The esophagus is radiation therapy in the treatment of cancer. Surgical and drug treatment of esophageal cancer Preparation and conducting radiation therapy

The organs of the digestive system are one of the main locations of the localization of pathological malignant neoplasms.

In this case, the esophagus cancer is the most common diagnosis of about 90% of the number of all the revealed tumors of the gastrointestinal tract.

The disease is distinguished by relatively slow progression. What is this anomaly, and most importantly - what are the methods for its elimination?

Esophageal cancer is an atypical mutation of the department of the department, causing the appearance in its tissues of cancer tumors. Basically, has a flat-stacked structure. With incompeated therapy, therapy is characterized by extreme aggressiveness and unfavorable life forecast.

In most cases, from the moment of diagnosing the disease to death, in the case of its late detection, it takes about six months. When identifying pathology at the stage of its formation, a patient has every chance of overcoming 5 - 6 years of survival threshold.

It is noteworthy that men are sick of the esophagus cancer three times more often than women. The peak of the defeat falls on the elder age group - From 70 years.

What can medicine?

The treatment of pathology is determined by the stage and degree of damage to the body, as well as the general physical condition of the patient as a whole, and mainly includes operational methods of intervention, chemotherapy and radiation impact.

The positive dynamics is achieved in isolated cases - the exception is patients with limited lesions. Determine several trends:

basic - suggests radical or gentle (depending on the anamnesis) surgical intervention. Despite the large number of techniques, is considered the main and most effective option to combat the esophagus cancer.

After the operation, it is carried out a course of exposure to radial flows or receiving cytostatic preparations. The principle of the main direction of treatment is the maximum suppression of cancer cells and eliminating the lesion focus.

The goal is to complete or partially erase the patient and the approach to the conditions of his life is consumed comfortable;

palliative - Applicable patients with contraindications to surgical effects or in the event of the inoperability of this form of cancer. It may give a pronounced effect with a complex selection of conservative ways to suppress cancer cells, bypassing an attempt to amputate the place of primary localization of the neoplasm.

With a competently selected scheme of therapy, prolonged clinical improvements are possible, improving the quality of life and extending it;

support - K. this method exposure to the tumor conservative methods Treatment. It is assigned at the stages of active progression when the operation will no longer bring a positive result and the growth of the anomalies is almost uncontrollable.

The course purpose of the reception of chemotherapeutic drugs will slow down the proliferation of the tumor to adjacent tissue, reduce the metastasis rate, and the irradiation stops the development of secondary cancer and slow down the atypical processes of cell-bottoming.

In addition, supporting treatment The main goal sets a decrease in the symptomatic manifestations of the disease, which are quite pronounced at the final stages and is difficult to transfer the patient.

The reception of painkillers will help a person cope with pain syndrome, and the drugs of the directional spectrum of action - somewhat will extend his life.

Surgical intervention

For an effective result, a radical resection is necessary in the process of operational intervention, which includes the amputation of the tumor itself at the tissue level, which retained its structural integrity and non-cellular mutation.

As well as all lymph nodal compounds that can potentially be amazed by cancerous formations. In addition, the removal of the proximal part of the stomach is shown, which contains the distal path of the outflow of the lymphatic fluid.

The technique involves the additional mobilization of the gastric department in the direction of the vertex, followed by the formation of the anastomosis, and the overall mobilization of the thick and small intestine.

A mandatory effect in carrying out the resection of the esophagus is lymphodissection - not less than immediately in two cavities of lymphatic metastasis. Basically, these are submandibular lymph nodes.

Piroplasty used in the process of manipulation will make it possible to drain the stomach. These procedures are extremely complex, and the age factor plays not in favor of the patient. Hence the risk of complications and the development of internal inflammations of soft tissues.

Postoperative complications include the development of fistulas, insufficient functionality of anastomosis, a bull reflex provoking strong pain Behind the chest zone, circulatory disorder, heart failure. Female outcome occurs in 10% of cases.

Chemotherapy

Tumors affecting the esophagus department are characterized by a low degree of sensitivity to the affecting effect of chemical components contained in anticancer drugs.

For this reason, the treatment method applies only comprehensively, with its effectiveness in reducing the magnitude of the tumor - about 10 - 30%. It is worth noting that the degree of positive dynamics does not depend on the name of the selected drug - their affecting the ability to influence the anomaly is almost identical.

With this form of cancer, combined receiving schemes are prescribed medicines. Basically, it is cisplatin and 5-fluorouxyl, as well as their derivatives - Doxorubicin, Bleomycin, Mitomycin, Windesin. It is them more than others adapted to eliminate active flat-belling formations.

The treatment system is based on a comprehensive combination with radiation therapy, which precedes the course of receiving chemotherapy.

