys.

In addition to the H- and F-systems, tissues that are incapable of cellular renewal in an adult body (nervous tissue and muscle) are isolated.

When tissues with different organizational and cellular structures are exposed to ionizing radiation, they react differently over time and morphologically. This knowledge makes it possible to predict the type, time and severity of possible radiation-induced pathological processes.

Thus, in H-systems early or acute radiation reactions, which are associated with stopping the division of the most poorly differentiated stem cells, which normally provide the processes of reparative tissue regeneration.

For F-systems, long-term biological consequences of irradiation are more typical, associated with microcirculation disorders, slow devastation of the parenchyma, and tissue fibrosis.

Tissues incapable of cellular renewal after irradiation at any dose are characterized by stochastic radiobiological effects.

Side effects radiation therapy:

1. general (asthenic and intoxication syndrome, myelo- and immunosuppression)
2. local: radiation reactions and radiation damage.

The likelihood and severity of common side effects during radiation therapy depends on:

1. volume of irradiated tissues (spot, local, regional, subtotal, total irradiation)
2. irradiation zones (extremities, pelvis, mediastinum, abdominal cavity, celiac plexus, brain)
3. total absorbed dose.
4. general somatic condition of the patient

Radiation reactions- This reactive changes normal tissues under the influence of ionizing radiation, occurring during a course of radiation therapy and lasting no more than 100 days (3 months) after its completion, and being reversible.

The main mechanism of pathogenesis: temporary block of reparative regeneration.

Radiation reactions are characteristic of tissues with rapid renewal (H-systems: bone marrow, epithelial tissues). 100 days is deadline to repair sublethal genomic damage. Radiation reactions occur in 100% of cases during radiation therapy.

The main prominent example is radiation dermatitis. Clinical manifestations arise from the 10-15th session of radiation therapy. Most pronounced in fold areas (neck, axillary areas, crotch). The skin of the abdomen is highly radiosensitive. Characterized by 4 degrees.

Another, no less clinically significant, manifestation of radiation reactions is radiation mucositis. It also has 4 degrees. Most pronounced during radiation therapy of oral tumors and abdominal cavity. Manifests itself in the form of radiation stomatitis and enteritis. Despite the temporary nature of these phenomena, they can be so pronounced that they require stopping or discontinuing treatment, as well as significant drug correction.

The epithelium of the rectum, bladder, esophagus and stomach has a lower proliferation rate than in the oral cavity or small intestine. In this connection, radiation reactions may be less pronounced.

The severity and likelihood of radiation reactions depend on the following factors::

1. irradiation zones
2. volume of irradiated tissues
3. total dose and fractionation regimen of radiation therapy
4. initial state of reparation processes

The task of the radiotherapist: when the 2-3 degree of radiation reaction is reached, stop treatment in order to preserve the reserve pool of stem cells (surviving cells of the basal layer that have gone into interphase), which will ensure further repair of the epithelium.

Diseases such as diabetes, systemic atherosclerosis, immunodeficiency conditions, long-term use of corticosteroid hormones and NSAIDs, hypotrophic status of the patient, decompensation of any somatic pathology, numerous courses of chemotherapy significantly disrupt reparative processes in tissues.

That. The role of therapeutic specialties related to oncology is enormous in terms of preparing the patient for radiation therapy, as well as in the post-radiation period. Objectives: correction and compensation of somatic pathology (diabetes mellitus, broncho-obstructive pulmonary diseases, systemic atherosclerosis, coronary artery disease, circulatory failure), correction of reparative processes (nutritional support, correction of myelo and immunodeficiencies).

Summary: Radiation reactions occur in 100% of patients undergoing radiation therapy, must be temporary, and can be significantly clinically pronounced, affecting the patient’s quality of life.

Radiation damage– this is a degenerative-dystrophic change in normal tissues, which is persistent and irreversible, occurring in the long-term period (peak frequency 1-2 years after radiation therapy). Radiation damage is mainly typical for systems with slow updates. The frequency of occurrence should be no more than 5%.

Main pathogenetic mechanism: damage to microcirculation vessels resulting in chronic ischemia and the development of processes of fibrosis of the organ parenchyma.

