Radiotherapy refers to the use of controllable artificial radiation (gamma rays, x rays, electron rays, c rays, alpha rays, neutron rays, etc.). Ionize and kill tissue cells, thus killing cancer cells and curing cancer. This is a very effective method to treat malignant tumor.
Its mechanism is that high-energy radiation releases energy in the process of penetrating tissues and cells, resulting in ionization effect, directly or indirectly destroying DNA and macromolecular protein in cells, affecting cell metabolism, growth and division, and eventually leading to cell death. As an effective means to treat breast cancer, radiotherapy has the following characteristics.
(1) has little damage to normal tissues of human body and can maintain normal appearance of human body. (2) The irradiation process is less limited by human anatomical structure, and local irradiation can kill lymph nodes and cancer tissues that cannot be removed by surgery.
(3) When some advanced breast cancers have bone, brain and liver metastases and cannot be treated surgically, radiotherapy is still effective, which can alleviate the disease, control symptoms and prolong life. (4) Some patients with surgical contraindications can still receive radiotherapy.
2. Which breast cancer patients need radiotherapy?
No matter which operation method is chosen, radiotherapy should be given after operation in order to reduce the recurrence probability: (1) The maximum diameter of the primary tumor is ≥5 cm, or the tumor invades the skin and chest wall; (2) axillary lymph node metastasis ≥ 4; (3) High-risk patients with age ≤40 years, hormone receptor negative, HER2 positive and axillary lymph nodes. Usually, women who meet the above requirements need postoperative adjuvant chemotherapy.
Radiotherapy is usually performed within 2-4 weeks after the completion of postoperative adjuvant chemotherapy, and endocrine therapy or targeted therapy can be started at the same time. Radiotherapy also has some side effects, such as loss of appetite, skin damage, leukopenia, radiation pneumonia and so on.
Generally, it is mild and does not affect daily life. In severe cases, symptomatic treatment with drugs is needed.
3. What should I pay attention to during radiotherapy for breast cancer?
In the process of radiotherapy, try not to interrupt the treatment, so as not to prolong the treatment time and reduce the radiotherapy effect.
In order to make the toxin released by tumor cell necrosis caused by radiotherapy excreted as soon as possible, drink plenty of water. Drink about 3000 ml of water every day to increase urine output and reduce systemic reactions.
When patients receive radiotherapy, there will be some radiotherapy reactions, such as oral mucosal reaction and loss of appetite. Because these reactions will affect the appetite of patients, it is very important to adjust the diet of radiotherapy patients, which can make radiotherapy go on more smoothly. First of all, patients should follow the principle of "three highs and one low".
The so-called three highs refer to high vitamins, high protein and high calories, such as lean meat, seafood and fresh fruits and vegetables; A low finger and low fat; Secondly, patients should focus on light and digestible food, avoid greasy and spicy food, and try to be delicious and mellow, so that patients can easily accept it; Third, adjust the diet according to the reaction in radiotherapy, such as eating some animal liver, spinach, soy products, etc. after leukopenia. If the patient suffers from loss of appetite and indigestion due to radiotherapy, he can eat more meals in small quantities and several times without reducing the total intake.
Taboo is not advocated during radiotherapy. If you can take ginsenoside Rh2 (life-saving factor), you can improve your appetite and reduce various side effects.
4. What should I pay attention to during radiotherapy for breast cancer?
Attention should be paid to breast cancer radiotherapy: (1) Before radiotherapy, the doctor will locate it, that is, mark the irradiation field with skin ink at the part of the body that needs irradiation.
Therefore, we should try our best to protect the clarity of the line at ordinary times. If it is not clear, please ask the doctor in charge to redraw it in time, and don't wait until it is all gone, so as to ensure the accuracy of the radiotherapy site.
(2) Wear clothes that are easy to put on and take off during radiotherapy. It is advisable to wear cotton underwear, especially the collar, to avoid rubbing the neck and aggravating radiation damage. (3) During radiotherapy, white blood cells should be checked on time according to the doctor's advice.
Leukopenia during radiotherapy is generally not as serious as during chemotherapy. (4) During radiotherapy, the skin should avoid direct sunlight and contact with cold or overheated * * *.