Depending on the clinical picture Progressing the disease, the patient is prescribed from 4 to 6 courses, each of which has 21 days break, after which the selected cytostatic reception scheme is repeated. With a comprehensive application, the effectiveness of the method is up to 40%.

The main complication after such treatment is the excessive toxication of the body caused by the products of the tumor decay, as well as a negative effect on the human body of the drugs themselves. Most often, the patient is pursued: nausea, attacks of vomiting, weakness, blood pathology, liver dysfunction.

Radiation therapy

The radiation treatment of the esophagus tumor, when the operation is contraindicated, is still considered the most effective option for the treatment of patients with this diagnosis and is characterized as palliative.

Modern techniques and innovative equipment help increase the efficiency of radial flows by their point filing to the location of the tumor, which made it possible to reduce the symptomatic manifestations of the disease by an average of 35%.

Especially persistent positive dynamics gives an intra-proper irradiating method. The essence of the technology is in the introduction of a special thin probing device into the lumen of the department so that the cobalt tip, sourcing radioactive wave oscillations, is fixed at the level of the formation of the neoplasm.

The irradiating devices put on the perimeter of the pathology boundaries and the most accurately affects it.

Efficiency from such procedures is able to extend the sick life on average for 10 - 12 months, subject to the general satisfactory physical condition organism.

Features of therapy at each stage

The specificity of therapy, its goals and objectives, as well as the combination of methods and the duration of the courses in this form of cancer, primarily depend on the stage of the disease and look like this:

1 Stage - It is a stage of formation and because the treatment will be chosen correctly, the chance of a patient on full recovery will be selected. Basically, it is an operational intervention - its effectiveness at this stage is highest. To secure the positive dynamics and reducing the risk of developing recurrent processes. radiation therapy;

2 Stage - Depending on the degree of proliferation of the tumor, the doctor can either carry out an operation - if the lesion is in the upper or lower third of the department, or limit the irradiation - if the pathology has formed in the central zone of the esophagus. Admissible gentle resection.

Additionally, X-ray therapy is carried out - rotary damage by irradiation or radium therapy in an intrabate way;

3 Stage - At this stage, surgery is usually not prescribed due to its low efficiency. TELEGAMMEAPY I. x-ray irradiation - the most justified as a supportive integrated effect on the tumor, techniques.

If, as a result of these measures, the magnitude of the pathology decreased by 35 - 40%, after the course of radiation therapy, it is possible to consider the implementation of the new formation amputation to the method described above.

At the stage of rehabilitation - chemotherapy courses to minimize the risk of developing secondary cancer, which occurs in more than 50% of cases;

4 Stage - Surgical intervention and irradiation are excluded. Conducted only symptomatic treatmentaimed at improving the quality of life of the patient and its maximum extension. As additional measures, applying fistula, anastomosis and other options for palliative effects on the organ.

Read more about the selection of treatment methods is described in the video from the medical conference:

If you have found a mistake, please select the text fragment and click Ctrl + Enter..

Generally accepted that surgery It is best for the treatment of adenocarcinoma of the esophagus (almost always the lesions of the lower third), in case there are damage to operational. In most other cases, especially for lesions in upper third and the cervical part of the esophagus, the best choice of treatment is the combination of chemotherapy and radiation therapy. A surgeon or radiotherapist should determine the type of treatment (radical or palliative) before the start of local therapy.

Radical treatment of esophagus cancer

When thinking radical surgical operation For patients who are generally suitable for it and do not have signs of remote metastasis, it is important to determine the degree of damage prior to the final resection. To do this, trial laparotomy is recommended that has become the usual part of many operations when the recovery is achieved by moving (transposition) of the colon and creating the viable channel between the throat and the stomach.

Radical removal of the esophagus, Cherney (Czerny) for the first time more than 100 years ago, is currently carried out in one stage with gastroofic anastomaosis or movement (transposition) of the colon. Previously, during operations, it was left permanent gastrostom for power supply.

Only a smaller part patients with cancer of the esophagus may be radically operated, the most frequent testimony for such an operation is the lesion of the medium or lower third of the esophagus, especially if histology is an adenocarcin, and the patients are suitable without explicit signs The presence of metastases. Until recently, there was practically no indication that preoperative radiation therapy or chemotherapy affects the degree of radicality resection, mortality rates for surgery or total survival.

But in a recent large-scale study in UK A striking improvement is shown when using a preoperative combination of chemotherapy (cisplatin and fluorouracil) with radiation therapy. Survival coefficients for 2 years amounted to 43% and 34% (using chemotherapy and without it); Median survival coefficients (with the use of chemotherapy) was 16.8 months compared with 13.3 months (without it). The data of previous studies were disappointing.

