| Ch 8 | Page 10 / 25 | |
| Cancer Radiotherapy |
Main radiotherapy indications | |
Brain tumours
Radiotherapy slightly improves the very poor prognosis of these tumours:
- glioblastoma,
Head and neck tumours
Radiotherapy can be used alone (in order to preserve organs) or in association with surgery (either pre-operatively or more often post-operatively treating both the primitive tumour and the satellite node territories). Among these tumours:
Bronchial tumours
Apart from a few rare exceptions, bronchial tumours cannot be cured by radiotherapy alone. It is generally used:
Oesophageal tumours
The results of radiotherapy alone or in association with chemotherapy are identical to those obtained with surgery, without the risks and drawbacks of oesophagectomy. Survival remains modest.
Breast tumours
The results of randomised trials clearly demonstrate the importance of radiotherapy in favour of the irradiation of the breast or the chest wall after surgery:
- After lumpectomy: radiotherapy is mandatory to radically avoid local relapse (see results by Fisher)
- After mastectomy, radiotherapy is useful if margins are invaded.
Unfortunately there have been no such clear trial results concerning the node territories. The irradiation of the armpit is a risk factor of lymphoedema. Radiotherapy of the internal mammary node is difficult without irradiating the heart.
- Radiotherapy of the armpit is therefore subject to controversy: whereas most authors irradiate N+ tumours, many do not irradiate N- tumours.
- Concerning the internal mammary nodes, radiotherapy is necessary for certain authors when the tumour is located internally or if there are enlarged nodes. For others, chemotherapy is more useful.
Unfortunately, trials concerning node irradiation are relatively old: the technique used is sometimes doubtful and, at the time, there was no efficient chemotherapy such as anthracycline or docetaxel.
Pancreas tumours
Results are very poor even when associated with chemotherapy: it is very difficult to deliver a correct dose to this deeply situated organ which is surrounded by many organs at risk. On the other hand, liver metastases develop very quickly.
Cervix uteri tumours
Many treatment modalities have been proposed without any proof of the superiority of one attitude compared to another. The usual treatment is therefore:
Further trials should help us to determine the best treatment.
Endometrial tumours
- Surgery is the most efficient treatment
- Brachytherapy is used post-operatively when infiltration of the endometrium is deep (sometimes radiotherapy)
- Rarely, for very obese patients, vaginal and endometrial brachytherapy is proposed to avoid surgery
Prostate tumours
There have been no trials (and there probably never will be) establishing the superiority of any one method over others:
- Surgery is sometimes followed by radiotherapy if margins are positive
- Radiotherapy alone appears to give similar results to those obtained by surgery (generally in more advanced disease)
- Brachytherapy gives similar results to surgery. It can be administered alone or in association with external radiotherapy
- Hormonotherapy is associated to radiotherapy in locally advanced prostate cancer, with a clear increase in survival.
Bladder tumours
- The main treatment is surgery
- However, radiotherapy (associated with chemotherapy) is performed in order to preserve the bladder, and could be efficient in localised tumours
Rectum tumours
- It has been clearly demonstrated that pre-surgical irradiation of the pelvis improves the local control of rectal tumours.
- Post-surgical radiotherapy is used in the case of positive margins.
Testicular tumours
- Solely for pure seminoma: radiotherapy seems to be the perfect treatment for nodes
- However chemotherapy is so efficient, even in seminoma, that it is performed more and more often as an alternative to radiotherapy, even in localised tumours.
Soft tissue Sarcoma
- Radiotherapy should complete surgery in order ensure complete lesion sterilisation. A relatively high dose should be administered (approximately 65 Gy).
- Local control of soft tissue sarcoma is the only current method for curing patients.
Lymphoma
Radiotherapy, associated with chemotherapy, remains an important treatment modality in lymphoma.
- Hodgkin's disease
- Non Hodgkin's Lymphoma
Skin tumours
- Surgery is most often carried out.
- However, radiotherapy using a low intensity beam (200 kV) allows complete sterilisation with very aesthetic results. It should be preferred in the case of surface or in-depth cancer spread.
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