5. What are the methods of radiotherapy for breast cancer?
There are several methods of radiotherapy for breast cancer: (1) Clinical application of radical radiotherapy: In the past, surgery was the main treatment for breast cancer, supplemented by radiotherapy.
At present, breast-conserving surgery and radiotherapy of Kanemoto are the main methods for early breast cancer, that is, surgery is the auxiliary method and radiotherapy is the main method. 80% patients are willing to accept Kanemoto radiotherapy for breast-conserving surgery for early breast cancer.
Because this treatment can keep the shape of the healthy room, and the arm movement function is better than radical surgery. Radical radiotherapy is more strict than conventional radiotherapy, and it has new requirements in location, dose and time.
Some experts have suggested that radical radiotherapy should not only kill cancer cells to the maximum extent, but also protect normal breast tissue to the maximum extent. Therefore, three-dimensional conformal radiotherapy for breast cancer has emerged, that is, regional irradiation with the goal of narrowing the irradiation field, focusing the radiation dose on the tumor area (lesion area) of human body to kill tumor cells to the maximum extent, so that normal tissues around human tumors are less or free from unnecessary radiation irradiation, thereby improving the curative effect of breast cancer radiotherapy and reducing radiation reactions and complications. Foreign statistical data show that the recurrence rate of early breast cancer patients within 10 years is 7% if radical radiotherapy is used after breast-conserving surgery.
2%; Without radical radiotherapy, the recurrence rate can reach 22%. Domestic data also show that the recurrence rates of patients who received radical radiotherapy and those who did not receive radical radiotherapy were 6.
7% and 19. 6%。
It shows that radical radiotherapy is an important means to prevent the recurrence of early breast cancer after breast-conserving surgery. (2) Preoperative radiotherapy for advanced breast cancer: Because the cancer focus is large, preoperative radiotherapy can improve the resection rate and reduce the local recurrence rate and distant metastasis rate.
Shanghai Cancer Hospital reported that the 5-year survival rate of ID stage breast cancer patients after simple surgery was 22%, and the 5-year survival rate of preoperative radiotherapy plus surgery increased to 38%. Wallgren reported that the recurrence rate, distant metastasis and mortality of preoperative radiotherapy patients were lower than those of radiotherapy alone.
In order to better protect normal tissues and reduce complications, high-energy radiation should be used as much as possible in preoperative radiotherapy. Radiotherapy for advanced breast cancer belongs to the category of simple radiotherapy, not adjuvant therapy.
Radical mastectomy is effective for patients with advanced cancer after radiotherapy. More than 80% patients with advanced breast cancer can effectively relieve the pain of bone metastasis through radiotherapy.
Metastatic cancer can also be reduced by radiotherapy, and then other treatments can be implemented. (3) Radiotherapy for recurrent cancer focus: The cancer focus of recurrent breast cancer is basically located in the ipsilateral armpit, or the recurrent cancer focus of ipsilateral internal mammary lymph nodes, and the cancer focus around the incision or on the chest wall. Recurrent cancer foci in these areas cannot be completely removed by surgery. The only better treatment is radiotherapy, which can control the recurrent cancer focus.
According to foreign reports, the local control rate of recurrent cancer after radiotherapy can reach 42%? 70%, the 5-year survival rate can reach 2 1%? 50%。 (4) Postoperative radiotherapy for breast cancer: The principles of postoperative radiotherapy for breast cancer are as follows: postoperative radiotherapy is not needed for cases with no lymph node metastasis confirmed by pathology; For cases with local or regional recurrence, postoperative radiotherapy still has certain value, which can reduce the recurrence rate and improve the quality of life.
Professor Zhang of Shanghai Cancer Hospital believes that postoperative radiotherapy should be considered in the following situations: (1) Cases with lymph node metastasis in the upper and middle axilla confirmed by pathology; Metastatic lymph nodes account for more than half of the total number of lymph nodes; The total number of lymph nodes is unclear, and the number of metastatic lymph nodes exceeds 3 cases; Cases in which the primary lesion is located in the inner or central part of * * * without internal mammary lymph node dissection, especially when axillary lymph nodes are positive; 4 cases after simple resection. Professor Zhang also suggested that after normal radical operation, only the clavicle and parasternal region need to be irradiated, and the axillary region does not need to be irradiated; After simple resection, the lymphatic region of the chest wall should be irradiated.