Operation with esophageal cancer:
(but) full removal esophagus with the replacement of the colon;
(b) Mobilization of the stomach and reduce in the case of carcinoma of the lower third of the esophagus.

For patients carcinoma The upper third of the esophagus is usually chosen by radiation therapy, but some doctors are inclined in this case to surgical treatment. The randomized comparison of these types of treatment was not carried out. The combinations of chemrapyatherapy are now considered much more efficient than only radiation therapy.

Radiation therapy (with related chemotherapy or without it) compared with the operation has a number of advantages, including broader applicability (because most patients are in old age and eat poorly), the ability to avoid laryngectomy, as well as significant relief of dysphagia for most patients, with curable , at a minimum, 10% of patients are able to transfer high doses: only 60 g daily portions for 6 weeks. In addition, surgical treatment is characterized by mortality of approximately 10% (Fig. 14.6), it is unlike radial therapy not suitable for patients with regional dissemination of the disease.

And indeed, in the classical review is given mortality coefficientequal to 29% in patients around the world who received treatment in the 1970s, however, the mortality of operations decreased with the improvement of the selection of patients, surgical equipment and supporting treatment. Despite the bad general resultsWhen the operation has an advantage - temporary relief can be very good, as well as when radiation therapy, in some cases it can lead to curable.

Upper third esophagus It is technically difficult to expose due to the length of the processing area and proximity. spinal cord. The irradiation zones in the ideal case must extend at least 5 cm above and lower from the known limits of the propagation of the disease in order to adequately process the possible propagation of the lesion in the submissible wall layer. As with postper-shaped carcinomas, it is often necessary to use complex technical techniques, using intertwined, crack, inclined, multiple irradiation fields, often with compensators (transformers).

It is also necessary to carefully planning The irradiation on two or three levels so that the tissue of the cylindrical form receives the same high dose of radiation, but at the same time that the adjacent spinal cord does not occur.

Radical radiation therapy in the case of carcinoma cervical department esophagus.
Due to the asymmetric anatomy, a plan for complex multipoloral irradiation is necessary.

For tumors middle third esophagus As the main treatment, radiation therapy is increasingly used, sometimes in combination with the operation. Some surgeons believe that the operation proceeds easier, and its long-term results are better when conducting preoperative irradiation. In technical terms, preoperative and radical radiation therapy of the tumors of the middle third of the esophagus is lighter than the tumors of the upper third of the esophagus. As in relation to the tumors of the upper third of the esophagus, currently synchronous chemo and radiation therapy is widely used for the average third of the esophagus; In our center, the standard of treatment is now a combination of mitomycin C and 5-FU.

When cancer of the lower third of the esophagus Operation is often preferred, while reconstruction, usually carried out with mobilized, less complex.

For cancer of the lower third of the esophagus There is a risk that the stomach will be affected by a tumor and will be not suitable for reconstruction. For inoperable tumors, radiation therapy may be useful.

Complications in the treatment of tumors All departments may be difficult or even severe both in the case of radiation therapy and during the operation. Radical radiation therapy is often accompanied by radiation inflammation of the esophagus (esophagitis) requiring treatment with alkaline or aspirin-containing suspensions for the local impact on the inflamed mucous membrane of the esophagus.

Possible later complications Includes radiation damage to the spinal cord and the lungs, which leads to radiation pulmonification and sometimes shortness of breath, coughing and reducing respiratory capacity, but in everyday practice such phenomena are rare. Fibrosis and scarring of the esophagus lead to its stricture, which may require an extension to preserve the opened state of the esophagus. Despite the above facts, most patients carry such treatment is surprisingly good, even with the use of chemotherapy.

TO surgical complications The stricture of the esophagus and the inconsistency of the anastomosis, as a result of this - mediastinitis, bulconite and sepsis, sometimes leading to the death of the patient.

In patients with dysplasia high degree in esophageal barrett The use of photodynamic therapy was promising. So far, the data is collected by a small number of patients, but this method of treatment is already recognized as the National Institute of Clinical Art (NICE) suitable in some cases.

Palliative treatment of esophagus cancer

Palliamentary treatment with esophageal cancer It can be very useful with the use of a celestine or other permanent prosthetic, radiation therapy or laser treatment (as well as both of them), or sometimes with a bypass operation, without an attempt to remove the place of the primary tumor, but with the creation of an alternative channel. For patients who cannot be subjected to radical operation and radiation therapy, it is always necessary to consider the possibility of palliative treatment, especially in cases of severe dysfagia. Moderate radiation doses can lead to pronounced clinically improvements.