Vascular endothelium belongs to the slowly renewing F-systems, although a hierarchy of cells is structurally visible. Therefore, the endothelium reacts to irradiation late (after 4-6 months).

Possible changes in the endothelium:

1. uncontrolled hyperplasia of endothelial cells with subsequent occlusion of the lumen of the vessel

2. cellular devastation with emptying and thrombosis of the vessel.

Thus, a section develops in the parenchyma of the organ chronic ischemia, which disrupts the trophism and restoration of parenchymal cells, and also provokes collagen synthesis and rapid tissue sclerosis.

The vascular pathogenesis of radiation damage is the most studied, but is not the leading one for all tissues. The following are known pathogenetic mechanisms:

- under the influence of radiation, it is possible to change the antigenic structure of biopolymers and cell membranes, which can induce autoimmune processes (AIT and hypothyroidism after neck irradiation, dilated cardiomyopathy)

- death of 2nd order pneumocytes can lead to a decrease in the synthesis of surfactant, collapse of the walls of the alveoli, and the development of bronchiolitis and alveolitis.

- high doses of ionizing radiation can cause demyelination of nerve fibers, gradual depletion of the pool of Schwann cells and oligodendroglial cells. These processes underlie damage to the structures of the central and peripheral nervous system, including the neuro-automatic system of the heart muscle.

— a decrease in the pool and functional activity of fibroblasts leads to incomplete resorption and “aging” of the structure of collagen fibers, which leads to loss of elasticity and excessive development of connective tissue.

Primary processes of fibrosis compress microcirculatory vessels and prevent neoangiogenesis, which aggravates trophic disorders and triggers a pathogenetic circle.

The likelihood of occurrence and severity of radiation damage depends on:

1. single and total radiation dose, fractionation regime (large-fractionated irradiation techniques are always more dangerous with the risk of developing damage than classic version radiation therapy)
2. volume of irradiation of a specific organ
3. the presence of other pathological processes in the irradiated tissue

Based on the requirements of the European Society of Radiological Oncology, the detection rate of radiation damage should not exceed 5%, and there should be no radiation damage of grade 3 or higher.

The average frequency of radiation injuries in the Russian Federation, which is published in official publications, is about 20%, but some authors talk about a frequency of at least 40%. Statistical study of this phenomenon is difficult due to the long time period after radiation therapy, the slowly progressive nature of the course, and the low awareness of doctors in matters of radiobiology and medical radiology.

Possible nosologies as a consequence of radiation damage.

With total brain irradiation in acute period the following phenomena are possible: headaches, nausea, vomiting, anorexia, asthenic syndrome, cerebral edema. And in the long-term period after this type of radiation therapy, most patients experience memory loss, mental and cognitive disorders, headaches, and in 20% of cases the development of dementia. Extreme degree radiation damage to the brain due to local high-dose irradiation - radionecrosis.

The spinal cord is very often included in the radiation field with any type of radiation therapy. In the long-term period, the formation of radiation myelitis is possible: paresthesia, impaired superficial and deep sensitivity, motor and pelvic disorders.

The structures of the eye are highly radiosensitive: radiation cataract, retinal and optic nerve atrophy.

Inner ear: sclerosis of the otolithic apparatus with progressive hearing loss.

When irradiating head and neck tumors in the long-term period, patients can experience chronic xerostomia due to sclerosis of the salivary glands, chronic periodontal disease with tooth loss.

Irradiation of the thyroid gland in the long-term period can provoke AIT with progressive hypothyroidism.

The respiratory parenchyma of the lungs is highly radiosensitive, which determines the possibility of both acute radiation pneumonitis (often masked as infectious pneumonia) and the development of radiation pneumosclerosis 6-12 months after the end of the course of radiation therapy, which leads to a decrease in tidal volumes.

The mesothelium of the pleura, pericardium and peritoneum is highly radiosensitive tissue. In the acute period, it can react to irradiation in the form of fluid transfer, and in the long-term period - in the form of an adhesive process.

The main pathological processes during irradiation of the kidney parenchyma are observed in the proximal and distal parts of the convoluted tubules, as well as in the microcirculation vessels. The main pathological process is nephrosclerosis with decreased function.

Radiation damage to the dermis, ligamentous-articular apparatus and striated muscles follows the path of vascular pathogenesis with subsequent fibrosis and sclerosis of the tissue. Severe damage - joint ankylosis, radiation skin ulcer.