6. What are the pre-radiotherapy education for breast cancer?
Pre-radiotherapy education for breast cancer includes: (1) psychological care: patients' lack of radiotherapy knowledge will cause anxiety and fear. Before treatment, the nurse should briefly introduce the knowledge about radiotherapy, possible adverse reactions of radiotherapy and matters needing attention, and introduce patients to read the knowledge manual about radiotherapy, which should be easy to understand and illustrated.
Before starting radiotherapy, accompany patients to visit the radiotherapy operating room and explain the radiotherapy process, so that patients can eliminate tension and fear and actively cooperate with the treatment. Psychological counseling should be based on patients' different cultural qualities, personality characteristics and psychological state.
Patients who are about to leave the hospital after radiotherapy in the ward can be asked to speak out to enhance their confidence in treatment. Strive for the support and cooperation of the social system, especially the patient's partner.
Instruct patients to listen to music, watch TV, play cards and chess, read books and read newspapers to distract patients. (2) *** Guide: Say the importance of * * * placement. In the process of radiotherapy, we must be calm and don't move our body, so as to improve the accuracy of radiotherapy and make the tumor tissue reach the expected radiation dose.
Avoid radiation damage to surrounding tissues and organs due to deviation of * * * *. (3) Dietary guidance: Eat more light, high-calorie, vitamin-rich and non-sexual foods, and eat more vegetables and fruits.
If the patient's gastrointestinal adverse reaction is serious, instruct the patient to eat a semi-liquid diet, and it is appropriate to eat a small amount of meals. Pay attention to the changes of blood routine during radiotherapy, and guide patients to eat some foods that are invigorating qi, enriching blood and nourishing, such as rice porridge, bone soup and black chicken soup.
Encourage patients to drink more water, more than 2 000m l per day, so as to increase the amount of urination, so that a large number of tumor cells caused by radiotherapy will be released from the body, thus reducing the whole body's radiotherapy reaction.
7. Under what circumstances should breast cancer patients do radiotherapy?
Breast cancer patients with the following items can use radiotherapy.
(1) Patients with stage I and II breast cancer, old and weak, suffering from serious cardiovascular diseases or other visceral diseases, and unsuitable for surgical treatment can be treated with radical radiotherapy. Radical radiotherapy has almost no absolute contraindications, and all patients can be treated as long as they are in good condition.
(2) Preoperative radiotherapy is mainly suitable for cases with advanced primary cancer, including larger cancer tissues, such as those with a diameter of more than 5cm, which have invaded the fascia of pectoralis major, seriously invaded the skin, * * * skin ulceration and edema, but the affected area does not exceed * * skin area 1/3. (3) The indications of postoperative radiotherapy are as follows: (1) Choose stage ⅰ and ⅱ breast cancer, do radical or extended radical operation, and rarely see chest wall recurrence in the operation area; ② After radical or extended radical mastectomy for stage Ⅰ and Ⅱ breast cancer, more than 4 or more than 50% axillary lymph nodes metastasized; (3) It is located in the middle or inside the tumor with metastasis.
(4) Palliative radiotherapy is suitable for stage Ⅲ and Ⅳ breast cancer. Distant metastasis is suitable for: ① bone metastasis, which has certain curative effect; ② Brain metastases can achieve a certain palliative effect; ③ Radiotherapy can also be used for lung and pleural metastasis.
8. What should I pay attention to after radiotherapy for breast cancer?
Give patients enough energy and eat more high-calorie foods, but don't eat chocolate and fat, and supplement enough vitamins and minerals. Some trace elements are very important for human body supplement, such as iron and zinc.
Patients will basically lose their hair after radiotherapy. Many women feel embarrassed after losing their hair. But if you want to wear a wig, you must not choose a wig attached to your skin. If you are allergic to wigs, don't bring them. Just wear a hat. After radiotherapy, you should eat more anticancer foods, such as Chinese cabbage, cabbage, kelp and other foods rich in anticancer ingredients. Regular consumption is very beneficial to breast cancer patients, but it is forbidden to eat some fried or sexual foods.
After radiotherapy, we should arrange the rest time reasonably, not too tired, and we must ensure 10 hours of sleep every day. At the same time, we should keep a light diet, eat as little salt as possible and drink some chicken soup.