In experienced hands holding a celestine or tensile esophageal tube A metal grid is a relatively safe and effective procedure that can be combined with radiation therapy. Common problems with the introduction of the tube include its movement, gastroofing fistula (sometimes associated with hitting the lungs of the stomach), styled pain and discomfort. Complications for palliative irradiation are minimal, as low doses are used: usually the treatment of a dose of 30 grams is beneficial for a 2-week period if dysphagia is not total, and high doses are rarely needed. In our center is widely used in-room brachytherapy, offering a simple and fast alternative.

The malignant esophageal tumor (esophagus cancer) takes the 6th place in the prevalence among malignant neoplasms. Among the main methods for the treatment of esophageal cancer are surgical treatment, and radiation therapy.

Radiation therapy can be used as an independent method of treating esophageal cancer ( initial stages diseases without signs and when radical surgery It is impossible for any reason), and can be used in combination with surgery and / or chemotherapy. Exposure can be carried out both remote and contact method. In the second case, the radiation source is placed in the lumen of the esophagus near the tumor.

The use of radiation therapy for the treatment of esophageal cancer has an influence of both tumor education (decrease in size, reduction of growth activity, better operation) and on the way of the outflow of lymphs from the esophagus, killing tumor cells that can be in regional lymph nodes.

With Operable Esword Cancer, radiation therapy is carried out by courses, before and after surgery. Prior to surgical intervention, radiotherapy is used in infiltrative and undifferentiated forms of cancer, as well as the location of the tumor in the middle and upper part of the esophagus - in places where the radical removal of the tumor is quite difficult. After surgical intervention, radiotherapy is carried out when the operation failed to remove the tumor radically, or if there is a risk of cancer cells into the surrounding tissues.

With the inoperable forms of the esophageal cancer, radiotherapy is usually used as part of complex treatment regimens, together with chemotherapeutic treatment. For example, the use of a combination of cisplatin preparations and 5-fluorouracil, together with radiotherapy (with a dose of 50 Gy), about 20% of patients leads to a complete regression of the tumor process.

With launched cancer forms, in the presence of remote metastases, surgical treatment is useless due to the prevalence of the tumor process. For this group of patients, the main task is to preserve or restore enteric power (which is broken due to the development of the tumor). Among the palliative methods that are used in these cases are endoscopic laser or electro-coagulation, transduceral intubation of the esophagus through the location of the narrowing and radiation therapy (intra-pal).

Intra-proprietary irradiation is carried out by placing radioactive sources into the slope of the probe, which is installed in the lumen of the esophagus in the area of \u200b\u200bthe tumor location. With the stenosis of the esophagus, the patient's condition can improve by using parenteral nutrition and / or gastrostomy, which precede the implementation of the palliative radiation therapy program.

Popular foreign oncological clinics and centers

The Italian San Rafael clinic enjoys well-deserved authority as a medical center providing quality services for the diagnosis and treatment of a wide range oncological diseases. The center has a branch of oncohematology, hematology and bone marrow transplantation, etc.

American Memorial Oncology Center. Sloe-Kettering is one of the most famous and largest oncocentres not only in the United States, but also around the world. It has first-class healing equipment, actively applies advanced developments and techniques in the treatment of malignant tumors.

In the clinic of Assuut in the treatment of esophagus cancer in Israel, a team of highly professional doctors interacts with a patient, among them - oncologists, surgeons, radiation therapists, rehabilitation specialists, nutritionists, etc., such innovative methods are used as:

Minimal invasive surgery.
Endoscopic surgery.
Radiotherapy.
Targeted therapy.

In addition, participation in clinical studies is offered.

To get the consultation

Surgery

This is the basic in Israel, when the disease did not affect the lymph nodes. Essophectomy is most often carried out, there are several approaches to its implementation. The doctor will recommend the most appropriate technique based on the location of the tumor and the presence / absence of secondary foci.

As a rule, the operation includes removal:

parts or completely esophagus;
stomach segment;
lymph nodes closely located to malignant hearth.

The preserved part of the stomach is tightened up and connected with the esophagus segment. A nutritional tube may be needed until the patient is able to independently take food.

Potential side effects Surgery include:

leakage from anastomosis;
hoping;
heartburn;
problems with digestion.

Chemotherapy in the treatment of esophagus cancer in Israel

Chemotherapy applies cytostatic drugs in the fight against cancer, stopping its growth. Chemotherapy, moving along blood flow, reach malignant cells throughout the body.

For their introduction to the body use injections, droppers (for intravenous infusion), pumps.

List of possible issues that can be asked a doctor in the Assute Clinic:

Why in this case Is it necessary to treatment with cytostatic drugs?
What is the task of chemotherapy in a particular case?
Are there alternatives?
How is the treatment?
Will the central catheter take?
What are long-term and short-term side effects?
What measures can be taken to facilitate the undesirable effects of therapy?
What is the duration of the course?
Chemotherapy will conduct an outpatient or hospitalization?