Cardiac toxicity of antitumor treatment is a very common and pressing problem today. The mediastinal area is very often included in the treatment volumes irradiated (breast cancer, lymphoma, lung cancer, esophagus). This is one of the most dangerous side effects, which affects both the quality of life of patients and survival rates.

Primary cardiac risk: age over 50 years, arterial hypertension, overweight, hyperlipidemia, atherosclerosis, smoking, diabetes.

In addition to the presence of risk factors, most modern cytostatics (even cyclophosphamide and 5-FU) have cardiotoxicity (in its various variants).

Even with high-precision radiation equipment, it is impossible to limit the mediastinum from radiation as much as possible, due to a decrease in the radicalism of treatment and tumor control.

Heart diseases caused by radiation therapy:

- acute effusion pericarditis (with outcome in chronic exudative, or adhesive pericarditis), hypotensive syndrome. Observed in early period after and during a course of radiation therapy.

- angina pectoris and myocardial infarction (due to endarteritis of the coronary vessels). This is a late side effect, with maximum frequency at 3-5 years of follow-up.

- diffuse interstitial fibrosis of the myocardium resulting in restrictive cardiomyopathy, rhythm disorders (sinus tachycardia, various options atrial fibrillation, blockades). Fibrosis can lead to valve disorders (stenosis and insufficiency of the mitral and aortic valves)

— dilated cardiomyopathy as an outcome of autoimmune processes in the myocardium

- fibrosis of the large pulmonary volume can lead to increased pressure in the pulmonary artery with subsequent development pulmonary heart

— obstruction of the venous and lymphatic vessels of the mediastinum after irradiation can provoke chronic exudative pleurisy and pericarditis or chylothorax.

As shown clinical observations and studies, the total dose at which these pathological processes are possible is 30-40 Gy (in reality, the used SOD ranges from 46 to 70 Gy). And if we add to this the presence of primary cardiac problems, the behavior of massive cytostatic therapy, anesthesia, stress, then probability turns into inevitability.

Before starting treatment (including before chemotherapy), it is recommended: ECG, ultrasound of the heart (LVEF, diastolic indicators), type-B natriuretic peptide, troponin.

Contraindication for cardiotoxic interventions(radiation therapy to the mediastinal area or cardiotoxic chemotherapy) are: initial LVEF less than 50%, or a decrease in LVEF by 20% from initial, even normal level, even in the absence clinical signs heart failure. Sub- and decompensation of pathology of the cardiopulmonary system is also a contraindication.

However, radiation therapy is a highly effective antitumor treatment method; the frequency of its use in treatment regimens or as an independent method is increasing. Clinical and radiobiological experience in working with sources of ionizing radiation is being accumulated. The main direction of development of radiation therapy is to minimize the impact of ionizing radiation on normal tissue, with a more precise and high-dose effect on a malignant tumor.

Probably not worse than the disease today than cancer. This disease does not look at age or status. He mercilessly mows down everyone. Modern methods Tumor treatments are quite effective if the disease was detected on early stages. However, cancer treatment also has negative side. 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 fatal harm to organs and tissues. All neoplasms can be divided into benign and malignant.

Benign tumor cells are not much different from healthy cells. They grow slowly and do not spread beyond their source. They are much simpler and easier to treat. They are not fatal to the body.

Cells malignant neoplasms their structure is unlike normal healthy cells. Cancer grows quickly, affecting other organs and tissues (metastasizes).

Benign tumors do not cause any particular 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 growth of the tumor into other organs and tissues, that is, the formation of metastases. Treatment at this stage is aimed at pain relief and prolonging the patient’s life.

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

With a genetic predisposition.

With a weakened immune system.

Leading an unhealthy lifestyle.

Working under hazardous working conditions.

Those who have received any mechanical injuries.

For prevention purposes, you need to be examined by a therapist once a year and get tested. 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. Basic method. It is used in cases where cancer formation is not yet sufficient big sizes, and also when there are no metastases (early stages of the disease). Radiation or chemotherapy may be performed first.

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

Chemotherapy. Treating cancer with chemicals. Used in combination with radiation therapy or surgery to reduce the size of the tumor. It is also used to prevent metastasis.