Chemotherapy with esophagus cancer before surgery

Most patients who pass surgical treatment of esophageal cancer are prescribed cytostatic therapy. results clinical studies It is shown that such treatment reduces the risk of recurrence into 2 and 3 stages of the disease. And also this type of treatment reduces the size of malignant education so that the surgeon is easier to remove it. A diagram of drugs is often used - cisplatin and fluorouracil (5-FU).

Chemotherapy for esophageal cancer before and after surgery

During the diagnosis of the lower part of the esophagus or the location of the tumor in the esophageal-gastric transition, chemotherapy may be required before and after surgery (perioperative). It reduces tumor dimensions and chances of returning the disease.

Combination of chemotherapy and radiotherapy

This type of treatment is otherwise referred to as chemo-therapy. Sometimes it is prescribed to surgery to reduce the risk of recurrence.

If the tumor process did not spread, but it is difficult to remove, chemo-treatment capabilities can reduce the neoplasm. After that, the surgeon will be able to remove it. This type of treatment of the esophagus cancer is effective to surgical intervention during adenocarcinoma and the flat-cell type of cancer.

When the operation cannot be carried out or the patient does not agree, as an independent method of doctors can recommend chemo-therapy, especially with flat-stalling cancer in the upper third of the esophagus. Many experts believe in this situation that the results of this treatment are also effective as an operation.

Chemical therapy is quite intensive treatment. It is difficult to pass the whole course, and side effects will be more serious than separately. When making a decision, the doctor will evaluate the state of health, can the patient move it.

Ask a question to the doctor

Chemotherapy with esophagus cancer for symptoms

If the metastasis occurs in the body, chemotherapy is recommended to reduce tumor education, slowing down the growth of the disease, the weakening of its manifestations, for example, difficulties in swallowing. Treatment is mainly a combination of cytostatic agents. They will enter the body through a dropper and tablets. The main task is to facilitate the patient's condition so that the undesirable effects of therapy do not outweigh the advantages.

With the adenocarcinoma of the esophageal and gastric transition or the presence of a large amount of HER2 protein on the surface of cancer cells, targeting therapy can be recommended - Herceptan with cytostatics.

If chemotherapy turns out to be ineffective, the treatment of the esophagus cancer with a laser or the placement of the stent is to take the food to go down the esophagus.

Before chemotherapy should be consulted with a doctor about the adopted BAA, medical herbs, plant preparations. They can reduce the effectiveness of cytostatics.

Preparations of chemotherapy with esophagus cancer

Doctors use several different medicines and their combinations in the treatment of this disease. The results are higher when several drugs are used.

The choice is determined by the type of esophageal cancer and the alend stage. Based on research, it was found that certain cytostatics are more effective in the treatment of adenocarcinoma, others - with the therapy of flat-stacked cancer. If chemotherapy is considered in the later stages of the esophagus cancer, it is selected so that the minimum number of side effects occurred.

Chemotherapy:

Epirubicin.
Formuracyl, also called 5-fu.
Capecitabine, another name - Ksenoda.
Cisplatin, and sometimes carboplatin is used.
Oxaliplatin.
Paklitaxel (Taxol).

A combination of 2 or 3 drugs is prescribed - combinations, for example, ECF includes epirubicin, cisplatin and fluorouracil.

Some of the most common combinations for the adenocarcinoma of the esophagus:

CF or CX - Cisplatin and fluorouracil or capecitabine and cisplatin.
ECF - epirubicin, cisplatin and fluorouracil.
EOX - Epirubicin, Oxaliplatin and Capecitabine.

Israeli doctors also use irinotecan and vinorelbine.

For the introduction of most drugs use droppers. To receive FTOUROURCIL, the central catheter and the continuous flow of the drug in the body for several days or weeks are needed. Pompe (pump) are installed in the clinic.

Capecitabine is fluorouracil in tablets. Taking tablets for patients is often easier. Twice a day is prescribed the drug throughout the course of the treatment of esophageal cancer in Israel.

Most cytostatic combinations are given in outpatient conditions, sometimes it is necessary to stay overnight.

Learn prices for treatment

Side effects of chemotherapy with esophagus cancer

Cytostatic treatment causes certain side effects, which are due to a number of factors:

prescribed drugs;
dosage medication;
an individual reaction of the body.

Not every patient has all possible side effects. Some people react more than others. And different drugs have various unwanted consequences. Therefore, it is not possible to accurately predict. Most side effects It lasts a few days while the reception of drugs continues. List of some common unwanted manifestations:

Reducing the number of blood cells.
Increased risk of infection.
Nausea.
Diarrhea.
Thinning hair or loss.
Stomatitis.
Fatigue.

Chemotherapy and radiotherapy

Exposure can be appointed at the same time as chemotherapy. The method is called chemo-therapy. Exposure give every weekday 5 weeks.

Different techniques for conducting chemical treatment are applied. The patient can receive chemotherapy during irradiation course. Sometimes several cycles of chemotherapy passes the patient before starting radiotherapy.

Chemo-treatment therapy can be assigned to surgery or instead of it. Several different chemotherapeutic drugs are used. Most often, the combination of cisplatin and dedication is recommended.

Cisplatin gives intravenously, in outpatient conditions, sometimes it is necessary to stay overnight. Capecitabine in tablets take the entire course of therapy twice a day.

Radiotherapy takes each week's day 5 weeks. Most patients undergo chemo-treatment of esophageal cancer in outpatient conditions, however, due to negative consequences, hospitalization is sometimes required.

Side Effects of Chemology Therapy

This type of treatment is rather intense. Unwanted phenomena of chemotherapy and irradiation may occur - reduction of blood cells, increased fatigue, redness of the skin in the treatment area, nausea, sore throat, weight loss.

Nausea

Available effective drugs To eliminate this symptom.

Sore throat

Most patients who pass this treatment hurts the throat. Problems with swallowing can be exacerbated in the process of continuing therapy. The doctor will prescribe painkillers, can recommend solid food for some time to replace with liquid. Some patients use the pump to receive analgesics, it provides a permanent dose of medication and comfort throughout the treatment of esophageal cancer.

Loss of body weight

Due to problems with swallowing, patients can lose weight. Do not worry too much about it. In the event of a serious situation, the doctor may offer the placement of the nutrient tube (gastrostomic or ejunomatic) until the patient recover after therapy and will not be normally feed.

Order a free call

Radiation therapy with esophagus cancer

Radiation therapy uses ionizing radiation in the treatment of malignant disease.

The doctors of the Assutu clinic often use radiotherapy. A combination of cytostatics and irradiation can be recommended to cure the disease, as well as to surgery or instead of it. More often this type of treatment of esophageal cancer is prescribed instead of operation with damage to the upper third of the esophagus, especially with flat-stacked cancer.

If the disease is diagnosed in the later stages, the irradiation is also used. It can reduce the volume of the tumor and weaken the symptoms that provokes the neoplasm.

The advantage is used by outer radiation therapy during esophageal cancer, but, in addition to it, the internal - brachytherapy is sometimes recommended when the source of radioactive radiation is placed inside the esophagus.

During the reception, you can ask anyone interested questions in the Assute clinic. Sample list:

Why is radiotherapy recommended in this case?
What is its task?
Need remote radiotherapy or brachytherapy, or both types?
Is there any choice?
How long will the treatment?
What are possible - short-term and long-term side effects?
Does a special diet need for this period of time?
Can the patient take some measures to facilitate side effects?

External irradiation is carried out at the Institute of Radiation Therapy under the clinic of the Assute, mostly ambulatory. The duration of the course depends on the task of treating the esophagus cancer in Israel - cure the disease or weaken its manifestations.

Radiotherapy aimed at getting rid of the esophagus cancer involves the course of a duration of 4 to 6 weeks. The radiation oncologist will calculate the full dose of irradiation and shares it into small procedures - fractions.

On a day it is possible to get one fraction, treatment is carried out on weekdays until the total dose is given. Doctors prescribe radiotherapy in such a way as to balance side effects with the effect of the treatment of esophagus cancer.

Radiation therapy for monitoring the manifestations of the disease involves obtaining a smaller number of fractions. It may be one processing per day for several days or a number of procedures with a break in a few days between each.

Planning radiation therapy with esophageal cancer

Before starting treatment, a team of radiation oncologists is carefully plans to external radiotherapy. The total dose is calculated and the processing zone is determined. The planning process can take from a few minutes to two hours. A CT or MRI will be conducted to accurately determine the tumor and structures around it.

The processing area can be placed by special signs (tiny tattoos).

If the upper esophageal segment is affected, there will be a mask to preserve a fixed position while treatment is undergoing.

For several days it may be necessary to solve the final details of the plan.

Receiving radiation therapy with esophageal cancer in assets

Linear accelerators have big sizes. The machine can be fixed in one position or rotate around the body, providing irradiation from different directions. The doctor explains in detail the patient what will happen. The session takes from one minute to several. It is important to keep the desired position.