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



The most effective to date is surgery tumors. The operation has least amount side effects and gives the patient a greater chance of healthy life. However, application of the method is not always possible. In such cases, other treatment methods are used. The most common of which is radiation therapy. Although side effects after it cause many health problems, 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, the choice of treatment method should be made after a thorough examination and assessment of all risks for the patient.

Radiation therapy treatment, 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.



Radium, cobalt, iridium, and cesium are used for radiation. are compiled individually and depend on the characteristics of the tumor.

How is radiation therapy performed?

Radiotherapy can be carried out in several ways:

1. Irradiation at a distance.

   Contact irradiation.

   Intracavitary irradiation (a radioactive source is introduced 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 residual tumor formation);

before surgery (to reduce tumor size);

during the development of metastases;

during relapses of the disease.

Thus, the method has three goals:

Radical - complete removal of the tumor.

Palliative - reduction in tumor size.

Symptomatic - elimination of pain symptoms.



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

Who is contraindicated for radiation?

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. Separate group In humans, radiotherapy is generally contraindicated. These include patients who:

Severe anemia, cachexia (sharp loss of strength and exhaustion).

There are diseases of the heart and blood vessels.

Radiation therapy of the lungs is contraindicated for cancerous pleurisy.

Renal failure and diabetes mellitus are observed.

There is bleeding associated with the tumor.

There are multiple metastases with deep invasion into 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 suffer from side effects in the future. Since ionizing rays damage not only the structure but also healthy cells.

Side effects of radiation therapy

Radiation therapy is intense irradiation of the body with radioactive substances. In addition to the fact that this method is very effective in the fight against cancer, it has a whole bunch of side effects.

Radiation therapy has very different reviews from patients. For some, side effects appear after just a few procedures, while for others there are practically no side effects. One way or another, any unpleasant phenomena will disappear after completing the course of radiotherapy.

The most common consequences of the method:

Weakness, headache, dizziness, chills, elevated body temperature.

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

Changes in blood composition, decrease in platelets and leukocytes.

Increased number of heartbeats.

Swelling, dry skin, rashes in areas where radiation was applied.

Hair loss, hearing loss, vision loss.

Minor blood loss is caused by fragility of blood vessels.

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

Nutrition and renewal of the body after irradiation

During treatment of tumors, no matter what method, it is necessary to eat properly and balanced. This way you can avoid a lot unpleasant symptoms illness (nausea and vomiting), 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 avoid foods that contain preservatives, as well as salty, smoked and fatty foods.

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

Carbonated and alcoholic drinks are prohibited.

Preference should be given to fresh vegetables and fruits.

Besides proper nutrition, the patient should adhere to the following rules:

Get plenty of rest, especially after the radiation procedures themselves.

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

Spend more time outdoors.

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Radiation therapy has very different reviews from patients. However, without her successful treatment cancer is impossible. Sticking to simple rules, you can avoid many unpleasant consequences.

For what diseases is RT prescribed?

Radiotherapy is widely used in medicine to treat cancer and some other diseases. The dose of radiation depends on the severity of the illness and can be spread over a week or more. One session lasts from 1 to 5 minutes. Radiation irradiation is used to fight tumors that do not contain fluid or cysts (skin cancer, cervical, 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 tumor in size and also kill the remaining cancer cells. In addition to malignant tumors, diseases of the nervous system, bones and some others are also treated with the help of radio radiation. Radiation doses in such cases differ from oncological doses.

Repeated radiation therapy

Irradiation of cancer cells is accompanied by simultaneous irradiation of healthy cells. Side effects after RT are not pleasant phenomena. Of course, after canceling the course, the body recovers after some time. However, having received one dose of radiation, healthy tissues are unable to withstand repeated irradiation. If radiotherapy is used a second time, it is possible to in case of emergency and 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 late stages of cancer

The radiotherapy method is used not only to treat cancer, but also to prolong the patient’s life by late stages cancer, as well as to relieve symptoms of the disease.

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

Reduces and sometimes completely eliminates pain attacks.

Reduces blood pressure nervous system, on the bone, maintains capacity.

Reduces blood loss, if any.

Radiation for metastases is prescribed only to the sites of their spread. It should be remembered that radiation therapy has a variety of side effects. Therefore, if the patient is severely depleted and cannot withstand the dose of radiation, this method is not practiced.