Send a request

Brachytherapy in the treatment of esophageal cancer in Israel

Brachitherapy is a kind of radiation therapy when the source of irradiation is located inside the body, and not outside - from the linear accelerator. This type of treatment is not used as often as external radiotherapy. Typically, brachytherapy is used to slow down the development of the disease, instead of cure it. For example, after installing the stent to facilitate the process of swallowing.

The radioactive source is placed inside the esophagus for a certain time. It provides high doses of irradiation directly tumor. Since radiation is poorly propagated through body tissues surrounding healthy zones get a much smaller dose, they do not seriously suffer. The irradiation area is limited to approximately 1 cm around the radioactive source.

Two methods apply to provide such treatment of esophageal cancer in Israel by means of an endoscope or a naistric probe.

The doctor can accommodate a radioactive source during endoscopy. Endoscope, similar to a flexible telescope, lowered in the throat. It is equipped with light and camera, so the doctor sees the inner area. Before starting the procedure, the patient gives a sedative or light anesthetic. The radioactive source is installed next to the tumor. The radioactive material is sealed inside the tube, so can not find out.

By the same type used a nastastric probe. It is injected through the nose, lowered down the back of the throat to the stomach. Install the radioactive source and remove the probe.

The side effects of radiation therapy

Side effects are caused by the processing zone. In the treatment of esophageal cancer, this area can extend to the middle of the chest.

Unwanted consequences include:

short-term soreness when swallowing;
dry throat pain, which makes it difficult to swallowing;
increased fatigue;
redness skin cover in the processing zone;
hair loss on the body in the field of treatment.

Such phenomena usually occur gradually throughout the course, can increase by the end. The patient is usually able to eat only liquid or very soft food by the end of therapy.

If nausea is observed, antiemetic drugs are prescribed. Changes to the skin in most people are insignificant, some have more problems.

Side effects of radiation therapy in the treatment of symptoms

If secondary foci of the disease arose in the body, only a few procedures can be appointed. Therefore, it is likely that any unwanted manifestations will be absent. Radiation therapy is aimed at improving state and well-being.

Side effects of brachitherapia

Brachytherapy also has certain unwanted consequences of treatment. It can cause painful sensations when swallowing. Sometimes there are ulcers inside the esophagus. The doctor will appoint painkillers. During this period, we recommend liquid or very soft food.

Long-term side effects of radiation therapy

Both internal and external radiotherapy can cause long-term consequences. For example, provoke a narrowing or stricture of the esophagus. This will create difficulties in swallowing. A small operation can be carried out (dilatation) to expand the organ. This is usually performed in the process of endoscopic intervention.

Targeted esophagus cancer therapy

Targeted drugs help the body control the growth of malignant cells.

Herceptin in the treatment of metastatic esophagus cancer

With the adenocarcine of the esophageal and gastric transition, which has spread to other parts of the body, can be recommended by trastuzumab (gray) as the primary treatment of esophageal cancer. It is prescribed with chemotherapy.

Herceptin is effective, unless on the surface of cancer cells there are a large number of protein HER2. Before appointment of therapy, genetic tests are carried out.

Herceptin is prescribed in combination with cytostatis - cisplatin and capecitabine or fluorouracyl. Herceptin cannot cure metastatic cancer, but, according to tests, increases the survival of patients. The drug is introduced intravenously, every three weeks. This treatment of esophageal cancer continues while controls the disease.

Side Effects Herceptin

Among the most common undesirable manifestations: fatigue, diarrhea, allergic reactions, rash on the skin. These symptoms can be controlled by drugs.

Herceptin is able to cause damage to the heart, so tests are regularly held to find out how well the organ works.

Other preparations of targeted therapy

Researchers are studied by the drug Avastin (Bevacizumab) in the treatment of esophageal cancer, including the esophageal and gastric transition.

Prices for the treatment of esophageal cancer in Israel

Consultation of a specialist - 600 dollars.
Gastroscopy with checking on Helicobacter Pilori - 1080 dollars.
Common blood test - 260 dollars.
PET-CT - 1670 dollars.
Biochemical analysis - 280 dollars.
Study of materials (bioptate) - 680 dollars.
Research on oncomarcresses - 240 dollars.
Ezophagoscopy - 370 dollars.
Ultrasound - 340 dollars.
Target Now - 9,250 dollars.
Chemotherapy - 1180 dollars.
Medicines - from 360 dollars.
Radiation therapy - 140 dollars.
Ezophegtectomy - 59,000 dollars.
Full resection - 75,000 dollars.
Partial resection - 59,000 dollars.

Finishing the work of O. surgical treatment Patients with esophagus cancer cannot at least briefly not dwell on the radiation method that is widely used for the treatment of esophagus carcinoma.

Esophageal cancer - in which the impact of the rays should give good effect. Claire and Japha, Morrison believe that when the upper two-thirds of the esophagus cancer should be used radial treatment. Trautmann, Papillon, Goyon, Dufek, Lill, Dunlop, Barth, Dufek, Lill, Dunlop, Barth, Kern and others. Show that radiotherapy with the esophagus cancer gives a palliative effect.

Dufek, LILL applied X-ray therapy in 56 patients. Of these, 83% died in the first year, no one has lived to 3 years old, the average life of 6.7 months, while from the 9 patients radically operated by them live about 5 years.

Scheel, which applied radiation treatment with 399 patients with esophageal cancer, said that the remote results are bad: only two lived without recurrence of 5 years. Bad results received and a priest: out of 296 patients with esophageal cancer in 55% treatment was interrupted due to increased temperature and leukopenia, 81% of patients died towards the end of the 1st year, after 2 years alive 3%.

L. M. Goldstein, which used the method of long-term fractional irradiation through an unbelievable lead grid, also noted that the treatment was palliative; 75% of patients died during the 1st year; None survived 5 years.

In our country, Ya. G. Dillon one of the first began to widespread radiation therapy in esophageal cancer. He applied X-ray irradiation with many fields concentrically located around the hearth, and received good immediate results. According to T. G. Laroshchenko and S. I. Alekseeva, who used the Dillon technique in 58 patients, a good palliative result was observed in 28 and clinical direct cure - in 15.

With the introduction of radical irradiation methods into the practice of radical therapy, both immediate and remote results of the treatment of patients with esophageal cancer have become better.

By gunning, of 88 patients treated with the radios rotation method, 77 received a full course and 50 of them did not show signs of the disease. After 3 years, 8 patients were healthy, after 5 years - 4, after 6 years old, 1 patient. The author notes that the method was used in non-cultural patients with any localization of the tumor in the esophagus. If you irradiate operational patients, the results may have been better.

Scharar reported the results of the radiation treatment of 155 patients on the rotating table. Of these, 2% of patients were healthy 5 years, 4% -3; In 17% there was an improvement, 4.5% died from metastases, in 57%-impositions were absent or worsening. In 17 patients had bleeding, 34 - perforation of the esophagus. Scharar believes that compared to irradiation of the fields, rotary treatment is slightly better.

A. I. Ruderman leads data on 302 patients with esophagus cancer subjected to rotary irradiation. Of 302 patients, clinical cure was observed in 37%, palliative effect - in 39%. More than 2 years of 16% of patients lived from the group "clinically cured", more than 4 years - 7% and more than 5 years - 5 patients.

Adler and Deeb reported that after the death of 2 patients with esophageal cancer after 17 and 34 months after a combined outer and intreparent treatment during the esophageal section, it was not possible to detect the residual tumor.

Since 1958, the first reports appeared in the domestic literature about the treatment of patients with esophageal cancer radioactive cobalt-televisherapy. Currently, telega-SO-400 is currently used by the domestic installation of GUT-SO-400 in many radiopiological and oncological institutions of our country. A detailed study of both immediate and remote results of the treatment of patients with esophageal cancer is investigated, the influence of this type of rays on the body is investigated, etc. Evidence of increased interest in television administration during esophageal cancer is a large number of works on this issue.

1) from the stage of the esophagus cancer,

2) from irradiation techniques,

3) from the general state of the patient, etc. Nevertheless, M. A. Volkov and G. A. Zedgenidze quite definitely note that the results of the televisionmaherapy are much better than X-ray therapy.

According to 3. F. Bashnikova, from 200 treated patients, 24% live for more than 2 years and 5% -like 5 years. In A. Zedgenidze, out of 214 patients exposed to irradiation with the installation of GUT-SO-400, 117 more

2 years, 7 - 3 12 years, 2 - about 7 years. These are the best results described in the domestic literature on the radiation treatment of esophageal cancer. It should be noted that 3. F. Blovenov, in addition to the outer exposure, in some cases the intra-limited method of gammaterapy also applied. In addition, she prescribed chemotherapeutic drugs "in order to increase the effectiveness of treatment."

The results obtained by I. A. Popova, V. P. Shakova and L. I. Sergeyeva, much worse. Despite the fact that, according to L. I. Sergeyeva, out of 130 patients with esophagus cancer, under observation, 2 had I stage of the disease, in 58 - II, in 41 -III and only 29 - IV stage, more than 2 years There were only 8 people lived.

Watson and Brown, applying deep X-ray irradiation in 12 patients, noted that 5 of them live and healthy, and 7 died. Among the died in 4 at the opening of signs of carcinoma was not detected. The authors conclude that the esophagus cancer can be heal with deep radiotherapy with a directional beam.