Conclusion

The most terrible disease is cancer. The whole insidiousness of the disease is that it may not manifest itself in any way for many years and in just a couple of months it can bring a person to fatal outcome. Therefore, for the purpose of prevention, it is important to be periodically examined by a specialist. Detection of the disease in the early stages always results in complete healing. One of effective methods The fight against cancer is radiation therapy. Side effects, although unpleasant, however, completely disappear after discontinuation of the course.

Consequences and rehabilitation after radiotherapy occur due to the toxic effects of ionizing radiation on tissues close to the tumor. Radiation therapy is used in 60% of cancers. The therapeutic result of radiological therapy is the destruction of cancer cells and stabilization of the malignant process.

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Possible consequences after radiotherapy

Patients experience side effects, the severity of which depends on the duration of the course of radiation therapy and the depth of ionizing radiation to tissues. In most cases, the occurrence of radiological complications is of a purely individual nature. Most often, an inadequate reaction of the body of a cancer patient is observed in the form of skin lesions.

Consequences after radiotherapy include the following symptoms:

Skin reactions:

Skin that has been irradiated

As a result of the action of ionizing radiation, the epithelial layer becomes dry and sensitive to mechanical stimuli. This requires careful and careful care for the skin.

Skin reactions after radiotherapy are manifested by redness of the epidermis, a burning sensation and pain in the affected area. Such processes are similar to the clinical picture sunburn, but are characterized by an aggressive course. Radiological damage to the skin is accompanied by the formation of blisters, which ultimately act as entry gates for bacterial infection. If not carried out treatment after radiotherapy, then this is fraught with development purulent inflammation skin.

Skin pathology is usually diagnosed in the second week after the end of the course of radiation therapy. Radiological complications in most cases disappear after 1-2 months.

In oncological practice, it is customary to divide three degrees radiation injury epithelium:

1. 1st degree. Slight erythema (redness) of the skin surface.
2. 2nd degree. Patients experience hyperemia, peeling of the skin.
3. 3rd degree. This is the most severe variant of radiological dermatitis with extensive redness and keratinization of the epidermal layer of the skin.

Respiratory system dysfunction:

This symptomatology develops in cancer patients who have undergone radiological treatment of the thoracic region. Such patients often complain of shortness of breath, attacks of dry cough and sharp pain. Further progression respiratory complication accompanied by unproductive cough, which does not bring the slightest relief to the patient.

Pathology of mucous membranes:

A long course of irradiation of the abdominal cavity and pelvic organs can provoke the formation of symptoms of dryness of the intestinal mucosa or organs of the urinary system.

Complications after radiotherapy of intoxication nature:

• Intoxication

To reduce symptoms of intoxication, a cancer patient should balance daily diet nutrition, increase sleep duration and avoid heavy physical activity.

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Fast recovery after radiotherapy

After undergoing a radiological course of therapy, each patient experiences side effects to varying degrees. In general, in such cancer patients, after 7-10 days, the function of internal organs completely normalizes.

1. Strict adherence to the course of rehabilitation therapy prescribed by the oncologist.
2. Moderate exercise stress, which helps to tone the body and hyperventilate the lungs.
3. Fresh air. The patient's stay in the open air increases oxygen saturation of the blood, which significantly improves well-being.
4. Increased fluid intake. To the patient after radiotherapy You must drink at least 3 liters of water daily. These measures are aimed at stimulating the processes of eliminating toxins and free radicals from the body.
5. Refusal bad habits. Chronic smoking and alcohol consumption increases the amount of toxins in the patient's body, which in some cases can be life-threatening.
6. Balanced diet. The diet during this period should include an increased amount of fruits and vegetables. During the course, foods high in preservatives and food colorings should be avoided.
7. To prevent mechanical injury of the skin in the area of ​​radiation exposure, patients are recommended to wear loose-fitting clothing made exclusively from natural fabrics.

Consequences and rehabilitation after radiotherapy include mandatory preventive visits to an oncologist, which allows for timely detection and diagnosis. During preventive examination the doctor conducts visual and instrumental examinations of the skin. If necessary, the patient may be prescribed radiography, ultrasound examination and analysis on .